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Computerassistierte Diagnostik in der Zervixzytologie

Computer-assisted diagnostics in cervical cytology

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Zusammenfassung

Computerassistenz kann Screeningfehler reduzieren. Für die Zervixzytologie gibt es nur 2 Systeme: Das BD FocalPoint™ GS Imaging System (BD) verwendet Bilderkennungsalgorithmen, um Dünnschichtpräparate (Surepath, SP) und konventionelle Abstriche auszuwerten. Das ThinPrep® Imaging System basiert auf der densitometrischen Messung von Zellkernen. Diese Technik erfordert eine Dünnschichtpräparation. BD FocalPoint™ teilt die Präparate mit absteigender Wahrscheinlichkeit für das Vorliegen einer Auffälligkeit in 6 Gruppen ein. Eine weitere Option ist das „location guided screening“ (LGS). Hierbei werden an einem computerisierten Mikroskop die 15 Gesichtsfelder präsentiert, die mit höchster Wahrscheinlichkeit relevant sind. Mehrere Studien weisen darauf hin, dass mindestens eine Äquivalenz dieses Modus zum manuellen Screening bei konventionellen und SP-Präparaten besteht. Beim ThinPrep® Imaging System, das nur mit einem LGS-Modus arbeitet, fand die Mehrzahl der vorliegenden Studien eine signifikant höhere Sensitivität für histologisch bestätigte zervikale intraepitheliale Neoplasien vom Grad CIN 2 +. Allerdings hatten die meisten Studien ein retrospektives bzw. paralleles Design. Beide Systeme ermöglichen eine deutliche höhere Produktivität, setzen allerdings auch einen höheren technischen Gesamtaufwand voraus.

Abstract

Computer assistance has the ability to reduce screening errors. In cervical cytology only two systems are available: BD FocalPoint™ (BD) utilizes algorithms for image recognition to analyze thin-layer specimens (Surepath) and conventional slides. The ThinPrep® imaging system (Hologic) is based on the densitometric measurement of nuclei and requires a thin-layer preparation. The BD FocalPoint™ system assigns specimens according to declining probability of an abnormality to one of six groups. A further option is location-guided screening (LGS) where the 15 fields of view which are most relevant are presented on a computerized microscope. Several studies indicate that this mode is at least equivalent to manual screening with conventional and surepath (SP) slides. For the ThinPrep® imaging system which only uses the LGS mode the majority of available studies found a significantly higher sensitivity for histologically confirmed grade 2 cervical intraepithelial neoplasia (CIN 2 +). However, most were retrospective or parallel studies. Both systems allow a significantly higher productivity but require a higher technical expenditure.

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Literatur

  1. Alasio LM, Alphandery C, Grassi P et al (2001) Performance of the AutoPap Primary Screening System in the detection of high-risk cases in cervicovaginal smears. Acta Cytol 45:704–708

    Article  PubMed  CAS  Google Scholar 

  2. Anttila A, Pokhrel A, Kotaniemi-Talonen L et al (2011) Cervical cancer patterns with automation-assisted and conventional cytological screening: a randomized study. Int J Cancer 128:1204-1212. doi: 10.1002/ijc.25677

    Article  PubMed  CAS  Google Scholar 

  3. Bansal M, Austin RM, Zhao C (2009) High-risk HPV DNA detected in less than 2% of over 25,000 cytology negative imaged liquid-based Pap test samples from women 30 and older. Gynecol Oncol 115:257–261

    Article  PubMed  Google Scholar 

  4. Barroeta JE, Reilly ME, Steinhoff MM, Lawrence WD (2010) Utility of the Thin Prep Imaging System® in the detection of squamous intraepithelial abnormalities on retrospective evaluation: Can we trust the imager? Diagn Cytopathol, doi 10.1002/dc.21516

  5. Bibbo M, Hawthorne C (1999) Performance of the AutoPap primary screening system at Jefferson University Hospital. Acta Cytol 43:27–29

    Article  PubMed  CAS  Google Scholar 

  6. Biscotti CV, Dawson AE, Dziura B et al (2005) Assisted primary screening using the automated ThinPrep Imaging System. Am J Clin Pathol 123:281–287

    Article  PubMed  Google Scholar 

  7. Bolger N, Heffron C, Regan I et al (2006) Implementation and evaluation of a new automated interactive image analysis system. Acta Cytol 50:483–491

    Article  PubMed  Google Scholar 

  8. Chivukula M, Saad RS, Elishaev E et al (2007) Introduction of the Thin Prep Imaging System (TIS): experience in a high volume academic practice. Cytojournal 4:6

    Article  PubMed  Google Scholar 

  9. Chute DJ, Lim H, Kong CS (2010) BD focalpoint slide profiler performance with atypical glandular cells on SurePath Papanicolaou smears. Cancer Cytopathol 118:68–74

    Article  PubMed  Google Scholar 

  10. Confortini M, Bonardi L, Bulgaresi P et al (2003) A feasibility study of the use of the AutoPap screening system as a primary screening and location-guided rescreening device. Cancer 99:129–134

    Article  PubMed  Google Scholar 

  11. Cuschieri K, Wentzensen N (2008) Human papillomavirus mRNA and p16 detection as biomarkers for the improved diagnosis of cervical neoplasia. Cancer Epidemiol Biomarkers Prev 17:2536–2545

    Article  PubMed  CAS  Google Scholar 

  12. Davey E, d’Assuncao J, Irwig L et al. (2007) Accuracy of reading liquid based cytology slides using the ThinPrep Imager compared with conventional cytology: prospective study. BMJ 335:31

    Article  PubMed  Google Scholar 

  13. Duby JM, Difurio MJ (2009) Implementation of the ThinPrep imaging system in a tertiary military medical center. Cancer Cytopathol 25:264–270

    Article  Google Scholar 

  14. Dziura B, Quinn S, Richard K (2006) Performance of an imaging system vs. manual screening in the detection of squamous intraepithelial lesions of the uterine cervix. Acta Cytol 50:309–311

    Article  PubMed  Google Scholar 

  15. Elsheikh TM, Kirkpatrick JL, Cooper MK et al (2010) Increasing cytotechnologist workload above 100 slides per day using the ThinPrep imaging system leads to significant reductions in screening accuracy. Cancer Cytopathol 118:75–82

    Article  PubMed  Google Scholar 

  16. Friedlander MA, Rudomina D, Lin O (2008) Effectiveness of the Thin Prep Imaging System in the detection of adenocarcinoma of the gynaecologic system. Cancer 114:7–12

    Article  PubMed  Google Scholar 

  17. Halford JA, Batty T, Boost T et al (2010) Comparison of the sensitivity of conventional cytology and the ThinPrep Imaging System for 1,083 biopsy confirmed high-grade squamous lesions. Diagn Cytopathol 38:318–326

    PubMed  CAS  Google Scholar 

  18. Ikenberg H (2011) Thinlayer cytology and computerassistance in cytology. In: Petry KU (Hrsg) Modern methods for the diagnosis of HPV and cervical intraepithelial neoplasia in the prevention of cervical cancer. UNI-MED, Bremen, S 33–41

  19. Ikenberg H, Harlfinger W, Neis K et al (2011) A randomized trial comparing conventional cytology to liquid-based cytology with computer-assistance: results of the Rhine – Saar – Study. Eurogin, Lisbon 100 (abstract)

  20. Jordan B, Brinkmann-Smetanay F, Spieth S, Ikenberg H (2008) Data analysis from 2 years of routine use of the ThinPrep™-Imager in a German high volume laboratory. Eurogin, Nizza 180 (abstract)

  21. Joseph MG, Cragg F, Wright VC et al (1991) Cyto-histological correlates in a colposcopic clinic: a 1-year prospective study. Diagn Cytopathol 7:4774–4781

    Article  Google Scholar 

  22. Kitchener HC, Almonte M, Thomson C et al (2009) HPV testing in combination with liquid-based cytology in primary cervical screening (ARTISTIC): a randomised controlled trial. Lancet Oncol 10: 672–682

    Article  PubMed  Google Scholar 

  23. Kitchener HC, Blanks R, Cubie H et al (2011) MAVARIC – a comparison of automation-assisted and manual cervical screening: a randomised controlled trial. Health Technol Assess 15:1–170

    Google Scholar 

  24. Kitchener HC, Blanks R, Dunn G et al (2011) Automation-assisted versus manual reading of cervical cytology (MAVARIC): a randomised controlled trial. Lancet Oncol 12:56–64

    Article  PubMed  Google Scholar 

  25. Kinney WK, Manos MM, Hurley LB, Ransley JE (1998) Where’s the high-grade cervical neoplasia? The importance of minimally abnormal Papanicolaou diagnoses. Obstet Gynecol 91:973–973

    Article  PubMed  CAS  Google Scholar 

  26. Lozano R (2007) Comparison of computer-assisted and manual screening of cervical cytology. Gynecol Oncol 104:134–138

    Article  PubMed  Google Scholar 

  27. McCrory D, Matchar D, Bastian L et al (1999) Evaluation of cervical cytology. Evidence Report/Technology Assessment No. 5. AHCPR Publication No. 99-E010. Agency for Health Care Policy and Research, Rockville MD

  28. Miller F, Nagel L, Kenny-Moynihan M (2007) Implementation of the ThinPrep imaging system in a high-volume metropolitan laboratory. Diagn Cytopathol 35:213–217

    Article  PubMed  Google Scholar 

  29. Nieminen P, Kotaniemi-Talonen L, Hakama M et al (2007) Randomized evaluation trial on automation-assisted screening for cervical cancer: results after 777,000 invitations. J Med Screen 14:23–28

    Article  PubMed  Google Scholar 

  30. Pacheco MC, Conley RC, Pennington DW, Bishop JW (2008) Concordance between original screening and final diagnosis using imager vs. manual screen of cervical liquid-based cytology slides. Acta Cytol 52:575–578

    Article  PubMed  Google Scholar 

  31. Papillo JL, St John TL, Leiman G (2008) Effectiveness of the ThinPrep Imaging System: clinical experience in a low risk screening population. Diagn Cytopathol 36:155–160

    Article  PubMed  Google Scholar 

  32. Parker EM, Foti JA, Wilbur DC (2004) FocalPoint slide classification algorithms show robust performance in classification of high-grade lesions on SurePath liquid-based cervical cytology slides. Diagn Cytopathol 30:107–110

    Article  PubMed  Google Scholar 

  33. Passamonti B, Bulletti S, Camilli M et al (2007) Evaluation of the FocalPoint GS system performance in an Italian population-based screening of cervical abnormalities. Acta Cytol 51:865–871

    Article  PubMed  Google Scholar 

  34. Quddus MR, Neves T, Reilly ME et al (2009) Does the ThinPrep Imaging System increase the detection of high-risk HPV-positive ASC-US and AGUS? The Women and Infants Hospital experience with over 200,000 cervical cytology cases. Cytojournal 6:15

    Article  PubMed  Google Scholar 

  35. Roberts J, Thurloe J, Bowditch R et al (2007) A three-armed trial of the ThinPrep Imaging System. Diagn Cytopathol 35:96–102

    Article  PubMed  Google Scholar 

  36. Ronco G, Vineis C, Montanari G et al (2003) Impact of the AutoPap (currently FocalPoint) primary screening system location guide use on interpretation time and diagnosis. Cancer 99:83–88

    Article  PubMed  Google Scholar 

  37. Rowe LR, Marshall CJ, Berry M et al (2003) Accuracy of a slide profiler for endocervical cell detection in no-further-review conventional Pap smears. Acta Cytol 47:602–604

    Article  PubMed  Google Scholar 

  38. Schledermann D, Hyldebrandt T, Ejersbo D, Hoelund B (2007) Automated screening versus manual screening: a comparison of the ThinPrep imaging system and manual screening in a time study. Diagn Cytopathol 35:348–352

    Article  PubMed  Google Scholar 

  39. Sireci AN, Crapanzano JP, Mansukhani M et al (2010) Atypical glandular cells (AGC): ThinPrep Imaging System (TIS), manual screening (MS), and correlation with Hybrid Capture 2 (HC2) HPV DNA testing. Diagn Cytopathol 38:705–709

    PubMed  Google Scholar 

  40. Stevens MW, Milne AJ, Parkinson IH et al (2004) Effectiveness of AutoPap system location-guided screening in the evaluation of cervical cytology smears. Diagn Cytopathol 31:94–99

    Article  PubMed  Google Scholar 

  41. Thrall MJ, Russell DK, Bonfiglio TA, Hoda RS (2008) Use of the ThinPrep Imaging System does not alter the frequency of interpreting Papanicolaou tests as atypical squamous cells of undetermined significance. Cytojournal 5:10–15

    Article  PubMed  Google Scholar 

  42. Troni GM, Cariaggi MP, Bulgaresi P et al (2007) Reliability of sparing Papanicolaou test conventional reading in cases reported as No Further Review at AutoPap-assisted cytological screening: survey of 30,658 cases with follow-up cytological screening. Cancer 111:93–98

    Article  PubMed  Google Scholar 

  43. Vassilakos P, Carrel S, Petignat P et al (2002) Use of automated primary screening on liquid-based, thin-layer preparations. Acta Cytol 46:291–295

    Article  PubMed  Google Scholar 

  44. Wilbur D, Prey M, Miller W et al (1998) The AutoPap system for primary screening in cervical cytology. Comparing the results of a prospective, intended-use study with routine manual practice. Acta Cytol 42:214–220

    Article  PubMed  CAS  Google Scholar 

  45. Wilbur DC, Prey MU, Miller WM et al (1999) Detection of high grade squamous intraepithelial lesions and tumors using the AutoPap System: results of a primary screening clinical trial. Cancer 87:354–358

    Article  PubMed  CAS  Google Scholar 

  46. Wilbur DC, Parker EM, Foti JA (2002) Location-guided screening of liquid-based cervical cytology specimens: a potential improvement in accuracy and productivity is demonstrated in a preclinical feasibility trial. Am J Clin Pathol 118:399–407

    Article  PubMed  Google Scholar 

  47. Wilbur DC, Black-Schaffer WS, Luff RD et al (2009) The Becton Dickinson FocalPoint GS Imaging System: clinical trials demonstrate significantly improved sensitivity for the detection of important cervical lesions. Am J Clin Pathol 132:767–775

    Article  PubMed  Google Scholar 

  48. Zhao C, Florea A, Onisko A, Austin RM (2009) Histologic follow-up results in 662 patients with Pap test findings of atypical glandular cells: results from a large academic womens hospital laboratory employing sensitive screening methods. Gynecol Oncol 114:383–389

    Article  PubMed  Google Scholar 

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Der korrespondierende Autor weist auf folgende Beziehung/en hin: Der Autor ist gelegentlich Berater für und/oder hat Vortragshonorare/Reisekostenunterstützung von Abbott, B&D, Genprobe, Hologic, MTM, Qiagen, Roche erhalten.

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  1. MVZ Cytomol, Berner Str. 76, 60437, Frankfurt/Main, Deutschland

    H. Ikenberg

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Ikenberg, H. Computerassistierte Diagnostik in der Zervixzytologie. Pathologe 32, 476–483 (2011). https://doi.org/10.1007/s00292-011-1477-4

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