Does providing previous results change the accuracy of cervical cytology?

OBJECTIVE: To determine whether providing previous cytology and histology findings alters the accuracy of conventional cervical cytology reading or changes reading times. STUDY DESIGN: Each of 9 cytologists read 9 batches of 8 routinely referred Pap smears (total, 648 slides), with history (H) and without history (NH), at an interval of no less than 4 weeks. Each batch was read blind to the result of reading under the other strategy and to histology. Histologic cervical intraepithelial neoplasia 2 or more severe was the reference standard. Accuracy of reading was assessed across all thresholds using receiver operating characteristic (ROC) curves and by sensitivity and specificity at a cytology threshold of possible low grade squamous intraepithelial lesion (consistent with atypical squamous cells of undermined significance). RESULTS: Areas under the ROC curve, sensitivities and specificities were similar if read with or without history, except for 1 reader for whom reading with history increased the area under the ROC curve from 0.716 to 0.833 (increase of 0.117, p = 0.017) and the sensitivity from 0.57 to 0.79 (increase of 0.22, p = 0.014), without any significant change in specificity. Accuracy varied between subgroups defined by age and by the severity and timing of previous abnormalities, but the results of the comparison of accuracy in H and NH did not vary by subgroup. Mean reading times were 8.2 (H) and 7.9 (NH) minutes per slide, a difference of 0.34 minutes (p = 0.083). Differences in mean batch times (H-NH) between readers ranged from -0.08 to 1.0 minutes, the largest difference being for the reader whose accuracy increased. CONCLUSION: An accurate history might improve accuracy for some cytologists.

How should hearing screening tests be offered?

This paper deals with the question of how the general public should be addressed when offering hearing screening. Postal-based questionnaires in the United Kingdom, Germany, and The Netherlands were sent to users of hearing devices, those that are in the process of obtaining one, or those that have indicated that they have special interest in hearing. Results of the survey indicated that respondents were enthusiastic about the idea of being able to carry out hearing self-screening tests via the internet, telephone, or questionnaires. A questionnaire as a method to screen on hearing was generally preferred above using the internet, which was preferred over using the telephone for the test. About 27% of the respondents indicated to use exclusively one method. Most respondents indicated that either method provided would be of interest (41%), 17% indicated not to be interested in conducting screening tests using the internet.

Cervical cytology reading times: a comparison between ThinPrep Imager and conventional methods.

We aimed to compare the times cytologists spend reviewing cervical cytology slides processed by the ThinPrep Imager (TPI) with times they spend examining conventional cytology (CC) slides. We also aimed to examine the effect of cytologists' experience on reading times. Using a cross-sectional analytical design, we analyzed routine laboratory data, collected retrospectively over 7 months, for 41 cytologists, including paired data for 20 who read both TPI and CC slides. For the 20 cytologists who read both types of cytology, the mean reading rate was 13.3 slides per hour for TPI slides and 6.1 slides per hour for CC slides. The mean within-reader difference between TPI and CC rates was 7.2 slides per hour (P < 0.001). For CC reading, mean times did not differ between those who were additionally trained to read TPI slides and those who only read CC. Slower readers had greater increases in speed when using the TPI compared with CC reading than did faster readers (P < 0.001). More experienced cytologists tended to read CC slides more quickly than did those less experienced, but experience did not affect TPI reading times or within-reader differences in reading times between cytology types. The TPI significantly reduced reading times compared with CC. This reduction was greater amongst slower readers, and was unrelated to experience.

Accuracy of reading liquid based cytology slides using the ThinPrep Imager compared with conventional cytology: prospective study.

OBJECTIVE: To compare the accuracy of liquid based cytology using the computerised ThinPrep Imager with that of manually read conventional cytology. DESIGN: Prospective study. SETTING: Pathology laboratory in Sydney, Australia. PARTICIPANTS: 55,164 split sample pairs (liquid based sample collected after conventional sample from one collection) from consecutive samples of women choosing both types of cytology and whose specimens were examined between August 2004 and June 2005. MAIN OUTCOME MEASURES: Primary outcome was accuracy of slides for detecting squamous lesions. Secondary outcomes were rate of unsatisfactory slides, distribution of squamous cytological classifications, and accuracy of detecting glandular lesions. RESULTS: Fewer unsatisfactory slides were found for imager read cytology than for conventional cytology (1.8% v 3.1%; P<0.001). More slides were classified as abnormal by imager read cytology (7.4% v 6.0% overall and 2.8% v 2.2% for cervical intraepithelial neoplasia of grade 1 or higher). Among 550 patients in whom imager read cytology was cervical intraepithelial neoplasia grade 1 or higher and conventional cytology was less severe than grade 1, 133 of 380 biopsy samples taken were high grade histology. Among 294 patients in whom imager read cytology was less severe than cervical intraepithelial neoplasia grade 1 and conventional cytology was grade 1 or higher, 62 of 210 biopsy samples taken were high grade histology. Imager read cytology therefore detected 71 more cases of high grade histology than did conventional cytology, resulting from 170 more biopsies. Similar results were found when one pathologist reread the slides, masked to cytology results. CONCLUSION: The ThinPrep Imager detects 1.29 more cases of histological high grade squamous disease per 1000 women screened than conventional cytology, with cervical intraepithelial neoplasia grade 1 as the threshold for referral to colposcopy. More imager read slides than conventional slides were satisfactory for examination and more contained low grade cytological abnormalities.

Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: a systematic review.

BACKGROUND: Liquid-based cytology is reported to increase the sensitivity of cervical cytology and the proportion of slides that are satisfactory for assessment, in comparison with conventional cytology. Although some countries have changed to liquid-based cytology for cervical screening, controversy remains. We reviewed the published work to assess the performance of liquid-based cytology relative to conventional cytology in primary studies assessed to be of low, medium, or high methodological quality. METHODS: 56 primary studies were reviewed and assessed with strict methodological criteria. Liquid-based cytology and conventional cytology were compared in terms of the percentage of slides classified as unsatisfactory, the percentage of slides classified in each cytology category, and the accuracy of detection of high-grade disease. Data were examined for studies overall and in strata to examine the effect of study quality on results. FINDINGS: The median difference in the percentage of unsatisfactory slides between liquid-based cytology and conventional cytology was 0.17%. Only one small study was a randomised controlled trial. The classification of high-grade squamous epithelial lesion varied according to study quality (p=0.04), with conventional cytology classifying more slides in this category than did liquid-based cytology in high-quality studies (n=3) only. In medium-quality (n=30) and high-quality studies, liquid-based cytology classified more slides as atypical squamous cells of unknown significance than did conventional cytology when compared with low-quality studies (n=17; p=0.05). Only four studies provided sufficient verified data to allow estimation of sensitivity and specificity and comparison of test accuracy. INTERPRETATION: We saw no evidence that liquid-based cytology reduced the proportion of unsatisfactory slides, or detected more high-grade lesions in high-quality studies, than conventional cytology. This review does not lend support to claims of better performance by liquid-based cytology. Large randomised controlled trials are needed.

Nicotine-dependence symptoms are associated with smoking frequency in adolescents.

BACKGROUND: Although many sociodemographic and psychosocial factors have been identified as related to adolescent smoking, few studies have examined the role of nicotine-dependence (ND) symptoms. The objective was to study the association between ND symptoms and smoking status among adolescents in the early stages of the smoking onset process. METHODS: The McGill University Study on the Natural History of Nicotine Dependence is an ongoing 6-year prospective investigation of the natural history of ND among 1267 grade 7 students in ten Montreal high schools. The baseline response was 55.4%. Subjects for this cross-sectional analysis of baseline data, collected in 1999, included 241 past 3-month smokers (mean age [SD]=13.0+/-0.7 years at baseline). ND symptoms were measured in five indicators, including a measure based on the criteria for tobacco dependence in the International Classification of Diseases-10th Revision (ICD-10), the Hooked on Nicotine Checklist, and three symptom clusters (withdrawal, self-medication, and ND/cravings symptoms). The association between ND symptom indicators and each of sporadic, monthly, weekly, and daily smoking relative to less frequent smoking was investigated in multiple logistic regression analysis. RESULTS: Despite low cigarette exposure, 16.6% (95% confidence interval [CI], 11.9%-21.3%) of past 3-month smokers were tobacco dependent. The proportion increased from 0%, 3.1% (95% CI, 0.0%-9.2%), and 4.6% (95% CI, 0.2%-9.0%) among triers, sporadic smokers, and monthly smokers, respectively, to 19.4% (95% CI, 5.5%-33.3%) and 65.9% (95% CI, 51.9%-79.9%) among weekly and daily smokers, respectively. ND/cravings consistently distinguished each smoking category from less frequent smokers; the odds ratios (95% CI) for ND/cravings symptoms were 1.16 (0.99-1.35) in sporadic smokers; 1.17 (1.06-1.29) in monthly smokers; 1.34 (1.19-1.50) in weekly smokers; and 1.39 (1.22-1.59) in daily smokers. CONCLUSIONS: These data challenge current smoking onset models, which suggest that ND develops only after several years of heavy or daily smoking. ND symptoms are associated, at least cross-sectionally, with increased smoking in adolescents. To increase the likelihood of being effective, tobacco-control programs for children and adolescents will need to take early ND symptoms into account.

Medical tests: women's reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results.

OBJECTIVE: To determine women's preferences for and reported experience with medical test decision-making. DESIGN: Computer-assisted telephone survey. SETTING AND PARTICIPANTS: Six hundred and fifty-two women resident in households randomly selected from the New South Wales electronic white pages. MAIN OUTCOME MEASURES: Reported and preferred test and treatment (for comparison) decision-making, satisfaction with and anxiety about information on false results and side-effects; and effect of anxiety on desire for such information. RESULTS: Overall most women preferred to share test (94.6%) and treatment (91.2%) decision-making equally with their doctor, or to take a more active role, with only 5.4-8.9% reporting they wanted the doctor to make these decisions on their behalf. This pattern was consistent across all age groups. In general, women reported experiencing a decision-making role that was consistent with their preference. Women who had a usual doctor were more likely to report experiencing an active role in decision-making. More women reported receiving as much information as they wanted about the benefits of tests and treatment than about the side-effects of tests and treatment. Most women wanted information about the possibility of false test results (91.5%) and test side-effects (95.6%), but many reported the doctor never provided this information (false results = 40.0% and side-effects = 31.3%). A substantial proportion said this information would make them anxious (false results = 56.6% and side-effects = 43.1%), but reported they wanted the information anyway (false results = 77.6% and side-effects = 88.1%). CONCLUSIONS: Women prefer an active role in test and treatment decision-making. Many women reported receiving inadequate information. If so, this may jeopardize informed decision-making.