Background: AutoPap-assisted smear reading has been proposed prior to conventional manual reading; the latter may be unnecessary for cases reported as No Further Review (NFR) and would be required for cases reported as Review (REV).
Methods: The authors evaluated comparable concurrent screening cohorts who were undergoing a conventional manual (CONV) or an AutoPap-assisted smear reading within the same screening program. The authors evaluated the prevalence of CIN2+ at repeat screening in subjects 1) with a negative report at conventional Papanicolaou test (CONV- = 9605), 2) with a REV report at AutoPap, followed by a negative conventional reading (REV- = 17,576), and 3) with a NFR report at AutoPap, followed by a negative rapid review (NFR- = 3477) at previous (baseline) screening.
Results: Crude CIN2+ detection rate was 0.176% (17 of 9605), 0.187% (33 of 17,576), or 0.02% (1 of 3477) among baseline CONV-, REV-, or NFR- subjects, respectively. No significant difference in CIN2+ detection rates was evident when comparing the whole baseline CONV- and AutoPap- cohorts (0.176% versus 0.161%; chi(2) ((df=1)) = 2.48, P = .87), or baseline CONV- with baseline REV- subjects (chi(2) ((df=1)) = 2.49, P = .96), whereas a borderline difference was evident when comparing baseline NFR- with CONV- (chi(2) ((df=1)) = 3.07, P = .079) or with REV- (chi(2) ((df=1)) = 3.61, P = .057) subjects.
Conclusions: The authors' findings suggested that AutoPap assisted reading is comparable to conventional reading, as the frequency of CIN2+ detected at repeat screening did not differ between baseline CONV- or AutoPap- cohorts. The baseline NFR- subgroups showed a lower, borderline significant CIN2+ detection rate when compared to the CONV- cohort. The very low observed negative predictive value of an NFR report (0.02%) suggested that these subjects may safely return to periodic screening and that quality control measures such as rapid review or full manual reading of a random sample are probably not necessary.
(c) 2007 American Cancer Society.