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To the Editor.— The article by Dr O'Leary and colleagues¹ has important clinical implications. The results suggest that PAPNET-automated rescreening (Neuromedical Systems Inc, Suffern, NY) has little clinical utility since the cost does not justify the few incremental cases of cervical disease it may detect. This article confirms what many epidemiologists, clinicians, and scientists have suspected all along. Although the concept is sound, there is no automated rescreening technology to date that can address the poor sensitivity and specificity of the Papanicolaou (Pap) smear in cervical cancer screening.

The reported lack of sensitivity for the Pap smear ranges from 30% to 50% for significant disease (eg, high-grade dysplasias and cervical cancer) and as high as 50% for low-grade precursor lesions. Specificity is the primary concern for atypical squamous cells of undetermined significance (ASCUS) Pap smear results (25%).² In the majority of ASCUS cases, the cervix is normal; however, there are . . . [Full Text of this Article]

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RELATED ARTICLE

PAPNET-Assisted Rescreening of Cervical Smears: Cost and Accuracy Compared With a 100% Manual Rescreening Strategy
Timothy J. O'Leary, Miguel Tellado, Sally-Beth Buckner, Izzat S. Ali, Angelica Stevens, and Curtis W. Ollayos
JAMA. 1998;279(3):235-237.
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