34
Automation in Cervical Cytology
2 year conventional cytology
1 year liquid based cytology
$34,500-56,000 per YLS
>$51 million per YLS
F ig . 3 4 .2 2 C o s t-e ffe c tiv e n e s s m o d e lin g fo r c e rv ic a l c y to lo g y in te r v e n tio n s .
The cost-effectiveness of various interventions is plotted. Note that as
automated procedures are added or increased in frequency, the cost continues to increase, with plateauing of the effectiveness. Maximal gains in cost-
effectiveness are by procedures just above the beginning of the plateau. HpV, human papillomavirus; LYS, life year saved; VIA, visual inspection with acetic acid.
(After Goldie et al. 2006,115 with permission.)
F ig . 3 4 .2 3 In te rn e t-b a s e d c e rv ic a l c y to lo g y
remote scanning system
reading station screen. In this research project, conducted in conjunction
with the US Army, a Focalpoint Slide Scanner was adapted to package
and send, via the Internet, a series of up to 30 highest probability
field of view (FOV) images (these are the same images utilized for FOV
localization in Fig. 34.16) captured on review of the slide in a remote
location. Initial studies have revealed accuracy of triage of abnormal
cases similar to that of manual screening. Future adaptations of this
system might allow centralization of gynecologic cytology interpretation
services.117
F ig . 3 4 .2 4
Example of cervical cytology specimen of
h ig h -g ra d e
s q u a m o u s in tr a e p ith e lia l le s io n w it h th e a p p lic a tio n o f P roE xC
im m u n o s ta in
over the standard papanicolaou stain (Hp). ptoExC (Becton
Dickinson/tripath) is a marker of the aberrant cell cycle and identifies
accumulation of proteins seen when high-risk human papillomavirus
oncogenes are transcribed and interfere with normal DNA repair
mechanisms, allowing an accumulation of mutations to occur. Use of such
markers may, in the future, allow for more specific identification of high-
grade disease. In addition, the analysis of these types of specimens is highly
adaptable to automated scanning procedures.
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