Is Colposcopic Biopsy Overused among Women with a Cytological Diagnosis of Atypical Squamous Cells of Undetermined Significance (ASCUS)?

Lousuebsakul, Vichuda; Knutsen, Synnove M.F.; Singh, Pramil N.; Gram, Inger Torhild

doi:10.1089/154099903768248258

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…Although it might be argued that all is equivalent except diagnostic abilities provided enough diagnoses are examined, evidence that women with ASCUS are not homogenous exists 19,20 . This study shows adequate sampling will not ensure differences in ASCUS : SIL ratios result mainly from differing ASCUS rates.…”

Section: Discussionmentioning

confidence: 75%

The ASCUS : SIL ratio and the reference laboratory pathologist

Wachtel

Dahm

2003

Cytopathology

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The atypical squamous cells of undetermined significance (ASCUS) : squamous intraepithelial lesion (SIL) ratio was proposed to monitor laboratory use of the ASCUS diagnosis. This study addresses problems associated with comparing pathologists by this means. An intuitive example showed the ASCUS : SIL ratio depends on the prevalence of smears from patients who actually have SIL. In this study of 2000 cervical smears, each of five pathologists made 400 diagnoses. Differences among proportions of SIL diagnoses were statistically significant; differences among proportions of ASCUS diagnoses were not. Had an ASCUS : SIL ratio upper limit of 3.0 been used, two pathologists would have been misidentified as having high ASCUS diagnosis rates. Unlike the situation for laboratories, potential variability in SIL prevalence requires caution in the use of this ratio in assessing pathologists. An alternative measure that is independent of prevalence, the ASCUS : SIL odds ratio, is posited.

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Section: Discussionmentioning

confidence: 75%

The ASCUS : SIL ratio and the reference laboratory pathologist

Wachtel

Dahm

2003

Cytopathology

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“…Our findings indicate that the ASCUS category should be regarded as a good marker for identifying patients who have a higher chance of harbouring underling SIL and that colposcopic biopsy should be considered for these women, though the over‐use of colposcopy 20 should be kept in mind.…”

Section: Discussionmentioning

confidence: 83%

Colposcopic and histologic findings in women with a cytologic diagnosis of atypical squamous cells of undetermined significance

Yarandi

Mood

Mirashrafi

et al. 2004

Aust NZ J Obst Gynaeco

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“…Patient-level factors such as preferences [52, 53], health literacy [54], medical/psychological conditions [55, 56], and wealth [57, 58] are likely to have broad effects on overuse, as are differences in providers’ skills [59, 60], financial interests [61], and other cultural factors [59, 62–65]. Measuring systematic overuse would also provide insight on the role of tort litigation and the practice of defensive medicine [66], and would elucidate industry’s function in resource utilization [67].…”

Section: How Can Measuring Systematic Overuse Have An Impact?mentioning

confidence: 99%

Systematic Overuse of Healthcare Services: A Conceptual Model

Nassery

Segal

Chang

et al. 2014

Appl Health Econ Health Policy

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A perfect storm of factors influences the overuse of healthcare services in the USA. Considerable attention has been placed on geographic variation in utilization; however, empiric data has shown that geographic variation in utilization is not associated with overuse. While there has been renewed interest in overuse in recent years, much of the focus has been on the overuse of individual procedures. In this paper we argue that overuse should be thought of as a widespread and pervasive phenomenon that we coin as systematic overuse. While not directly observable (i.e., a latent phenomenon), we suggest that systematic overuse could be identified by tracking a portfolio of overused procedures. Such a portfolio would reflect systematic overuse if it is associated with higher healthcare costs and no health benefit (including worse health outcomes) across a healthcare system. In this report we define and conceptualize systematic overuse and illustrate how it can be identified and validated via a simple empirical example using several Choosing Wisely indicators. The concept of systematic overuse requires further development and empirical verification, and this paper provides an important first step, a conceptual framework, to that end.

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Is Colposcopic Biopsy Overused among Women with a Cytological Diagnosis of Atypical Squamous Cells of Undetermined Significance (ASCUS)?

Cited by 4 publications

References 20 publications

The ASCUS : SIL ratio and the reference laboratory pathologist

The ASCUS : SIL ratio and the reference laboratory pathologist

Colposcopic and histologic findings in women with a cytologic diagnosis of atypical squamous cells of undetermined significance

Systematic Overuse of Healthcare Services: A Conceptual Model

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