GEOGRAPHIC CYTOLOGY Whole, Turret and Step Methods of Rapid Rescreening: Is There Any Difference in Performance? Eliana Borin Lopes Montemor, B.Sc., 1 * Cecilia M. Roteli-Martins, M.D., Ph.D., 1 Luiz Carlos Zeferino, M.D., Ph.D., 1 Rita Goreti Amaral, Ph.D., P.M.I.A.C., 1 Gislaine Aparecida Fonsechi-Carvasan, B.Sc., 1 Neuza Kasumi Shirata, M.Sc., 2 Maria Lu ´ cia Utagawa, B.Sc., 2 Adhemar Longatto-Filho, M.Sc., Ph.D., P.M.I.A.C., 2,3 and Kari J. Syrjanen, M.D., Ph.D., F.I.A.C. 4 We compared the performance of the Whole, Turret and Step techniques of 100% rapid rescreening (RR) in detection of false- negatives in cervical cytology. We tested RR performance with cytologists trained and among those without training. We revised 1,000 consecutive slides from women participating in an ongoing international screening trial. Two teams of experienced cytologists performed the RR techniques: one trained in RR pro- cedures and the other not trained. The sensitivities in the trained group were Whole 46.6%, Turret 47.4% and Step 50.9%; and in the non-trained group were 38.6, 31.6 and 47.4%, respectively. The j coefficient showed a weak agreement between the two groups of cytologists and between the three RR techniques. The RR techniques are more valuable if used by trained cytologists. In the trained group, we did not observe significant differences between the RR techniques used, whereas in the non-trained group, the Step technique had the best sensitivity. Diagn. Cyto- pathol. 2007;35:57–60. ' 2006 Wiley-Liss, Inc. Key Words: rapid rescreening; Whole; Turret; Step; cervical cytology Well-conducted programs for cervical cancer prevention based on cytology screening are successful in many coun- tries, with markedly decreased incidence and mortality rates. 1–3 Despite the Papanicolaou test (Pap test) triumph as an inexpensive and efficient method, high false-nega- tive rates have hampered its performances worldwide. 4,5 Cytological screening is a complex repetitive and monotonous activity that depends on special skill of the professionals involved in the screening, including good concentration and posture, to support sometimes an exces- sive and stressing workload. 6 It is not surprising that errors can occur when a human being is subjected to an extreme pressure. Consequently, false-negative rates can increase. 7,8 During the past years, several measures have been introduced to control the quality of the cytologists, including internal and external quality assurance (QA), and automated pre-and post-screening; the last mentioned is likely to be too costly for most countries. The rapid rescreening (RR) was introduced in 1991 by Baker e Melcher, 7 using ‘‘Turret pattern’’ to rapidly screen the routine slides. The method proved successful in picking up abnormal cervical smears. Subsequently, other optional RR techniques have been introduced. The Step technique and random paths have been used, and some laboratories have attempted to rescreen the whole slide quickly. 9 Faraker introduced the Step technique in 1993, 10 and he was able to identify 92% of the dyskaryotic smears seeded into a series of 500 cases. The advantage of the Step and Turret methods is that the cytologist is screening at regular speed and thus likely to detect the abnormal cells in the path. The strength of the Whole slide screening is that all or most of the mate- rial is covered, although obviously at fairly high speed. 11 Dudding and colleagues 9 obtained their best results using Step, whereas others reported that Turret was superior in identifying cellular abnormalities missed in the primary screening. 11 1 Department of Gynecology, UNICAMP, Campinas, Brazil 2 Division of Pathology, Adolfo Lutz Institute, Sa ˜o Paulo, Brazil 3 Life and Health Sciences Research Institute, School of Health Scien- ces, University of Minho, Braga, Portugal 4 Department of Oncology and Radiotherapy, Turku University Hospi- tal, Turku, Finland *Correspondence to: Eliana Borin Lopes Montemor, R Timbo ´, 38- Alphaville, 13098-348, Campinas, SP, Brazil. E-mail: montemor@lexxa.com.br Received 12 April 2005; Accepted 4 August 2005 DOI 10.1002/dc.20405 Published online in Wiley InterScience (www.interscience.wiley.com). ' 2006 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 35, No 1 57