Pap Smear (cont.)

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What is the current status of the newer Pap smear technologies?

New technologies have been developed to try to circumvent the problem of false-negative Pap smears. False-negative results occur when a disease or condition is present but the test does not detect it. False-negative Pap smears (slides with abnormal cells judged to be "normal") are estimated to be between 5% and 30%.

The new techniques consist of alternative ways to prepare and read Pap smears. In one new preparation method known as liquid-based cytology, cervical cells are obtained as usual but a new technique is used to prepare the slides for analysis. The physician puts the cell sample into a vial of liquid preservative. The cells are then sent to the laboratory where they are filtered and spread on glass slides. This method removes any contamination from blood or mucous.

Prepared slides are usually read by cytotechnologists who examine thousands of slides under a microscope every day. This exhausting process may be subject to human error. Computer systems are now being developed to assist by providing an automated analysis of slides. Slides containing abnormally appearing cervical cells can first be automatically identified and then subjected to a second, manual re-screening.

Recent guidelines are conflicting as to whether to recommend the new technologies because sound scientific research is not available on which to base a thoughtful recommendation. Besides being more expensive, the underlying problem is that the new technologies (such as liquid-based cytology) have never been proven to decrease mortality from cervical cancer as compared to conventional Pap testing. In addition, even if future research shows that more cases of cervical cancer are detected with the new technologies versus the conventional Pap testing, there may be too many "false positive" cases in which women are labeled to have abnormal Pap smears when they are perfectly normal. This last point is critical. The information must be gathered before rational recommendations can be widely instituted.

Medically Reviewed by a Doctor on 2/21/2014

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