Objective: To assess the introduction of computer-assisted Pap test screening in cervical cancer screening. Various scenarios are considered: conventional and liquid-based cytology (LBC) slides, fully automatic instrumentation (Becton Dickinson FocalPoint™ Slide Profiler and Hologic ThinPrep® Imaging System), and semiautomatic scanner (Hologic Integrated Imager I-Squared). Methods: A working group was formed that included researchers from the largest centers already using instrumentation. A questionnaire on laboratory management and on social/ethical issues and annual workload was proposed. Prices for the technology were obtained directly from the producers; costs were calculated from observed and literature data. The scope of the report and final draft were submitted to a consulting committee of stakeholders. Results: The break-even point was found to be 49,000 cases/year, if conventional slides were used, while it was near the theoretical maximum capacity, 70,000 cases/year, with LBC slides. Efficiency increased with the volume of slides. Screening time decreased by two thirds for conventional slides and by less than half for LBC slides. Acceptance of the instrumentation by the users was good. Conclusions: Computer-assisted screening may increase productivity even if in most situations it will mean additional costs. Furthermore, primary screening with human papillomavirus tests will drastically reduce the need for Pap test reading.

Keywords:
Cervical cancer screening, Computer-assisted screening, Cytology, Health technology assessment
1.
Halford JA, Batty T, International Agency for Research on Cancer: Cancer incidence in five continents vol. VIII. 2002. www.iarc.fr/en/publications/pdfs-online/epi/sp155/ci5v8-cover.pdf.
2.
IARC Handbooks of Cancer Prevention: Cervix Cancer Screening. Lyon, IARC, 2005, vol 10.
3.
AIRTum: Cancer prevalence in Italy. Patients living with cancer, long-term survivors and cured patients. http://www.registri-tumori.it/cms/?q=Rapp2010.
4.
Giorgi Rossi P, Chini F, Borgia P, Gasticchi G, Carozzi FM, Confortini M, Angeloni C, Buzzoni C, Buonaguro FM, HPV Prevalence Working Group: Human papillomavirus (HPV), cervical cancer incidence and screening uptake: differences among northern, central and southern Italy. Epidemiol Prev 2012;36:108-119.
5.
Ministero della Salute - Direzione Generale della Prevenzione: Raccomandazioni per la pianificazione e l'esecuzione degli screening di popolazione per la prevenzione del cancro della mammella, del cancro della cervice uterina e del cancro del colon retto. 2005. http://www.osservatorionazionalescreening.it/ons/documentazione/raccomandazioni/screening_vers_completa.pdf.
6.
Gruppo Italiano Screening Cervicale (GISCi): Criteri per l'applicazione di nuove tecnologie nei programmi di screening della cervice uterina. 2007. www.gisci.it/documenti-gisci (accessed October 31, 2012).
7.
Ronco S, Accetta G, Angeloni C, Arbyn M, Barzon L, Biggeri A, Calvia M, Capoluongo E, Carozzi F, Cogo F, Confortini M, Cuzick J, Federici A, Frega A, Ghiringhello B, Gillio Tos A, Giordano L, Maioli P, Mejier CJLM, Naldoni C, Napoletano F, Perego D, Rabino V, Ribaldone R, Sapino A, Segnan N, Sideri M, Snijders PJF, Sotis C, Surico N, Zappa M, Zorzi M, Giorgi Rossi P: HTA report: ricerca del DNA di papillomavirus umano (HPV) come test primario per lo screening dei precursori del cancro del collo uterino. Epidemiol Prev 2012;36(suppl 1):e1-e72.
8.
Franco EL, Cuzick J, Hildesheim A, de Sanjosé S: 20. Issues in planning cervical cancer screening in the era of HPV vaccination. Vaccine 2006;24(suppl 3):S171-S177.
9.
Dalla Palma P, Moresco L, Giorgi Rossi P, Gruppo di lavoro HTA lettura computer assistita: Pap test con lettura computer-assistita per lo screening del cervicocarcinoma. HTA report. Epidemiol Prev 2012;36(suppl 3):e1-43.
10.
Arbyn M, Anttila A, Jordan J, et al (eds): European Commission. European Guidelines for Quality Assurance in Cervical Cancer Screening, ed 2. Luxembourg, Office for Official Publications of the European Communities, 2008, pp 1-291.
11.
Medical Services Advisory Committee: Automation assisted and liquid based cytology for cervical cancer screening. Canberra, Medical Services Advisory Committee, 2009. http://www.health.gov.au/internet/msac/publishing.nsf/Content/BAE45713D7D0FDEBCA257817001CB46D/$File/1122_MSAC_Assessment_Report.pdf.
12.
Broadstock M: Effectiveness and cost effectiveness of automated and semi-automated cervical screening devices: a systematic review of the literature. NZ Med J 2001;114:311-313.
13.
Anttila A, Pokhrel A, Kotaniemi-Talonen L, Hakama M, Malila N, Nieminen P: Cervical cancer patterns with automation-assisted and conventional cytological screening: a randomized study. Int J Cancer 2011;128:1204-1212.
14.
Hologic: Scottish ThinPrep Imager Feasibility Study. Insight: Hologic Diagnostic News. Crawley, Hologic, 2009, pp 12-13.
15.
Scottish Cervical Cytology Review Group Feasibility Subgroup: Cervical Cytology ThinPrep Imager (TIS) Feasibility Study - Report from the Feasibility Subgroup to Cervical Cytology Review Group. Edinburgh, Scottish Pathology Network, 2009. http://www.pathologyscotland.org/download/cervical_cytology_laboratory_provision/feasibility0911.pdf.
16.
Willis BH, Barton P, Pearmain P, Bryan S, Hyde C: Cervical screening programmes: can automation help? Evidence from systematic reviews, an economic analysis and a simulation modelling exercise applied to the UK. Health Technol Assess 2005;9:1-207.
17.
Kitchener HC, Blanks R, Cubie H, Desai M, Dunn G, Legood R, et al: MAVARIC - a comparison of automation-assisted and manual cervical screening: a randomised controlled trial. Health Technol Asess 2011;15:1-170.
18.
Kitchener HC, Blanks R, Dunn G, Gunn L, Desai M, Albrow R, Mather J, Rana DN, Cubie H, Moore C, Legood R, Gray A, Moss S: Automation-assisted versus manual reading of cervical cytology (MAVARIC): a randomised controlled trial. Lancet Oncol 2011;12:56-64.
19.
Angeloni C: Linee Guida operative regionali per la gestione dello screening - Regione Abruzzo Comitato Regionale per lo Screening, Pescara - 2009. http://sanitab.regione.abruzzo.it/screening/il+comitato+regionale+di+screening/index.htm.
20.
Bulgaresi P, Cariaggi MP, Troni MG, Ciatto S: Quality control of the AutoPap screening system employed as a primary screening device: rapid review of the smears coded as no further review. Tumori 2006;92:276-278.
21.
Confortini M, Bonardi L, Bulgaresi P, Cariaggi MP, Cecchini S, Ciatto S, et al: A feasability study of the use of the AutoPap Screening System as a primary screening and location guided rescreening device. Cancer Cytopathol 2003;99:129-134.
22.
Guarrera GM, Dalla Palma P, Pojer A, Lorenzin G, Chistè K, Rossi S, Condini S, Favaretti C: Introduzione di un sistema di lettura automatica dei Pap test per lo screening cervico-vaginale nella Provincia Autonoma di Trento. Clin Governance 2007;IV:22-30.
23.
Passamonti B, Bulletti S, Camilli M, D'Amico MR, Di Dato E, Gustinucci D, et al: Evaluation of the FocalPoint GS system performance in an Italian population-based screening of cervical abnormalities. Acta Cytol 2007;51:865-871.
24.
Ronco G, Vineis C, Montanari G, Orlassino R, Parisio F, Arnaud S, et al: Impact of the AutoPap (currently FocalPoint) primary screening system location guide use on interpretation time and diagnosis. Cancer Cytopathol 2003;99:83-88.
25.
Troni MG, Cariaggi MP, Bulgaresi P, Houssami N, Ciatto S: Reliability of sparing Papanicolaou test conventional reading in cases reported as No Further Review at AutoPap assisted cytological screening - survey of 30,658 cases with follow-up cytological screening. Cancer Cytopathol 2007;111:93-98.
26.
Kitchener HC, Almonte M, Dowie R, Stoykova B, Sargent A, Roberts C, et al: ARTISTIC: a randomised trial of HPV testing in primary cervical screening. Health Technol Assess 2009;13:1-150.
27.
Dziura B, Quinn S, Richard K: Performance of an imaging system vs manual screening in the detection of squamous intraepithelial lesions of the uterine cervix. Acta Cytol 2006;50:309-311.
28.
Palmer TJ, Nicoll SM, McKean ME, Park AJ, Bishop D, Baker L, Imrie JE: Prospective parallel randomized trial of the MultiCyte™ ThinPrep® imaging system: the Scottish experience. Cytopathology, E-pub ahead of print.
29.
Davey E, d'Assuncao J, Irwig L, Macaskill P, Chan SF, Richards A, Farnsworth A: Accuracy of reading liquid based cytology slides using the ThinPrep Imager compared with conventional cytology: prospective study. BMJ 2007;335:31.
30.
Bowditch RC, Clarke JM, Baird PJ, Greenberg ML: Results of an Australian trial using SurePath liquid-based cervical cytology with FocalPoint computer-assisted screening technology. Diagn Cytopathol 2012;40:1093-1099.
31.
Boost T, Duhig J, Hall J, Lee C, et al: Comparison of the sensitivity of conventional cytology and the ThinPrep Imaging System for 1,083 biopsy confirmed high grade squamous lesions. Diagn Cytopathol 2010;38:318-326.
32.
Boost T: A comparison of screening times between the ThinPrep Imager and conventional cytology. Diagn Cytopathol 2009;37:661-664.
33.
Davey E, Irwig L, Macaskill P, Chan SF, D'Assuncao J, Richards A, Farnsworth A: Cervical cytology reading times: ThinPrep Imager and conventional methods. Diagn Cytopathol 2007;35:550-554.
34.
Dowie R, Stoykova B, Crawford D, Desai M, Mather J, Morgan K, Shirt M: Liquid-based cytology can improve efficiency of cervical smear readers: evidence from timing surveys in two NHS cytology laboratories. Cytopathology 2006;17:65-72.
35.
Elsheikh TM, Kirkpatrick JL, Cooper MK, Johnson ML, Hawkins AP, Renshaw AA: Increasing cytotechnologist workload above 100 slides per day using the ThinPrep imaging system leads to significant reductions in screening accuracy. Cancer Cytopathol 2010;118:75-82.
36.
Elsheikh TM, Kirkpatrick JL, Fischer D, Herbert KD, Renshaw AA: Does the time of day or weekday affect screening accuracy? A pilot correlation study with cytotechnologist workload and abnormal rate detection using the ThinPrep Imaging System. Cancer Cytopathol 2010;118:41-46.
37.
Roberson J, Eltoum IA: Cytotechnology labor market: an update. Am J Clin Pathol 2010;134:820-825.
38.
Schledermann D, Hyldebrandt T, Ejersbo D, Hoelund B: Automated screening versus manual screening: a comparison of the ThinPrep imaging system and manual screening in a time study. Diagn Cytopathol 2007;35:348-352.
39.
Rowe LR, Marshall CJ, Berry M, Larson MA, Bentz JS: Accuracy of a slide profiler for endocervical cell detection in no-further-review conventional Pap smears. Acta Cytol 2003;47:602-604.
40.
Solomon D, Nayar R: The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria and Explanatory Notes, ed 2. New York, Springer, 2004.
41.
Finarelli AC, Pascucci MG, Baldacchini F: Strategie e coperture vaccinali per HPV nelle regioni. Rapporti ISTISAN 2010;10:62-69.
42.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012;137:516-542.
43.
Moyer VA, US Preventive Services Task Force: Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2012;156:880-891.
44.
Cuzick J, Mayrand MH, Ronco G, Snijders P, Wardle J: 10. New dimensions in cervical cancer screening. Vaccine 2006;24(suppl 3):S90-S97.
45.
Briggs AH, O'Brien BJ: The death of cost-minimization analysis? Health Econ 2001;10:179-184.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.