***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 Papanicolaou test has proven to be the most effective cancer screening test ever developed . However , with a declining number of skilled cytotechnologists , there is an increased need for computer assistance in cervical cancer screening . The ThinPrep Imaging System ( Cytyc Corporation , Marlborough , MA ) is a unique system that combines computer imaging technology and human interpretive expertise in the review of ThinPrep Pap test slides . The purpose of this study is to report on the introduction and validation of this technology and present data related to the performance and productivity in our laboratory . Following completion of the ThinPrep Imaging System validation protocol , all imaged ThinPrep Pap test results were tracked and compared with year-2003 manually screened results to identify whether the Imaging System was effective in aiding human interpretive skills . Cases rescreened in the 10 % r and om quality control ( QC ) program from the negative population that showed abnormal cells consistent with low- grade squamous intraepithelial lesion ( LSIL ) and above were compared with imaged versus non-imaged cases to establish an estimated laboratory false-negative ( F/N ) rate . The study compared results of 82,063 manually screened ThinPrep Pap tests in 2003 with 84,473 imaged ThinPrep Pap tests in 2004 . Results demonstrated a significant increase in LSIL ( 37 % ) and high- grade squamous intraepithelial lesion ( HSIL ) ( 42 % ) detection on the Imager cohort . The F/N rate was reduced by half . The evaluation period after validation of the Imager showed a significant increase in LSIL and HSIL detection with the ThinPrep Imaging System compared to manual screening . These results demonstrate that the Imager has the potential to allow the cytotechnologists to detect more disease and reduce the false-negative rate for the laboratory . Although not evaluated in this study , cytotechnologists reported increased job satisfaction BACKGROUND Although testing for human papillomavirus ( HPV ) has higher sensitivity and lower specificity than cytology alone for detecting cervical intraepithelial neoplasia ( CIN ) , studies comparing conventional and liquid-based cytology have had conflicting results . METHODS In the first phase of a two-phase multicenter r and omized controlled trial , women aged 35 - 60 years in the conventional arm ( n = 16,658 ) were screened using conventional cytology , and women in the experimental arm ( n = 16,706 ) had liquid-based cytology  and were tested for high-risk HPV types using the Hybrid Capture 2 assay . Women in the conventional arm were referred to colposcopy with atypical cells of undetermined significance ( ASCUS ) or higher and those in the experimental arm were referred with ASCUS or higher cytology or with a positive ( > or = 1 pg/mL ) HPV test . Sensitivity and positive predictive value ( PPV ) for detection of cervical intraepithelial neoplasia grade 2 or higher ( CIN2 + ) were calculated . RESULTS The screening methods and referral criterion applied in the experimental arm had higher sensitivity than that in the conventional arm ( relative sensitivity = 1.47 ; 95 % confidence interval [ CI ] = 1.03 to 2.09 ) but a lower PPV ( relative PPV = 0.40 ; 95 % CI = 0.23 to 0.66 ) . With HPV testing alone at > or = 1 pg/mL and at > or = 2 pg/mL , the gain in sensitivity compared with the conventional arm remained similar ( relative sensitivity = 1.43 , 95 % CI = 1.00 to 2.04 and relative sensitivity = 1.41 , 95 % CI = 0.98 to 2.01 , respectively ) but PPV progressively improved ( relative PPV = 0.58 , 95 % CI = 0.33 to 0.98 and relative PPV = 0.75 , 95 % CI = 0.45 and 1.27 , respectively ) . Referral based on liquid-based cytology alone did not increase sensitivity compared with conventional cytology ( relative sensitivity = 1.06 ; 95 % CI = 0.72 to 1.55 ) but reduced PPV ( relative PPV = 0.57 ; 95 % CI = 0.39 to 0.82 ) . CONCLUSIONS HPV testing alone was more sensitive than conventional cytology among women 35 - 60 years old . Adding liquid-based cytology improved sensitivity only marginally but increased false-positives . HPV testing using Hybrid Capture 2 with a 2 pg/mL cutoff may be more appropriate than a 1 pg/mL cutoff for primary cervical cancer screening OBJECTIVE To evaluate the FocalPoint Location-Guided Screening ( FPGS ) performance in computer-assisted primary screening of Papanicolaou-stained cervicovaginal smears . STUDY DESIGN A total of 37,306 routine consecutive conventional Pap slides were prospect ively processed on the FPGS . Each slid design ated by the instrument as Review was reported according to results obtained using a GS Review Station . Subsequently , all slides under went conventional manual rapid screening and reported results were compared . RESULTS Of the slides initially su bmi tted to the FPGS , 34,004 ( 91.15 % ) were qualified for scanning . Within these slides , the system classified 7,399 ( 21.8 % ) as needing No Further Review and ranked to Review the remaining 26,605 ( 78.2 % ) . Of the 418 cellular abnormalities found , 409 were classified for Review by FPGS and 9 minor grade lesions were classified in the " No Further Review " population . Overall , 352 ( 86 % ) of atypical squamous cell (ASC)+ were ranked in high-score quintiles , including 96 ( 94 % ) of the 102 high- grade squamous intraepithelial lesion ( HSIL ) or worse . Location-guided software identified cellular abnormalities , in the automatically selected fields of view , in 378 ( 92 % ) of the ranked abnormal slides , showing a sensitivity > 95 % on SILs . CONCLUSION Slide ranking and location-guided screening features are of value in detecting and triaging abnormal smears OBJECTIVE To compare the accuracy of thin-layer cytology with Autocyte PREP ( TriPath Imaging Inc. , Burlington , North Carolina , U.S.A. ) with conventional smears in 500 women undergoing cervical cone biopsy .  STUDY DESIGN The study was performed among 500 consecutive women presenting for cone biopsy for high grade cervical intraepithelial neoplasia ( CIN ) on biopsy in 350 ( 70 % ) and discrepant cytology/colpohistology in 150 ( 30 % ) . Before performing a cone biopsy , two cervical sample s were collected for conventional smears and thin-layer cytologic slides , with r and omization of the order . Conventional smears were stained and diagnosed at Pasteur Cerba , while thin-layer cytologic slides were processed at a local TriPath office ( Meylan , France ) and sent in a masked fashion for screening at Pasteur Cerba . Any slides initially read as normal were review ed again and reported without knowledge of the other cytologic or cone biopsy data . The final cytologic diagnoses for the two methods were compared with histopathology of the cone biopsy . RESULTS The conventional smear was unsatisfactory in 58 ( 11.6 % ) of cases , while there were 4 ( 0.8 % ) unsatisfactory thin-layer cytologic slides ( P < .001 ) . Endocervical cells were missing from 31 ( 6.2 % ) of conventional smears and 34 ( 6.8 % ) of thin-layer cytologic slides . For the pooled data , sensitivities of conventional smear and thin layer for detecting high grade CIN ( 0.82 % and 0.86 % , respectively ) were similar as were specificities ( 0.40 % and 0.43 % , respectively ) . When first sample s were compared , the sensitivities of the conventional smear and thin layer for high grade CIN were 0.79 % and 0.89 % , respectively ( P = .02 ) , with corresponding specificities of 0.41 % and 0.36 % ( P < .01 ) . CONCLUSION When controlled for sample order , the sensitivity of thin-layer cytology for detecting high grade CIN was significantly higher than that of conventional smears in patients with previous abnormal cytology , but at the expense of specificity To evaluate the effectiveness of  human papillomavirus ( HPV ) testing  in primary cervical screening . This was a cross-sectional study from the recruitment phase of a prospect i ve r and omised trial . Women were screened for HPV in addition to routine cervical cytology testing . Greater Manchester , attendees at routine NHS Cervical Screening Programme . In all , 24 510 women aged 20–64 screened with liquid-based cytology ( LBC ) and HPV testing at entry .  HPV testing in primary cervical screening . Type-specific HPV prevalence rates are presented in relation to age as well as cytological and histological findings at entry . In all , 24 510 women had adequate cytology and HPV results . Cytology results at entry were : 87 % normal , 11 % borderline or mild , 1.1 % moderate and 0.6 % severe dyskaryosis or worse . Prevalence of HPV decreased sharply with age , from 40 % at age 20–24 to 12 % at 35–39 and 7 % or less above age 50 . It increased with cytological grade , from 10 % of normal cytology and 31 % of borderline to 70 % mild , 86 % moderate , and 96 % of severe dyskaryosis or worse . HPV 16 or HPV 18 accounted for 64 % of infections in women with severe or worse cytology , and one or both were found in 61 % of women with severe dyskaryosis but in only 2.2 % of those with normal cytology . The majority of young women in Greater Manchester have been infected with a high-risk HPV by the age of 30 . HPV testing is practicable as a primary routine screening test , but in women aged under 30 years , this would lead to a substantial increase in retesting and referral rates . HPV 16 and HPV 18 are more predictive of underlying disease , but other HPV types account for 30 % of high- grade disease BACKGROUND Testing for human papillomavirus ( HPV ) DNA is reportedly more sensitive than cytology for the detection of high- grade cervical intraepithelial neoplasia ( CIN ) . The effectiveness of HPV testing in primary cervical screening was assessed in the ARTISTIC trial , which was done over two screening rounds approximately 3 years apart ( 2001 - 03 and 2004 - 07 ) by comparing liquid-based cytology ( LBC ) combined with HPV testing against LBC alone . METHODS Women aged 20 - 64 years who were undergoing routine screening as part of the English National Health Service Cervical Screening Programme in Greater Manchester were r and omly assigned ( between July , 2001 , and September , 2003 ) in a ratio of 3:1 to either combined LBC and HPV testing in which the results were revealed and acted on , or to combined LBC and HPV testing where the HPV result was concealed from the patient and investigator . The primary outcome was the detection rate of cervical intraepithelial neoplasia grade 3 or worse ( CIN3 + ) in the second screening round , analysed by intention to treat . This trial is registered with the International St and ard R and omised Controlled Trial Number IS RCT N25417821 . FINDINGS There were 24 510 eligible women at entry ( 18 386 in the revealed group , 6124 in the concealed group ) . In the first round of screening 233 women ( 1.27 % ) in the revealed group had CIN3 + , compared with 80 ( 1.31 % ) women in the concealed group ( odds ratio [ OR ] 0.97 , 95 % CI 0.75 - 1.25 ; p>0.2 ) . There was an unexpectedly large drop in the proportion of women with CIN3 + between the first and second rounds of screening in both groups , at 0.25 % ( 29 of 11 676 ) in the revealed group and 0.47 % ( 18 of 3866 women ) in the concealed group ( OR 0.53 , 95 % CI 0.30 - 0.96 ; p=0.042 ) . For both rounds combined , the proportion of women with CIN3 + were 1.51 % ( revealed ) and 1.77 % ( concealed ) ( OR 0.85 , 95 % CI 0.67 - 1.08 ; p>0.2 ) . INTERPRETATION LBC combined with HPV testing result ed in a significantly lower detection rate of CIN3 + in the second round of screening compared with LBC screening alone , but the effect was small . Over the two screening rounds combined , co-testing did not detect a higher rate of CIN3 + or CIN2 + than LBC alone . Potential changes in screening methodology should be assessed over at least two screening rounds . FUNDING National Institute of Health Research Health Technology Assess 
    Output:
    
As also reported in earlier review s , the meta- analysis by Kleijnen Systematic Review s showed that HPV-based screening offers better protection against invasive cervical cancer compared to cytology-based screening .