Costs and outcomes of PAPNET secondary screening technology for cervical cytologic evaluation - A community hospital's experience

Objective: To determine the effectiveness of and costs associated with semi automated rescreening of Papanicolaou smears with negative findings at a co mmunity hospital. Design: A prospective study of 1200 Papanicolaou smear slides with negative findings using the PAPNET screening system (Neuromedical Systems, Incorpor ated, Suffern, NY). Setting: Community hospital laboratory. Patients: Patients with negative findings on Papanicolaou smears who agreed to have their smears reviewed using PAPNET. Interventions: None. Main Outcome Measures: Results of rescreening and resources involved in pro cessing the PAPNET review. Results: Screening with PAPNET identified 8 patients with atypical squamous cells of undetermined significance (ASCUS) that were not diagnosed on init ial screening, yielding a false-negative rate in our laboratory of 0.7% for ASCUS. No low- or high-grade squamous intraepithelial lesions were identif ied. Based on our laboratory processing 6000 Papanicolaou smears a year, at $19 per slide, it would cost our laboratory $102 600 for PAPNET review of all smears with negative findings. In contrast, the estimated cost to have another cytotechnologist review all such smears manually would cost $11 977 . The rate of changed diagnoses in the PAPNET group was similar to the rate in our standard rescreening of 10% of all smears with negative findings. M ean turnaround time for a PAPNET screen was 13.9 days, compared with 3.9 da ys for manual review. Conclusions For a laboratory with a low percentage of smears with abnormal findings, a quality cytotechnologist and pathologist, and required quality assurance standards in place, PAPNET may not improve appreciably the pick-u p rate for missed cervical lesions, and may add significantly to the cost a nd turnaround time of cytologic evaluation of cervical smears.