PAPNET ANALYSIS OF REPORTEDLY NEGATIVE SMEARS PRECEDING THE DIAGNOSISOF A HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION OR CARCINOMA

One hundred fourteen cervical smears obtained from 18 women developing biopsy-proven high-grade squamous intraepithelial lesions and two wit h invasive squamous carcinomas were analyzed by two pathologists using the PAPNET neural network-based automated screening system (PAPNET An alyses A and B). The smears were originally reported as negative and h ad been previously rescreened and reclassified according to The Bethes da System. Using the PAPNET video displays of 128 potentially abnormal cellular images per smear, each reviewer (PAPNET A and B) determined whether a smear required conventional rescreening. Results of the PAPN ET triage were compared with the reclassification diagnoses of the sme ars by conventional microscopy. PAPNET Analysis A selected eight (14%) smears reclassified as negative, 25 (69%) as atypical squamous cells of undetermined significance, and 15 (71%) as squamous intraepithelial lesions (SIL) for rescreening. In PAPNET Analysis A, two (10%) SILs w ere not selected for rescreening, and four (19%) were considered unsat isfactory for analysis. PAPNET Analysis B selected 21 (37%) smears rec lassified as negative, 25 (69%) as atypical squamous cells of undeterm ined significance, and 18 (86%) as SIL for review. In PAPNET Analysis B, two (10%) SILs were missed, and one (5%) smear was unsatisfactory f or analysis. Each PAPNET analysis selected smears for rescreening in 1 9 (95%) of 20 patients and detected SILs in 10 patients that were miss ed in the original screeening. Using PAPNET, SILs would have been dete cted a median of 56 months (PAPNET A) and 62 months (PAPNET B) before their actual discovery. These preliminary data suggest that PAPNET may help detect SILs missed in routine cytologic screening. The specifici ty and clinical utility of PAPNET are being assessed in larger studies .