1. AUTHOR	Boronow RC
INSTITUTION	University of Mississippi Medical School, Mississippi Baptist Medical Center, Jackson, USA.
TITLE	Death of the Papanicolaou smear? A tale of three reasons.
SOURCE	Am J Obstet Gynecol  1998 Aug;179(2):391-6
ISSN	0002-9378
ABSTRACT	The Papanicolaou smear is arguably the most cost-effective cancer screening test ever devised. Yet future availability of this low-cost test is seriously threatened by increasing litigation, huge awards, and the implied linkage between "error" and "negligence." The expectation of a 0 error standard, even for a screening test, is central in the current medical-legal climate. Three reasons for this escalating problem will be explored, as follows: (1) substandard laboratories; (2) misunderstanding of the Papanicolaou smear by the media, the public, the legal profession, and physicians, compounded by the "greed factor"; (3) an "acceptable error rate" in quality laboratories for Papanicolaou smear screening. I will explore the future of the Papanicolaou smear and will make specific recommendations for all obstetricians-gynecologists.
2. AUTHOR	Fahey MT; Irwig L; Macaskill P
INSTITUTION	Department of Public Health, University of Sydney, New South Wales, Australia.
TITLE	Meta-analysis of Pap test accuracy [see comments]
SOURCE	Am J Epidemiol  1995 Apr 1;141(7):680-9
ISSN	0002-9262
ABSTRACT	A literature search identified 62 studies published by August 1992 comparing Papanicolaou (Pap) test results with histology. Critical appraisal revealed that 82% of these had potential for verification bias and that only 37% stated that cytology and histology were independently assessed. Estimates of sensitivity and specificity ranged from 11 to 99% and 14 to 97%, respectively, and were highly negatively correlated (r = -0.63). Meta-analysis was used to combine data from 59 studies to estimate the accuracy of the Pap test using a summary receiver operating characteristic curve and to examine the effect of study quality. The summary receiver operating characteristic curve suggests that the Pap test may be unable to achieve concurrently high sensitivity and specificity. For example, specificity in the 90-95% range corresponds to sensitivity in the 20-35% range. Pap test accuracy was not associated with reported study characteristics or dimensions of quality. Future primary studies should pay more attention to methodologic standards for the conduct and reporting of diagnostic test evaluations.

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