Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.— The article by Dr O'Leary
and colleagues1 and the Editorial by Dr
Garber2 present a misleading view of automated
cervical cytology smear rescreening. Although the authors briefly suggest
that PAPNET rescreening might prove more effective in a higher-risk population,
neither article adequately points out how unusual a setting was studied. The
women of the armed forces have outstanding access to health care services
and are encouraged to avail themselves of them liberally. The low prevalence
of lesions expected in this population is confirmed by the unusually low number
of abnormal Pap smears found in the study by O'Leary et al. Furthermore, PAPNET
was used "off label" in this study and was applied to Pap smears already twice
manually rescreened; the indicated use of PAPNET is as the first rescreening
after examination by a cytologist. Because the smears actually examined with
PAPNET had already been twice filtered for false negatives, the initially
small number of false-negative smears in the sample was dramatically reduced.
Accordingly, it is remarkable that PAPNET found as many as it did. The comparison
with 100% manual rescreening was, for related reasons, biased: the manual
rescreening results were based on Pap smears that had been rescreened only
once, leaving a greater number of false negatives to be detected.
Schechter CB. Rescreening of Cervical Papanicolaou Smears Using PAPNET. JAMA. 1998;279(22):1785–1788. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-22-jac80008
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