The diagnostic value of computer-assisted primary cervical smear screening: a longitudinal cohort study.

Abstract

To assess computer-assisted (neural network based) cervical smear screening as a primary tool for the early detection of cervical dysplasia. Longitudinal cohort study. Cytology laboratory reviewing cervical smears taken by general practitioners in a mass screening program in the Netherlands. 846 women who developed (pre-)neoplasia of the cervix in the seven years after the baseline smear, and 5217 controls. Cervical smears were evaluated both by conventional light microscopy and with use of the PAPNET Testing System by the same cytotechnologists. Seven year histological and cytological follow-up results were obtained for all women from a nation-wide pathology database. Conventional screening diagnosed dysplasia or carcinoma in the baseline smears of 458 (54.1%) of the 846 women who were diagnosed with (pre-)neoplasia during follow-up, whereas computer-assisted PAPNET analysis detected such lesions in 462 (54.6%) of these women. In the control population of 5217 (86.0%) women, in whom follow-up revealed no cervical dysplasia, conventional screening gave false positive results in 210 (4.0%) and computer-assisted PAPNET analysis gave false positive results in 207 (4.0%) smears. The areas under the receiver operation curves (AUC) were 80% (95% confidence interval, 78 to 82%) and 79% (95% confidence interval, 77 to 81%) for conventional and PAPNET-assisted screening, respectively. The PAPNET Testing System has similar diagnostic value as the conventional screening of Pap smears when used for primary screening.