SIMULATION OF PRIMARY CERVICAL-CANCER SCREENING BY THE PAPNET SYSTEM IN AN UNSCREENED, HIGH-RISK COMMUNITY

OBJECTIVE: To evaluate the performance of the PAPNET system as a prima ry cervical cancer screening modality in an unscreened population with a high prevalence of cervical cancer and its precursor lesions. STUDY DESIGN: Consecutive cervical smears from 3,106 women, screened and re ported in the usual manner, were submitted for analysis by the PAPNET system. The original manual screening diagnoses were compared with tho se obtained by PAPNET analysis. By inclusion of normal and abnormal sm ears, this evaluation not only provided quality assurance for the labo ratory but also simulated primary screening by automation. RESULTS: Co mparison of the two methods of screening showed statistically signific ant superiority of the PAPNET over conventional screening (89.6% vs. 6 3.8%, respectively) in low grade lesions, including atypical squamous and atypical glandular cells of uncertain significance (ASCUS and AGUS , respectively) and low grade squamous intraepithelial lesion. Convers ely, there plas no significant difference between PAPNET and manual de tection (87.5%, vs. 94.6%) for more significant abnormalities, includi ng high grade squamous intraepithelial lesions and invasive carcinoma. CONCLUSION: The PAPNET system, which would probably not be affordable as a quality assurance modality only in the public health sector of t his country, was shown to be more than sufficiently effective as a pri mary screening method for the large numbers of women likely to undergo cervical cancer screening in anticipated mass population programs.