The impact of the introduction of liquid based cytology on the variation in the proportion of inadequate samples between GP practices

Harrison, Wayne; Teale, Alison; Jones, Suzanne; Mohammed, Mohammed A.

doi:10.1186/1471-2458-7-191

Cited by 11 publications

(9 citation statements)

References 8 publications

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“…The proportions of inadequate samples decreased drastically with implementation of LBC in all laboratories (data not shown; reported for Hvidovre) . This phenomenon has been well described, and suggests that our data were comparable with previously published studies.…”

Section: Discussionsupporting

confidence: 90%

Impact of technology on cytology outcome in cervical cancer screening of young and older women

Rask

Lynge

Franzmann

et al. 2013

Intl Journal of Cancer

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Little is known about age-dependent variation in outcomes of cervical cytology with modern technologies. This populationbased study evaluated age-dependent changes after routine implementation of ThinPrep and SurePath technology in two independent laboratories, and controlled for time trends in a third laboratory using manually read conventional cytology continually. Data were collected from the Danish National Health Care Registers. For each laboratory, we compared proportions of abnormal cytology defined as atypical squamous cells of undetermined significance or worse (ASCUS1) by age and technology phase. The study included 489,960 cytological samples with no recent abnormality from women aged 23-59 years, routinely screened between 1998 and 2007. Implementation of SurePath liquid-based cytology (LBC) was followed by an increase in abnormal cytology in women aged 23-29 years from 4.6 to 6.1%, relative proportion (RP): 1.31 [95% confidence interval (CI): 1.08-1.61], and a decrease in women aged 45-59 years from 2.9 to 2.0%, RP: 0.71 (95% CI: 0.60-0.83). Implementation of ThinPrep LBC was followed by a decrease in abnormal cytology both in women aged 23-29 years from 7.7 to 6.8%, RP: 0.89 (95% CI: 0.78-1.02) and in women aged 45-59 years from 3.4 to 1.0%, RP: 0.30 (95% CI: 0.24-0.37). With implementation of imaging-assisted reading, regardless of the brand of technology, the proportion of abnormality increased by around 30% in all age groups (range from 19 to 41%). In the laboratory with unchanged technology no trends in abnormality proportions were observed. The impact of LBC implementation on cytological abnormality proportions varied considerably across age groups.Liquid-based cytology (LBC) and automation-assisted reading of cytological samples have been widely implemented in cervical screening. Little attention has been given in the literature to how cytological abnormality proportions change by age, as a consequence of implementing new cytological technologies. [1][2][3] It is reasonable to test for a potential effect by age, given that infections with human papillomavirus (HPV) and cervical abnormalities are age-dependent.The impact of new cytological technologies on the overall abnormality proportions has been well studied.2,4-8 Important changes in screening efficiency can, though, go unnoticed when the data have not been stratified accordingly. Changes in the abnormality rates in screening are not without an impact on both the women and the health care system.A recent Danish observational study, 9 based on 390,000 cytological samples from the Department of Pathology,

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Section: Discussionsupporting

confidence: 90%

Impact of technology on cytology outcome in cervical cancer screening of young and older women

Rask

Lynge

Franzmann

et al. 2013

Intl Journal of Cancer

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“…4 Unsatisfactory tests account for a number of screening failures, and are a source of distress to women and a waste of resources. 5 It is assumed that LBC decreases the unsatisfactory rate by reducing the number of cases that are inadequate because of obscuring inflammatory cells and blood or because of inhomogeneous distribution or bad fixation of cells. However, to our knowledge differences in the underlying causes and relevance of unsatisfactory smear results for LBC as compared with CP have never been investigated within the setting of an RCT.…”

mentioning

confidence: 99%

Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

Siebers¹,

Klinkhamer²,

Vedder³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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N Context.-Recent randomized controlled trials have shown a significant decrease in unsatisfactory rates for liquid-based cytology (LBC) compared with conventional Papanicolaou test (CP). The underlying causes and relevance of unsatisfactory results for LBC and CP have never been compared within the setting of a randomized controlled trial.Objective.-To examine differences in causes and relevance of unsatisfactory and satisfactory but limited by (SBLB) results for LBC and CP.Design.-Data from the Netherlands ThinPrep Versus Conventional Cytology (NETHCON) trial were used, involving 89 784 women. Causes and relevance of unsatisfactory and SBLB results were analyzed.Results.-The primary cause for unsatisfactory results for CP and LBC was scant cellularity. Other causes for unsatisfactory CPs were virtually eliminated with LBC. The same was true for SBLB subcategories, with the exception of SBLB absence of transformation zone component and SBLB scant cellularity. The SBLB absence of transformation zone component showed a statistically significant 22% and SBLB scant cellularity a 12% nonsignificant increase with LBC. The detection rates of abnormalities found during 18 months of follow-up of unsatisfactory test results did not differ significantly between the 2 study arms, nor did they differ from the initial test positivity rates from the NETHCON trial.Conclusions.-Liquid-based cytology shows an almost complete elimination of most causes for unsatisfactory CP, with scant cellularity remaining as the sole cause for unsatisfactory LBC. On the other hand, with LBC a significant increase of smears without a transformation zone component was noted. Women with an unsatisfactory test result are not at increased risk for cervical abnormalities either with LBC or with CP.Trial Registration.-Nederlands Trial Register, NTR1032, www.trialregister.nl.(Arch Pathol Lab Med. 2012;136:76-83; doi: 10.5858/ arpa.2011-0113-OA) L iquid-based cytology (LBC) has been largely adopted as an alternative to cervical cancer screening with conventional Papanicolaou tests (CP) in many Western countries. However, recent evidence from 2 randomized controlled trials (RCTs) 1,2 and a meta-analysis comparing the performance of LBC and CP 3 supports the conclusion of equal accuracy for both methods. Yet the RCT has shown a significant decrease in unsatisfactory rates for LBC as compared with CP. 4 Unsatisfactory tests account for a number of screening failures, and are a source of distress to women and a waste of resources.5 It is assumed that LBC decreases the unsatisfactory rate by reducing the number of cases that are inadequate because of obscuring inflammatory cells and blood or because of inhomogeneous distribution or bad fixation of cells. However, to our knowledge differences in the underlying causes and relevance of unsatisfactory smear results for LBC as compared with CP have never been investigated within the setting of an RCT. The aim of the study is to examine the underlying causes for inadequacy in LBC and CP, using the data of the Neth...

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“…Given that LBC results in fewer inadequate smears than CP implies that the evaluation of LBC will be considerably affected by how frequently conventional cytology produces inadequate smears. In the UK, the rate for inadequate smears with CP was over 11 %, which in LBC studies was reduced to \ 2 % [31,32]. In the Dutch situation, however, CP already has a low rate of inadequate smears of 1.11 %, limiting the benefit of lowering this frequency.…”

Section: Discussionmentioning

confidence: 94%

Liquid-based cervical cytology using ThinPrep technology: weighing the pros and cons in a cost-effectiveness analysis

Bekker‐Grob

Kok

Bulten

et al. 2012

Cancer Causes Control

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Regarding test characteristics and costs of LBC and CP, only under certain conditions will a change from CP to manually screened ThinPrep LBC be cost-effective. If none of these conditions are met, implementation of manually screened ThinPrep LBC seems warranted only if there are advantages other than cost-effectiveness. Further research is needed to establish whether other LBC systems will be more favorable with regard to cost-effectiveness.

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The impact of the introduction of liquid based cytology on the variation in the proportion of inadequate samples between GP practices

Cited by 11 publications

References 8 publications

Impact of technology on cytology outcome in cervical cancer screening of young and older women

Impact of technology on cytology outcome in cervical cancer screening of young and older women

Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

Liquid-based cervical cytology using ThinPrep technology: weighing the pros and cons in a cost-effectiveness analysis

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