***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The authors compared the accuracy of conventionally prepared smears and smears prepared by an automated , fluid-based , thin-layer processing device in the detection of cytologic abnormalities . A total of 3218 patients from five centers took part in this study , in which a single cervical sample was split into a matched pair . The conventional smear was made in the routine fashion ; the remainder of the cells on the sampling device were rinsed into a transport-fixation fluid . A slide was then prepared from the solution using the thin-layer processor . Diagnostic findings identified on the two preparations were compared in a blinded fashion , and a discrepancy resolution procedure was used to eliminate screening differences . Overall , there was a high correlation in the diagnoses of the two methods . For low- grade or more severe disease , the thin-layer method result ed in a 13 % increase in the rate of detection , as compared with the conventional Papanicolaou smear technique OBJECTIVE To obtain preliminary data on the Roche CytoRich thin-layer system for the preparation of gynecologic cytology specimens , derived from a pre clinical startup evaluation of the instrument and comparing the CytoRich method to conventional smears . STUDY DESIGN At six different clinical sites , 286 pairs of conventional and CytoRich slides derived from the same patient sample were compared for the following : final Bethesda classification diagnosis , specimen adequacy and presence of microorganisms . RESULTS The study showed agreement between the methods for an exact Bethesda diagnosis in 78 % and agreement within one Bethesda diagnosis category in 95 % . The CytoRich method diagnosed more cases of squamous intraepithelial lesion ( SIL ) than did the conventional method , and the differences in SIL detection were statistically significant . The CytoRich method identified similar numbers of cases with microorganisms as did the conventional smears , and the CytoRich system improved overall specimen adequacy as compared to the conventional method , with fewer cases of unsatisfactory and less-than-optimal smears . CONCLUSION The CytoRich method may improve the overall sensitivity and specificity of the cervical cytology procedure . Clinical trials to verify these preliminary data are ongoing OBJECTIVE To examine the efficacy of the ThinPrep method , an automated , fluid-based technique for the collection and preparation of exfoliated and aspirated cells in cervical cytology . STUDY DESIGN A total of 251 patients participated . From each patient a sample was obtained by scraping with a wooden spatula , split and prepared with both conventional Papanicolaou and ThinPrep methods . In the ThinPrep processor , epithelial cells were homogenized in a vial of preservative solution and r and omly sample d onto a microscopic slide . From a single vial of sample suspension a series of 10 ThinPrep slides of the same quality were made . All cells were concentrated within an approximately 20-mm-diameter circle in a uniform , thin layer on the ThinPrep slide . RESULTS Twenty-five percent of the screening area , 10 % of the epithelial cells observed and 50 % of the screening time were required to arrive at a final diagnosis as compared with the Papanicolaou smear . Virtually complete concurrence was ascertained between the Papanicolaou and ThinPrep diagnoses , for direct agreement of 95.3 % and agreement within one diagnostic grade of 99.5 % . CONCLUSION An overall improvement was ascertained in the preparation of microscopic slides and the recognition of abnormal cells with the ThinPrep method OBJECTIVE To compare the AutoCyte PREP direct-to-vial procedure to the conventional Pap smear in two large and similar patient groups compiled from the testing experience of three cytology laboratories in Switzerl and and France . STUDY DESIGN R and omly selected , large patient groups were evaluated using either the conventional Pap smear or the AutoCyte PREP direct-to-vial liquid-based preparation . Results were then compared statistically as to disease detection and sample adequacy . RESULTS Specimen adequacy was greatly improved in the group tested with the AutoCyte PREP . PREP also demonstrated a significant reduction in ASCUS and ASCUS : LSIL+ ratios . The three laboratories participating in this review found significantly improved detection of both low and high grade SIL . Routine use of AutoCyte PREP for cervical cytology screening offers substantial improvements in adequacy and disease detection OBJECTIVE To compare the cytologic diagnoses and specimen adequacy of the ThinPrep Pap Test with historical data within a distinct patient population to assess test performance and its impact on clinical practice . STUDY DESIGN A total of 16,314 ThinPrep Pap tests were processed and evaluated at Fletcher Allen Health Care over a seven-month period . A subset of 8,574 tests from a selected provider group ( cohort ) was compared to the  historical conventional cervical cytologic smear data  from the cohort population for both cytologic diagnoses and specimen adequacy . The cohort consisted of 12 practice groups , including 60 physicians and providers , utilizing the  ThinPrep Pap Test as their primary cervical cancer screening sampling technique . Cytologic diagnoses and specimen adequacy were classified using the Bethesda system . RESULTS Using a three-tiered diagnostic system similar to the Cytyc clinical trials ( within normal limits [ WNL ] , atypical squamous cells of undetermined significance [ASCUS]/atypical gl and ular cells of undetermined significance [ AGUS ] and low grade squamous intraepithelial lesion and higher [LSIL]+ ) , the ThinPrep method increased the percentage of cases that could be definitively diagnosed as WNL by 1.71 % , lowered the percentage of ambiguous or borderline cases diagnosed as ASCUS/AGUS by 26.59 % and increased the percentage of cases diagnostic of LSIL+ by 52.15 % in the cohort population . Further subdivision by the Bethesda classification showed that the identification of infectious agents increased 25.51 % and the detection of high grade squamous intraepithelial lesion/carcinoma increased 55.14 % . Concurrently , cases reported as benign cellular changes ( reactive/reparative ) decreased 23.1 % , and the percentage of cases reported as unsatisfactory/"limited by ... " was reduced 52.71 % . Histologic correlation of cases reported as squamous intraepithelial lesion revealed that the percentage of patients with subsequent benign biopsies was reduced by 31.7 % utilizing the ThinPrep technique . Further , the percentage of ThinPrep patients with histologically confirmed cervical intraepithelial neoplasia ( CIN ) 1 and CIN 2/3 increased by 16.3 % and 9.3 % , respectively . CONCLUSION Implementation of the ThinPrep Pap Test result ed in statistically significant improvements in both diagnostic yield and specimen adequacy , as seen by others in clinical trials . Comparison of results to historical data within a cohort population reinforced earlier data and lent further support to the cl aim that the ThinPrep Pap Test is " significantly more effective " than the conventional smear in clinical practice OBJECTIVE To eliminate the disadvantages and inherent bias of split- sample studies by evaluating the relative performance of monolayers and conventional cervical cytologic smears in a single laboratory through evaluation of two large and similar , r and omly derived patient groups from the same geographical and demographically similar population . STUDY DESIGN Two r and omly created large patient groups from the same population were evaluated using conventional microscopic screening .  One group was tested using the conventional smear . The other was evaluated using only the new liquid-preservative-based CytoRich preparation ( AutoCyte , Inc. , Elon College , North Carolina , U.S.A. ) with the intended direct-tovial cell collection method . Results were then compared statistically as to disease detection and sample adequacy . RESULTS Age comparisons between the two groups demonstrated equivalency . Specimen adequacy was greatly improved in the group tested with the CytoRich monolayer preparation . The monolayer group also demonstrated a significant reduction in ambiguous atypical squamous cells of undetermined significance /atypical gl and ular cells of undetermined significance diagnoses and a threefold increase in the detection of squamous intraepithelial lesion and cancer . CONCLUSION Routine use of homogeneous monolayer preparations as a total replacement for the conventional smear can be expected to dramatically improve specimen adequacy and sensitivity of the conventional smear alone . Direct-to-vial use of the new monolayer preparation generated significantly better results than those shown in any of the earlier split- sample trials OBJECTIVE To compare the CytoRich system with conventional cervical cytology  in a university medical center hospital laboratory . STUDY DESIGN The CytoRich system combines liquid preservation , selective reduction of blood/inflammation , thin-layer preparation and discrete staining . Two thous and thirty-two parallel conventional and CytoRich sample s were examined as part of a multicenter trial of the  CytoRich/AutoCyte systems .  Same-patient conventional and CytoRich slides were su bmi tted to separate cytotechnologists blindly . The results were compared , and all nonmatching sample pairs were review ed again . A consensus diagnosis was derived for all cases . The initial readings of the CytoRich and conventional smears were compared with each other and with the consensus diagnosis . RESULTS Of the 148 squamous intraepithelial lesions ( SILs ) found by either method , 85 % were found by CytoRich , while only 58.5 % were found by conventional smear . As compared with the consensus diagnosis , CytoRich slides had 86.7 % sensitivity for SIL and 99.1 % specificity , while the conventional slides had 63.6 % sensitivity and 99.7 % specificity . Consensus review result ed in upgrading to SIL in 1.8 % of conventional slides and 1.4 % of CytoRich slides . The biopsy correlation results were similar for the two methods . CONCLUSION The CytoRich system affords excellent cellular presentations and superior sensitivity for SILs when compared to the conventional technique OBJECTIVE To assess specimen adequacy of the ThinPrep slide preparation method in routine use . STUDY DESIGN Two studies , a feasibility study of 299 women and a clinical study of 499 women , were conducted . A broom-type collection device was used and rinsed directly into Pre-servCyt vials . Slides were prepared with the ThinPrep 2000 device , screened and classified according to the Bethesda System . The proportion of ThinPrep slides described as " Satisfactory But Limited By : No Endocervical Component  ( SBLB : No ECC ) " was then compared to the proportion of  SBLB : No ECC slides found on conventional smears in a previously conducted clinical trial of over 7,000 patients . RESULTS For the feasibility study the proportion of ThinPrep slides described as SBLB : No ECC  was 9.36 % as compared to the clinical trial combined rate of 9.4 % for conventional smears . For the clinical study , 4.96 % of ThinPrep slides were SBLB : No ECC  as compared to the 4.4 % SBLB : No  ECC rate for conventional smears from the same clinical trial . The proportions were statistically equivalent for both studies . CONCLUSION It is expected that the rate of representing endocervical component will be maintained when the ThinPrep preparation method is used routinely in place of the conventional cytologic smear method Several studies have examined the role of tests for human papillomavirus ( HPV ) in screening for cervical cancer but as yet the relevance is unclear . We looked at HPV testing for types 16 , 18 , 31 , and 33 on material taken at the time of a cervical smear in 2009 eligible women having routine screening . Women with any degree of dyskaryosis or high levels of one of these HPV types were referred for colposcopy . 44 % of the cervical intraepithelial neoplasia ( CIN ) lesions of grade 2/3 detected had negative cytology and were found only by HPV testing . A further 22 % of the CIN 2/3 lesions were positive for HPV but showed only borderline or mild cytological changes . The positive predictive value of HPV testing was 42 % , which was similar to that for moderate dyskaryosis . HPV types 16 and 31 were more sensitive and specific for CIN 2/3 than were types 18 or 33 . However , 25 % of the CIN 2/3 lesions were not detected by these four HPV tests . We suggest that HPV testing could usefully augment but not replace conventional cytology . These results should stimulate a much larger r and omised trial to assess the impact of these improved CIN 2/3 detection rates on the subsequent incidence of invasive cancer Objective To compare the cytologic diagnoses and specimen adequacy of a fluid-based , thin-layer preparation and conventional Papanicolaou tests . Methods A total of 7360 women from six separate sites — three screening centers and three hospitals — participated in split- sample /matched-pair , double-masked clinical trials . A conventional Papanicolaou test was performed , after which residual material on the sampling device was rinsed into a fluid preservative from which a thin-layer slide ( ThinPrep ) was prepared using the ThinPrep 2000 automated slide processor ( Cytyc Corp. , Boxborough , MA ) . Conventional and ThinPrep slides were read independently . Cytologic diagnoses and specimen adequacy were classified using the Bethesda system . Results For the three screening centers , 65 % more diagnoses of low- grade squamous intraepithelial lesions and higher were made on the ThinPrep slides ( P < .001 ) ; for the three hospital centers , 6 % more of these diagnoses were made with the ThinPrep method ( P = .294 ) . Comparison of specimen adequacy showed a significant increase in satisfactory spec 
    Output:
    
Effectiveness There is some evidence that liquid-based cytological methods offer the following advantages over traditional smear techniques : • a reduction in the proportion of inadequate specimens • an improvement in sensitivity • a possible reduction in specimen interpretation times .
Conclusions From the evidence available , it is likely that the liquid-based cytology technique will reduce the number of false-negative test results , reduce the number of unsatisfactory specimens and may decrease the time needed for examination of specimens by cytologists .
In this review , it became clear that increasing the coverage of the programme , and the use of more effective cervical specimen collection devices are also important ways of reducing the burden of the invasive cervical cancer .