EM1 - New Directions in Cervical Cytology Screening
EM2 - Modern Management of External Anogenital Warts
EM3 - Management of Abnormal Smears. The State of the Art
EM4 - Role of HPV Testing in Cervical Cancer Screening

EM1 - New Directions in Cervical Cytology Screening

Chairs: E McGoogan and M Hutchinson

J Bishop, USA L G Koss, ISA
E McGoogan, Scotland R Richart, USA
M. Hutchinson, USA M Roy France
J Kelly, USA A Verhest, Belgium

This "Experts'Meeting" covered a variety of technologies undergoing development, testing or actual introduction into cytology screening programmes. The speakers acknowledged the major contribution made by cervical screening programmes in reducing mortality from cervical cancer and that the basic screening test used in these programmes had been the Papanicolaou smear (Pap test). However, several speakers alluded to the watershed event which occured in the USA when, in 1987, the lay press reported on accuracy problems associated with the Pap test. Both regulatory bodies and financiers took notice of this problem that, as Professor Koss noted, had long been evident from the cytology literature. To a large extent the corporate driven efforts to enhance the Pap test have been undertaken to reduce the false negatives and thereby reduce the opportunities for litigation. Drs Verhest, Hutchinson and McGoogan reported on the results of studies using liquid based preparations. These reports suggest that specimen quality can be significantly improved and that diagnostic results are equivalent or superior to those obtained with conventional smears. Not surprisingly, results vary with device employed, study population and experimental design. That liquid based preparations are easier to read, have a higher sensitivity with at least equivalent specificity, and are well suited to simultaneous testing for HPV, chlamydia, gonorrhoea and other pathogens was emphasised by Dr Richart who also showed that this approach can indeed be cost effective.

Dr M Roy gave an overview of the many possibilities whereby tele-medicine can enhance several aspects of gynaecologic testing including continuing education, quality control in cytology and colposcopy and direct consultations for primary or second opinions for cytology and colposcopy.

Dr J Bishop and Mr J Kelly reviewed the current state of the art with respect to computer assisted automation. As we begin the 21st century, most instruments employ liquid based preparations. Diagnostic decisions are technologist directed, instrument directed or an integrated approach employing both technologist and instrument derived data.

Dr McGoogan described the attributes necessary for new technology to be of value in a real world working environment. In brief, neither sensitivity nor specificity must be compromised and new tests must be cost-effective. Advances in molecular diagnostics offer the opportunity to research the pathogenesis of cervical cancer and potentially identify new markers which may further the sensitivity and specificity of screening. In conclusion, well organised screening programmes have enjoyed great success over the years, yet manpower (human screeners) shortages continue worldwide and access to testing remains limited. For the future, we must evaluate carefully how we use our ressources — man, machine, molecular — to accomplish the greatest good.

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