PAPNET-Directed Rescreening of Cervicovaginal Smears:A Study of 101 Cases of Atypical Squamous Cells of Undetermined Significance

Abstract

Many women having cervicovaginal smears interpreted as atypical squamous cells of undetermined significance (ASCUS) ultimately prove to harbor squamous intraepithelial lesions (SIL). The question is whether rare cells diagnostic of SIL are present in so-called "atypical" smears, but simply go undetected. To test whether the PAPNET Cytological Screening System, an automated system, can detect the (assumed) presence of such cells, six reviewers independently evaluated PAPNET video images generated for 101 cases conventionally diagnosed as ASCUS. Using PAPNET-identified microscopic coordinates, selected cases were then manually reviewed and reclassified according to consensus opinion. Overall, 35 cases were reclassified as SIL (22 low grade; 13 high grade). Histologic correlations showed 37 of the 101 cases conventionally interpreted as ASCUS carried tissue diagnoses of SIL, (28 low grade; 8 high grade, 1 ungraded). Using PAPNET, 24 of the 37 (65%) corresponding smears were reclassified as SIL (15 low grades; 9 high grade).

Long-Term Outcome and Relative Risk in Women With Atypical Squamous Cells of Undetermined Significance

“…Other factors that may prove more useful in differentiating women with ASCUS at high risk from those at low risk include ability to subclassify ASCUS on the basis of cytologic features, 16 ancillary studies such as human papillomavirus testing, 17 automation, 18,19 and patient variables such as age and compliance. 2 Women who had a history of atypical cells had a greater probability of ASCUS than did women with no such history.…”

Quality Control of Cervical Cytology in High-Risk Women

“…9,11,23,24 The cost issue was not evaluated in this study. However, this aspect has been considered in other studies: the detection of a few additional abnormalities in a low-risk population with the PAPNET System occurred at relatively high cost.…”

Human papillomavirus and cervical cancer

“…The PapNet system is approved for rescreening only. There has been some dispute about how much accuracy is gained through the use of these automated systems, especially in light of the additional expense (62,97,103 HPV DNA or RNA can be demonstrated in biopsy tissues by in situ hybridization with probes labeled with either radioisotopes or chemically reactive ligands which are detected by autoradiography, fluorescence, or a detection of color reaction. In situ hybridization can localize HPV nucleic acid sequences inside individual cells while preserving cell and tissue morphology to allow simultaneous assessment of the morphological alterations associated with the lesion.…”