Improvement in the routine screening performance of cytotechnologists over time

BACKGROUND:

Documenting the performance of gynecologic screening in actual practice settings is difficult to achieve. In the current study, the screening performance of 11 individual cytotechnologists as well as that of the overall laboratory over 2 consecutive time periods was examined using the rapid prescreening (RPS) method.

METHODS:

RPS was performed by all cytotechnologists in a single laboratory over 2 separate 8‐month periods. The sensitivity of screening for individual and groups of cytotechnologists was examined. For purposes of comparison, cytotechnologists were divided into 2 groups: screeners with an overall routine sensitivity ≥95% and screeners with an overall sensitivity <95%.

RESULTS:

Atypical squamous cells (ASC) were used as a threshold, and routine screening sensitivity was found to vary from 68.3% to 96.8%. The overall sensitivity of the laboratory for RPS and routine screening was 43.6% and 88.4%, respectively. Over time, the overall laboratory sensitivity of routine screening improved from 85.3% to 91.3% (P = .01). During this same time frame, the sensitivity of the screeners with an overall sensitivity <95% improved from 79.3% to 91.2% (P < .001), whereas the sensitivity of screeners with an overall routine sensitivity ≥95% remained the same (96.1% to 96.4%; P = .6).

CONCLUSIONS:

In addition to improved overall performance of the laboratory by detecting and correcting errors, the results of the current study indicate that using RPS consistently over time might play a role leading to improved performance of cytotechnologists with an overall routine sensitivity <95% but not of cytotechnologists with an overall routine sensitivity ≥95%. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

A screening methodology based on Random Forests to improve the detection of gene�Cgene interactions

The search for susceptibility loci in gene–gene interactions imposes a methodological and computational challenge for statisticians because of the large dimensionality inherent to the modelling of gene–gene interactions or epistasis. In an era in which genome-wide scans have become relatively common, new powerful methods are required to handle the huge amount of feasible gene–gene interactions and to weed out false positives and negatives from these results. One solution to the dimensionality problem is to reduce data by preliminary screening of markers to select the best candidates for further analysis. Ideally, this screening step is statistically independent of the testing phase. Initially developed for small numbers of markers, the Multifactor Dimensionality Reduction (MDR) method is a nonparametric, model-free data reduction technique to associate sets of markers with optimal predictive properties to disease. In this study, we examine the power of MDR in larger data sets and compare it with other approaches that are able to identify gene–gene interactions. Under various interaction models (purely and not purely epistatic), we use a Random Forest (RF)-based prescreening method, before executing MDR, to improve its performance. We find that the power of MDR increases when noisy SNPs are first removed, by creating a collection of candidate markers with RFs. We validate our technique by extensive simulation studies and by application to asthma data from the European Committee of Respiratory Health Study II.     

Improvement in the routine screening of cervical smears: A study using rapid prescreening and 100% rapid review as internal quality control methods

Background:

High rates of false‐negative results constitute a routine problem in cytology laboratories. Of currently available internal quality control methods, 10% random review is the least effective in detecting false‐negatives in routine screening. There is evidence that 100% rapid review and rapid prescreening perform well for this purpose. This study compared the performance of rapid prescreening and 100% rapid review as internal quality control methods for cervical cytology exams.

Methods:

Over 27 months, 12,208 cervical cytology smears were submitted to rapid prescreening and routine screening. The 100% rapid review method was performed on all smears classified as negative or unsatisfactory at routine screening. Conflicting results obtained with either method were reviewed in detail to define final diagnosis, which was considered the gold standard for evaluating the performance of rapid prescreening and 100% rapid review.

Results:

Compared with final diagnosis, the sensitivity of routine screening and rapid prescreening was 72.9% and 75.6%, respectively. Considering only smears classified as negative or unsatisfactory at routine screening, the sensitivity of rapid prescreening and 100% rapid review was 90.2% and 57,0%, respectively. Of 244 cases (2.0%) of false‐negative results at routine screening, rapid prescreening identified 220 cases (1.80%), whereas 100% rapid review identified 140 (1.15%). Rapid prescreening detected all cases of HSIL identified as false‐negatives.

Conclusions:

Rapid prescreening is more effective than 100% rapid review for the detection of false‐negatives at routine screening, thus providing subsidies for the performance of cervical cytology, the principal function of which is to detect precursor lesions of cervical cancer. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.     

兰州军区东片艾滋病初筛实验室2014年考核结果分析

目的 了解艾滋病初筛实验室建设工作状况,发现问题和提出建议,促进实验室检测工作准确、安全和规范.方法 采用现场调查和盲样检测对初筛实验室进行考核,分析现场考核结果.结果 12个初筛实验室均能较好地进行艾滋病初筛检测,检测过程符合要求,结果正确,全部达标.部分实验室存在硬件设施有欠缺、软件建设质量有不足、质量管理工作有待加强的问题.结论 本区艾滋病初筛实验室能较好地开展艾滋病抗体初筛检测工作,但实验室建设质量水平有差异,需要针对存在的问题相应地加以改进.     

Selective screening for nongynecologic cytology specimens: modifying the screening process for improved efficiency and practice

Nongynecologic (NG) cytology cases usually generate multiple slides. In cases showing overtly malignant or neoplastic cells, the cytotechnologist (CT) may not need to screen all slides. We test the hypothesis that selective screening of a subset of slides by the CT is as effective as "routine screening" of all slides. The selective screening process (SSP) was performed by having the cytotechnologist (CT) screen and mark overtly malignant or neoplastic cells on up to three slides. Cases requiring more slides to be screened were not included in SSP. For each SSP case, the total slide count, number of slides screened, final diagnosis, and cytologic-histologic correlation (CHC) data were collected over 10 months and compared to the data from routinely screened cases. SSP was performed on 191 cases during a 10-month period. An average of 1.9 slides per case was screened by the cytotechnologist using the SSP. The average number of unscreened slides passed to the pathologist was 6.3 per case. On average, SSP resulted in 83.6 min of CT's time saved per day. Quality control by CHC demonstrated no false-positive cases in either the SSP or "routinely screened" groups. The diagnostic accuracy of the specific cytology diagnoses was 98% by SSP and 100% by "routine screening." SSP provides a mechanism for the cytotechnologist to "screen" fewer slides and pass the cases to the pathologist more efficiently without compromising overall patient care.     

HSIL, epithelial cell abnormality-adjusted workload, and the Thinprep imaging system

Previous studies have suggested that the sensitivity of the ThinPrep Imaging System (TIS) for high-grade intraepithelial lesion (HSIL) and worse may be decreased at workloads above 100 slides/day. On the other hand, at a threshold of atypical squamous cells of undetermined significance (ASCUS) and above, sensitivity of the TIS appears to more closely correlated with epithelial cell abnormality (ECA)-adjusted workload (ECA rate × actual slides/day) rather than total workload. We sought to determine if the sensitivity of the TIS for HSIL could also be shown to be correlated with ECA-adjusted workload. The change in sensitivity for HSIL from manual screening to TIS screening consistently correlated negatively with ECA-adjusted workload both in the original Food and Drug Administration trial study and in independent studies available in the literature. Both sources suggest that sensitivity near 100% can be achieved with ECA-adjusted workloads of 5-7 slides/day. For a laboratory with an ECA rate of 10%, this represents a total workload of 50-70 slides/day. We conclude that measuring the ECA-adjusted workload is a valuable method to assess workload for the ThinPrep Imaging System.     

Neurofeedback Overtraining and the Vulnerable Patient

Neurofeedback overtraining in vulnerable patients can cause transient, site-specific functional decline that may be distressing to the patient and trainer. Susceptible patients can be identified before training with a checklist, and overtraining then avoided by close observation of training response. Procedures are described and a possible mechanism is offered.     

北京市通州区农村儿童哮喘初筛问卷调查分析

目的：初筛北京市通州区农村儿童支气管哮喘患病率,为农村儿童支气管哮喘的防治和管理提供流行病学依据。方法采取随机整群抽样的调查方法,应用2011年全国哮喘防治协作组制定的儿童哮喘流行病学调查初筛表,对通州区5个乡村共12所幼儿园、卫生保健院及中小学校0～14岁儿童进行问卷调查,对问卷调查结果进行统计学分析。结果共发出初筛问卷4000份,有效问卷3779份,有效应答率94．5％。问卷调查结果显示,通州区农村儿童哮喘（婴幼儿及儿童哮喘）患病率为1．2％,男女患病率分别为1．7％、0．8％,男童显著高于女童（ P＜0．05）;过敏性鼻炎、有湿疹史、有家族过敏史患儿的哮喘患病率分别高于无过敏性鼻炎、无湿疹史、无家族过敏史患儿（P＜0．05或＜0．01）。结论北京市通州区农村儿童哮喘患病率较低,且在性别、年龄及合并变应性疾病、家族过敏史上有其特点。