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Lauri E Markowitz - One of the best experts on this subject based on the ideXlab platform.

  • Use of home-obtained vaginal swabs to facilitate Rescreening for Chlamydia trachomatis infections: two randomized controlled trials.
    Obstetrics & Gynecology, 2011
    Co-Authors: Bradley P Stoner, Stephanie N Taylor, Leandro Mena, Lin H Tian, Kathleen Hutchins, David H Martin, John R. Papp, Lauri E Markowitz
    Abstract:

    OBJECTIVE:To determine whether the use of home-based, self-obtained vaginal swabs among women who were treated for Chlamydia infection can increase Rescreening rates in comparison with clinic-based Rescreening, and to identify subgroups in which Rescreening could be enhanced using self-obtained vagi

  • O3-S3.06 Rescreening for chlamydial infection using home-based, self-obtained vaginal swabs: a randomised controlled trial in family planning clinic clients
    Sexually Transmitted Infections, 2011
    Co-Authors: Bradley P Stoner, Stephanie N Taylor, Leandro Mena, Kathleen Hutchins, David H Martin, L Tian, John R. Papp, Lauri E Markowitz
    Abstract:

    Background Family planning clinics provide contraceptive and preventive services for millions of low-income individuals. Screening and treatment for Chlamydia trachomatis infection in these clinics is a major part of the chlamydia control program in the USA. For women diagnosed with chlamydia, Rescreening 3 months after treatment is recommended according to national guidelines. However, Rescreening rates are low. The time and effort needed for patients to return to the clinic and the lack of access to follow-up care may contribute to the poor adherence to the Rescreening recommendation. Methods We conducted a randomised controlled trial in family planning clinics in three cities. After informed consent, women/girls >16 years treated for laboratory-confirmed chlamydial infection were randomly assigned to the Home Group (mailed a vaginal swab kit for self collection at home) or the Clinic Group (made a clinic appointment) for Rescreening at 3 months following treatment. Reminder calls were made about 2 weeks before scheduled Rescreening. The endpoint was Rescreening within a 7 week window, 1 week before to 6 weeks after, the scheduled Rescreening date. Results 404 women were enrolled and their group assignments were randomised by opening centrally stuffed envelops. Women assigned to the Home Group had higher Rescreening rate than those in the Clinic Group: Overall, 40.8% of 196 in the Home Group and 20.7% of 208 in the Clinic Group were rescreened (p Conclusions Use of home-based, self-obtained vaginal swabs resulted in a significant increase in Rescreening rates compared to Rescreening in the clinic. Our findings indicate a role for home-based specimen collection as an alternative to clinic-based Rescreening for chlamydia in women.

  • Use of home-obtained vaginal swabs to facilitate Rescreening for Chlamydia trachomatis infections: two randomized controlled trials.
    Obstetrics and gynecology, 2011
    Co-Authors: Bradley P Stoner, Stephanie N Taylor, Leandro Mena, Lin H Tian, John Papp, Kathleen Hutchins, David H Martin, Lauri E Markowitz
    Abstract:

    To determine whether the use of home-based, self-obtained vaginal swabs among women who were treated for Chlamydia infection can increase Rescreening rates in comparison with clinic-based Rescreening, and to identify subgroups in which Rescreening could be enhanced using self-obtained vaginal swabs. Two randomized trials were conducted: one with enrollment in sexually transmitted disease (STD) clinics and the other in family planning clinics. Study participants were recruited from STD (n = 880) and family planning clinics (n = 412) in three cities. Females aged 16 years or older who were treated for Chlamydia infection were randomly assigned to the home group (swab collection kits mailed to home) or the clinic group (made clinic appointments) for Rescreening at 3 months after treatment, with reminder calls about 2 weeks before the scheduled Rescreening date. Groups were similar with respect to age and other demographic characteristics. Women assigned to the home group had higher Rescreening rates than those in the clinic group. In STD clinics, Rescreening rates were 26.7% (home) compared with 19.1% (clinic) (P = .01). In family planning clinics, Rescreening rates were 40.8% (home) compared with 20.7% (clinic) (P<.001). Among women reached by reminder calls, Rescreening rates were also significantly higher in the home groups: 43.5% compared with 33.0% in STD clinic participants and 59.2% compared with 37.8% in family planning clinic participants (both P<.05). The rates of reinfection ranged from 12.9% to 19.4%, and the differences by group were not statistically significant (P ≥ .3). In STD and family planning clinics, use of home-based, self-obtained vaginal swabs resulted in significant increases in Rescreening rates compared with Rescreening in the clinic. Home-based specimen collection can be an alternative to clinic-based Rescreening for Chlamydia infection in women. Clinicaltrials.gov, www.clinicaltrials.gov, NCT 00132457. I.

Stephen S. Raab - One of the best experts on this subject based on the ideXlab platform.

  • Effectiveness of Rapid PRescreening and 10% Rescreening in Liquid-Based Papanicolaou Testing
    American journal of clinical pathology, 2012
    Co-Authors: Heather S. Currens, Katharine Nejkauf, Lynn Wagner, Stephen S. Raab
    Abstract:

    Although rapid pRescreening (RPS) has been shown to be an effective quality control procedure for detecting false-negative conventional Papanicolaou (Pap) tests, RPS has not been widely implemented in the United States. In our laboratory, cytotechnologists performed RPS in 3,567 liquid-based Pap tests: 1,911 SurePath (BD Diagnostics–TriPath, Burlington, NC) preparations that were manually screened and 1,656 ThinPrep Pap tests (Hologic, Bedford, MA) that were imaged using the ThinPrep Imaging System (Hologic). We compared the sensitivity of RPS, 10% Rescreening (R-10%), and routine screening (RS). In contrast with previously published findings, we found that RS + RPS did not improve screening sensitivity compared with RS + R-10%. These results support the following hypotheses: (1) Higher baseline RS sensitivity as a result of Pap test diagnoses standardization implemented for quality improvement purposes decreases the performance impact of RPS. (2) R-10% and RPS quality assurance methods detect diagnostic failures caused by different types of cognitive errors.

  • effectiveness of rapid pRescreening and 10 Rescreening in liquid based papanicolaou testing
    American Journal of Clinical Pathology, 2012
    Co-Authors: Heather S. Currens, Katharine Nejkauf, Lynn Wagner, Stephen S. Raab
    Abstract:

    Although rapid pRescreening (RPS) has been shown to be an effective quality control procedure for detecting false-negative conventional Papanicolaou (Pap) tests, RPS has not been widely implemented in the United States. In our laboratory, cytotechnologists performed RPS in 3,567 liquid-based Pap tests: 1,911 SurePath (BD Diagnostics–TriPath, Burlington, NC) preparations that were manually screened and 1,656 ThinPrep Pap tests (Hologic, Bedford, MA) that were imaged using the ThinPrep Imaging System (Hologic). We compared the sensitivity of RPS, 10% Rescreening (R-10%), and routine screening (RS). In contrast with previously published findings, we found that RS + RPS did not improve screening sensitivity compared with RS + R-10%. These results support the following hypotheses: (1) Higher baseline RS sensitivity as a result of Pap test diagnoses standardization implemented for quality improvement purposes decreases the performance impact of RPS. (2) R-10% and RPS quality assurance methods detect diagnostic failures caused by different types of cognitive errors.

  • Cost effectiveness of Rescreening cervicovaginal smears.
    American journal of clinical pathology, 1999
    Co-Authors: Stephen S. Raab, N. S. Bishop
    Abstract:

    Although cytology laboratories are mandated to rescreen at least 10% of cervicovaginal smears, there is no uniform national Rescreening practice. Follow-up data for 16,188 rescreened cervicovaginal smears were studied and decision analysis was performed to determine an optimal Rescreening strategy. High-grade dysplasia was detected in 0.40% of women with a history of cervical disease and in 0.04% without a history of cervical disease. Compared with 0% Rescreening of smears, with 15% Rescreening the cost to gain a year of discounted life expectancy was $386,890 for women without a history of cervical disease, and $2,980 for women with a history of cervical disease. We conclude that Rescreening only smears from women with a history of cervical disease could save US laboratories more than $11.2 million annually without seriously compromising care.

  • The cost-effectiveness of cervical-vaginal Rescreening.
    American journal of clinical pathology, 1997
    Co-Authors: Stephen S. Raab
    Abstract:

    Although most laboratories practice 10% manual Rescreening, the cost-effectiveness of this and other Rescreening strategies rarely has been evaluated. Using data obtained from the medical literature, a decision model was created in which Rescreening strategies were compared with nonRescreening strategies for the number of false-negative and false-positive diagnoses, cancers, life expectancy, and cost-effectiveness. The strategy of 10% Rescreening with a repeated cervical-vaginal smear yielded almost no gain in life expectancy compared with an equivalent strategy with no Rescreening. With 100% Rescreening, the gain in life expectancy was only 0.24 days per patient. A 100% Rescreening strategy generally was more cost-effective than a no-Rescreening strategy at costs of Rescreening varying from $2 to $10 per patient. A 10% Rescreening strategy has limited utility. In addition, 100% Rescreening strategies are more cost-effective than nonRescreening strategies, but only if the Rescreening cost is low.

Johannes Bogers - One of the best experts on this subject based on the ideXlab platform.

  • quality control for normal liquid based cytology Rescreening high risk hpv targeted reviewing and or high risk hpv detection
    Journal of Cellular and Molecular Medicine, 2009
    Co-Authors: Christophe E. Depuydt, Marc Arbyn, Ina Benoy, Johan Vandepitte, Annie J. Vereecken, Johannes Bogers
    Abstract:

    The objective of this prospective study was to compare the number of CIN2+cases detected in negative cytology by different quality control (QC) methods. Full Rescreening, high-risk (HR) human papillomavirus (HPV)-targeted reviewing and HR HPV detection were compared. Randomly selected negative cytology detected by BD FocalPoint™ (NFR), by guided screening of the prescreened which needed further review (GS) and by manual screening (MS) was used. A 3-year follow-up period was available. Full Rescreening of cytology only detected 23.5% of CIN2+ cases, whereas the cytological Rescreening of oncogenic positive slides (high-risk HPV-targeted reviewing) detected 7 of 17 CIN2+ cases (41.2%). Quantitative real-time PCR for 15 oncogenic HPV types detected all CIN2+ cases. Relative sensitivity to detect histological CIN2+ was 0.24 for full Rescreening, 0.41 for HR-targeted reviewing and 1.00 for HR HPV detection. In more than half of the reviewed negative cytological preparations associated with histological CIN2+cases no morphologically abnormal cells were detected despite a positive HPV test. The visual cut-off for the detection of abnormal cytology was established at 6.5 HR HPV copies/cell. High-risk HPV detection has a higher yield for detection of CIN2+ cases as compared to manual screening followed by 5% full review, or compared to targeted reviewing of smears positive for oncogenic HPV types, and show diagnostic properties that support its use as a QC procedure in cytologic laboratories.

  • Quality control for normal liquid-based cytology: Rescreening, high-risk HPV targeted reviewing and/or high-risk HPV detection?
    Journal of cellular and molecular medicine, 2008
    Co-Authors: Christophe E. Depuydt, Marc Arbyn, Ina Benoy, Johan Vandepitte, Annie J. Vereecken, Johannes Bogers
    Abstract:

    The objective of this prospective study was to compare the number of CIN2+cases detected in negative cytology by different quality control (QC) methods. Full Rescreening, high-risk (HR) human papillomavirus (HPV)-targeted reviewing and HR HPV detection were compared. Randomly selected negative cytology detected by BD FocalPoint™ (NFR), by guided screening of the prescreened which needed further review (GS) and by manual screening (MS) was used. A 3-year follow-up period was available. Full Rescreening of cytology only detected 23.5% of CIN2+ cases, whereas the cytological Rescreening of oncogenic positive slides (high-risk HPV-targeted reviewing) detected 7 of 17 CIN2+ cases (41.2%). Quantitative real-time PCR for 15 oncogenic HPV types detected all CIN2+ cases. Relative sensitivity to detect histological CIN2+ was 0.24 for full Rescreening, 0.41 for HR-targeted reviewing and 1.00 for HR HPV detection. In more than half of the reviewed negative cytological preparations associated with histological CIN2+cases no morphologically abnormal cells were detected despite a positive HPV test. The visual cut-off for the detection of abnormal cytology was established at 6.5 HR HPV copies/cell. High-risk HPV detection has a higher yield for detection of CIN2+ cases as compared to manual screening followed by 5% full review, or compared to targeted reviewing of smears positive for oncogenic HPV types, and show diagnostic properties that support its use as a QC procedure in cytologic laboratories.

Bradley P Stoner - One of the best experts on this subject based on the ideXlab platform.

  • Use of home-obtained vaginal swabs to facilitate Rescreening for Chlamydia trachomatis infections: two randomized controlled trials.
    Obstetrics & Gynecology, 2011
    Co-Authors: Bradley P Stoner, Stephanie N Taylor, Leandro Mena, Lin H Tian, Kathleen Hutchins, David H Martin, John R. Papp, Lauri E Markowitz
    Abstract:

    OBJECTIVE:To determine whether the use of home-based, self-obtained vaginal swabs among women who were treated for Chlamydia infection can increase Rescreening rates in comparison with clinic-based Rescreening, and to identify subgroups in which Rescreening could be enhanced using self-obtained vagi

  • O3-S3.06 Rescreening for chlamydial infection using home-based, self-obtained vaginal swabs: a randomised controlled trial in family planning clinic clients
    Sexually Transmitted Infections, 2011
    Co-Authors: Bradley P Stoner, Stephanie N Taylor, Leandro Mena, Kathleen Hutchins, David H Martin, L Tian, John R. Papp, Lauri E Markowitz
    Abstract:

    Background Family planning clinics provide contraceptive and preventive services for millions of low-income individuals. Screening and treatment for Chlamydia trachomatis infection in these clinics is a major part of the chlamydia control program in the USA. For women diagnosed with chlamydia, Rescreening 3 months after treatment is recommended according to national guidelines. However, Rescreening rates are low. The time and effort needed for patients to return to the clinic and the lack of access to follow-up care may contribute to the poor adherence to the Rescreening recommendation. Methods We conducted a randomised controlled trial in family planning clinics in three cities. After informed consent, women/girls >16 years treated for laboratory-confirmed chlamydial infection were randomly assigned to the Home Group (mailed a vaginal swab kit for self collection at home) or the Clinic Group (made a clinic appointment) for Rescreening at 3 months following treatment. Reminder calls were made about 2 weeks before scheduled Rescreening. The endpoint was Rescreening within a 7 week window, 1 week before to 6 weeks after, the scheduled Rescreening date. Results 404 women were enrolled and their group assignments were randomised by opening centrally stuffed envelops. Women assigned to the Home Group had higher Rescreening rate than those in the Clinic Group: Overall, 40.8% of 196 in the Home Group and 20.7% of 208 in the Clinic Group were rescreened (p Conclusions Use of home-based, self-obtained vaginal swabs resulted in a significant increase in Rescreening rates compared to Rescreening in the clinic. Our findings indicate a role for home-based specimen collection as an alternative to clinic-based Rescreening for chlamydia in women.

  • Use of home-obtained vaginal swabs to facilitate Rescreening for Chlamydia trachomatis infections: two randomized controlled trials.
    Obstetrics and gynecology, 2011
    Co-Authors: Bradley P Stoner, Stephanie N Taylor, Leandro Mena, Lin H Tian, John Papp, Kathleen Hutchins, David H Martin, Lauri E Markowitz
    Abstract:

    To determine whether the use of home-based, self-obtained vaginal swabs among women who were treated for Chlamydia infection can increase Rescreening rates in comparison with clinic-based Rescreening, and to identify subgroups in which Rescreening could be enhanced using self-obtained vaginal swabs. Two randomized trials were conducted: one with enrollment in sexually transmitted disease (STD) clinics and the other in family planning clinics. Study participants were recruited from STD (n = 880) and family planning clinics (n = 412) in three cities. Females aged 16 years or older who were treated for Chlamydia infection were randomly assigned to the home group (swab collection kits mailed to home) or the clinic group (made clinic appointments) for Rescreening at 3 months after treatment, with reminder calls about 2 weeks before the scheduled Rescreening date. Groups were similar with respect to age and other demographic characteristics. Women assigned to the home group had higher Rescreening rates than those in the clinic group. In STD clinics, Rescreening rates were 26.7% (home) compared with 19.1% (clinic) (P = .01). In family planning clinics, Rescreening rates were 40.8% (home) compared with 20.7% (clinic) (P<.001). Among women reached by reminder calls, Rescreening rates were also significantly higher in the home groups: 43.5% compared with 33.0% in STD clinic participants and 59.2% compared with 37.8% in family planning clinic participants (both P<.05). The rates of reinfection ranged from 12.9% to 19.4%, and the differences by group were not statistically significant (P ≥ .3). In STD and family planning clinics, use of home-based, self-obtained vaginal swabs resulted in significant increases in Rescreening rates compared with Rescreening in the clinic. Home-based specimen collection can be an alternative to clinic-based Rescreening for Chlamydia infection in women. Clinicaltrials.gov, www.clinicaltrials.gov, NCT 00132457. I.

Andrew A Renshaw - One of the best experts on this subject based on the ideXlab platform.

  • the human false negative rate of Rescreening pap tests measured in a two arm prospective clinical trial
    Cancer, 2001
    Co-Authors: Andrew A Renshaw, M Karen B S Lezon, C David M D Wilbur
    Abstract:

    BACKGROUND: Routine quality control Rescreening often is used to calculate the false-negative rate (FNR) of gynecologic cytology. Theoretic analysis suggests that this is not appropriate, due to the high FNR of Rescreening and the inability to actually measure it. The authors sought to determine the FNR of manual Rescreening in a large, prospective, two-arm clinical trial using an analytic instrument in the evaluation. METHODS: The results of the Autopap System Clinical Trial, encompassing 25,124 analyzed slides, were reviewed. The false-negative and false-positive rates at various thresholds were determined for routine primary screening, routine Rescreening, Autopap primary screening, and Autopap Rescreening by using a simple, standard methodology. RESULTS: The FNR of routine manual Rescreening at the level of atypical squamous cells of undetermined significance (ASCUS) was 73%, more than 3 times the FNR of primary screening; 11 cases were detected. The FNR of Autopap Rescreening was 34%; 80 cases were detected. Routine manual Rescreening decreased the laboratory FNR by less than 1%; Autopap Rescreening reduced the overall laboratory FNR by 5.7%. At the same time, the false-positive rate for Autopap screening was significantly less than that of routine manual screening at the ASCUS level (4.7% vs. 5.6%; P < 0.0001). Rescreening with the Autopap system remained more sensitive than manual Rescreening at the low grade squamous intraepithelial lesions threshold (FNR of 58.8% vs. 100%, respectively), although the number of cases rescreened was low. CONCLUSIONS: Routine manual Rescreening cannot be used to calculate the FNR of primary screening. Routine Rescreening is an extremely ineffective method to detect error and thereby decrease a laboratory's FNR. The Autopap system is a much more effective way of detecting errors within a laboratory and reduces the laboratory's FNR by greater than 25%.

  • The human false-negative rate of Rescreening Pap tests. Measured in a two-arm prospective clinical trial.
    Cancer, 2001
    Co-Authors: Andrew A Renshaw, M Karen B S Lezon, David C. Wilbur
    Abstract:

    BACKGROUND Routine quality control Rescreening often is used to calculate the false-negative rate (FNR) of gynecologic cytology. Theoretic analysis suggests that this is not appropriate, due to the high FNR of Rescreening and the inability to actually measure it. The authors sought to determine the FNR of manual Rescreening in a large, prospective, two-arm clinical trial using an analytic instrument in the evaluation. METHODS The results of the Autopap System Clinical Trial, encompassing 25,124 analyzed slides, were reviewed. The false-negative and false-positive rates at various thresholds were determined for routine primary screening, routine Rescreening, Autopap primary screening, and Autopap Rescreening by using a simple, standard methodology. RESULTS The FNR of routine manual Rescreening at the level of atypical squamous cells of undetermined significance (ASCUS) was 73%, more than 3 times the FNR of primary screening; 11 cases were detected. The FNR of Autopap Rescreening was 34%; 80 cases were detected. Routine manual Rescreening decreased the laboratory FNR by less than 1%; Autopap Rescreening reduced the overall laboratory FNR by 5.7%. At the same time, the false-positive rate for Autopap screening was significantly less than that of routine manual screening at the ASCUS level (4.7% vs. 5.6%; P < 0.0001). Rescreening with the Autopap system remained more sensitive than manual Rescreening at the low grade squamous intraepithelial lesions threshold (FNR of 58.8% vs. 100%, respectively), although the number of cases rescreened was low. CONCLUSIONS Routine manual Rescreening cannot be used to calculate the FNR of primary screening. Routine Rescreening is an extremely ineffective method to detect error and thereby decrease a laboratory's FNR. The Autopap system is a much more effective way of detecting errors within a laboratory and reduces the laboratory's FNR by greater than 25%. Cancer (Cancer Cytopathol) 2001;93:106–110. © 2001 American Cancer Society.

  • false negative rate of cervical cytologic smear screening as determined by rapid Rescreening
    Acta Cytologica, 1999
    Co-Authors: Andrew A Renshaw, Sheryl Dinisco, Bronya Bellerose, Larry J. Minter
    Abstract:

    OBJECTIVE: To determine the reliability of the false negative rate (FNR) of cervical cytologic smear screening by rapid Rescreening. STUDY DESIGN: A test set of 401 cases (311 originally diagnosed as negative, 74 as atypical squamous cells of undetermined significance [ASCUS], 14 as low grade squamous intraepithelial lesion [LSIL] and 2 as high grade squamous intraepithelial lesion [HSIL]) were rapidly (30 seconds each) rescreened by five cytotechnologists with no prior experience in rapid Rescreening, and the FNRs of rapid Rescreening and primary screening were determined. These results were compared with each other and with the FNR of primary screening as determined by routine Rescreening of all cases with no time limit. RESULTS: All five observers detected a different group of abnormal cases; only 9% of all cases originally diagnosed as ASCUS or worse and 43% of all cases diagnosed as LSIL or worse were detected by all five observers. Nevertheless, using ASCUS as the threshold for an abnormal result, the FNR of rapid Rescreening fell into a relatively narrow range, 61-74% (mean, 68.2 +/- 5.0); using LSIL as the threshold resulted in FNRs of rapid Rescreening between 25% and 38% (30.0 +/- 4.7). Each observer, using rapid Rescreening, detected between one and three false negative cases; routine Rescreening of all cases without a time limit detected five cases. The FNR of cervical cytologic smear screening, as determined by rapid Rescreening, was 18.4 +/- 6.1% as compared with 14.8% by routine Rescreening without a time limit. CONCLUSION: The FNR of rapid Rescreening is relatively reproducible even though the individual cases identified varied between reviewers. The FNR of rapid Rescreening is similar to that of routine Rescreening. Rapid pRescreening may be the most logistically simple method to determine the true FNR of a laboratory.

  • performance characteristics of rapid 30 second pRescreening implications for calculating the false negative rate and comparison with other quality assurance techniques
    American Journal of Clinical Pathology, 1999
    Co-Authors: Andrew A Renshaw, Larry J. Minter, Janet A Cronin, Dorothy Nappi, Terry Whitman, Michael Jiroutek, Edmund S Cibas
    Abstract:

    : Rapid (30-second) pRescreening of cervicovaginal smears can be used to detect false-negative cases and determine the false-negative rate of primary screening, but the performance characteristics have not been evaluated fully. A test set of 242 cases including 80 originally false-negative cases were rapidly screened by 4 different cytotechnologists on 2 occasions. Intraobserver and interobserver reproducibility were good. Median specificity for each round of observations was 89% (range, 30%-96%). Median sensitivity for all true-positive cases was 78% (range, 63%-97%); for all false-negative cases it was 59% (range, 38%-89%). The relative sensitivity of rapid screening for true-positive and false-negative cases varied with the diagnosis. Rapid screening detected almost the same percentage of false-negative cases of atypical squamous cells of uncertain significance (ASCUS) as true-positive ASCUS cases (median ratio, 1.12; range, 0.72-1.52). The median ratio of false-negative to true-positive ASCUS cases was significantly different than the ratio for low-grade plus high-grade squamous intraepithelial lesions (0.68; range, 0.50-0.96). Although performance varies between individuals, in this test population the reproducibility, specificity, and sensitivity were good. Because it detects more false-negative cases at a lower cost per case than routine Rescreening, rapid pRescreening should be considered as an alternative to current quality control measures.

  • a more accurate measure of the false negative rate of papanicolaou smear screening is obtained by determining the false negative rate of the Rescreening process
    Cancer, 1997
    Co-Authors: Andrew A Renshaw, Sheryl Dinisco, Larry J. Minter, Edmund S Cibas
    Abstract:

    BACKGROUND The false-negative rate (FNR), or fraction, of Papanicolaou (Pap) smear screening has been proposed as a useful quality assessment measure. The FNR should account for the FNR of the Rescreening process itself. The authors measured the FNR of the Rescreening process by Rescreening a set of abnormal smears. METHODS A randomly selected group of negative (150) and abnormal (91) smears were rescreened in a blinded fashion. A diagnosis of atypical squamous cells of undetermined significance (ASCUS) or worse was used as a positive (abnormal) result. All discrepancies were confirmed by consensus review. The true FNR of screening Pap smears was calculated as: True FNR = calculated FNR/(1-FNR of Rescreening)(1) RESULTS When rescreened, 17 originally negative cases were interpreted as ASCUS and 5 as unsatisfactory. Twenty-three originally abnormal cases (22 ASCUS and 1 low grade squamous intraepithelial lesion) were interpreted as negative. After consensus review, only 1 of the originally negative cases was believed to be ASCUS and 1 unsatisfactory; 18 of the 23 originally abnormal cases were believed to be Rescreening errors and 5 of the 23 originally abnormal cases were believed to be false-positives. The FNR of Pap smear screening as traditionally calculated was 6.1%, which was slightly less than the laboratory's usual FNR. The FNR of review screening was 20.9%. The true FNR of Pap smear screening was 7.8% and the false-positive rate was 0.6%. CONCLUSIONS The FNR of Rescreening is not insubstantial. It can and should be measured by Rescreening abnormal smears, and when taken into account yields a more accurate measure of the FNR of Pap smear screening. Cancer (Cancer Cytopathol) 1997; 81:272-6. © 1997 American Cancer Society.