Sensitivity and workload for manual and automated gynecologic screening: best current estimates

Sensitivity for screening gynecologic cytology appears to be correlated with workload, but data in the literature is limited. We gathered all known published data that included independently estimated measures of sensitivity and workload, for manual and automated screening, including individual cytotechnologist (CT) and laboratory data. We then attempted to synthesize the best estimates of sensitivity with workload volume. While this interpretation is limited by the scarcity of collected data and the few assumptions needed to combine the data, our results suggest that manual and automated screening correlate differently with workload. Manual screening was directly related to total workload volume, appeared to reach near 100% sensitivity for some individual CTs at workloads of ∼30 slides/day, and decreased to below 80% sensitivity at ∼70 slides /day. Most CTs performed at a higher sensitivity than the laboratory averages, but a small subset of CTs had significantly lower sensitivities with similar workload volumes. Sensitivity of automated screening, on the other hand, was more closely correlated with epithelial cell abnormality (ECA)-adjusted workload (ECA × total slides/day). While these results are preliminary and additional studies are warranted to confirm them, our results may be useful in monitoring workload limits in gynecologic cytology. Diagn. Cytopathol. 2010. © 2010 Wiley-Liss, Inc.