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Comparison of Automated Platforms for STI Testing: Continuous Random Access vs. Batch Testing
Max Chernesky, PhD, with a Panther® System customer review by Robyn Thon MT(ASCP)
References: 1. Liverani CA, et al. Am J Transl Res 2012; 4(4): 452-457 2. References available at www.gen-probe.com/products-services/aptima-hpv-assays 3. Aptima® HPV assay package insert # 503789 Rev A 2013 Table 22.
ADS-00948 ©2014 Hologic, Inc. All rights reserved. Hologic, Aptima, Panther, ThinPrep and associated logos are
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Brought to you by Hologic, a leader in women’s health.
Aptima® HPV Assay | ThinPrep® Pap Test | Aptima Combo 2® AssayAptima® Trichomonas vaginalis Assay | Panther® System
CERVICAL CANCER SCREENING
Cervical cancer screening has evolvedThe Aptima® HPV assay is now available on the Panther® system. The Aptima® HPV assay detects HPV mRNA. Studies show HPV mRNA is indicative of infections that may lead to disease.1
With the Panther® system, labs of all sizes can leverage the power of a highly fl exible, fully automated test platform, along with the most comprehensive women’s health menu. In addition to HPV, laboratories can obtain results for CT/GC and Trichomonas vaginalis, all from a 1-ml ThinPrep® Pap test sample.
When using the Aptima HPV assay, you will benefi t from:
• Excellent sensitivity — Demonstrating similar sensitivity to DNA-based HPV tests in multiple clinicalstudies involving approximately 45,000 women worldwide.2
• Improved specifi city — Reducing false-positives by 24% in the clinical trial.3
• Workfl ow freedom and total control — Expanding the women’s health menu on a fully automated platform.
Interested in learning more about the Aptima HPV assay and the Panther system? Contact us.
Aptima_HPV_Lab_Ad ADS-00948 10.875 x 15 4183r4.indd 1 2/5/14 3:39 PM
Comparison of Automated Platforms for STI Testing: Continuous Random Access ���
vs. Batch Testing
Max Chernesky
St. Joseph’s Healthcare/McMaster University, Hamilton, ON
Making an Informed Decision
Cost per Test
Equipment Cost
Hands on Time
Consumable Cost Labor Cost
Space Requirements
Time to Result Return Visits
.
Maintenance
Test Capacity
3
Making an Informed Decision ���Workflow studies give quantifiable and objective metrics
Workflow Studies
Hands on Time
Time to Result
Maintenance
Time
Test Capacity
Return Visits
4
Automated and Semi Automated Instruments
Batching
m2000 Abbott
Viper XTR Becton Dickinson
cobas 4800 Roche
Tigris Hologic|Gen-Probe
Continuous Random Access Panther Hologic|Gen-Probe
m2000 (Abbott) • Batching • Separate units for specimen extraction (m2000sp) and detection (m2000rt)
• 93 specimens per run with return visits
6
Viper XTR (BD) • Batching • Single unit for specimen extraction and detection • Max 92 specimens processed per batch without a return visit
7
cobas 4800 (Roche) • Batching • Separate units for specimen extraction (x480) and detection (z480)
• 94 specimens per batch
8
9
Tigris (Hologic) • Batching • Single unit for specimen extraction and detection
• Max 176 (9 racks x 20) specimens processed per batch
• Non-batch random access • Single unit for specimen extraction and detection
• Max 118 (8 racks x 15) specimens initially with continuous feed 10
Panther (Hologic)
Methods
• 2 investigators travelled to each testing site for a 96-test run
• Second visit timed 192 tests • Both vaginal and urine samples were tested
for C. trachomatis
11
Study Parameters (96 and 192 tests) 1. Total Hands-on Time���
Total time required for manual interaction including daily maintenance
2. Return Visits��� Number of times operator is required to return to the instrument
3. Time to Result��� Time from start-up to first and final result
4. Maintenance��� Cumulative hands-on time required for daily, weekly, and monthly maintenance based on 20 testing days
12
Hands-on Time
1. Pre-analytical Interactions 2. Reagent Preparation and Loading 3. Sample Preparation and Loading 4. In-Process Interactions (Return Visits) 5. Post-analytical Interactions 6. Daily Maintenance
13
Normalization • Some instruments are designed to process
more than 96 or 192 tests • e.g. pre-analytical waste management in Tigris
took 7 min 12 sec for every 1000 tests������normalized time for 96 tests
• = 7 min 12 sec x 96��� 1000���= 41.5 sec
14
1:00 0:58
2:09
Δ71
m2000
1:41
2:17
Δ37
Viper XTR
Δ58
0:40
1:38
cobas 4800
0:28
Δ6
0:34
Tigris
0:21
Δ12
0:33
Panther 0:00
0:30
1:30
2:00
2:30
Total Hands-on Time for 96 and 192 tests (h
:mm
)
15
4:55
5:58
Tigris
2:00
4:00
6:00
8:00
5:27
7:01
10:00
6:11
9:57
m2000
3:31
5:08
Viper XTR
4:23
6:08
cobas 4800
Panther 0:00
(h:m
m)
Time to Results for 96 and 192 Tests
Time to First Results
Results Results Results Results Results
Results Results Results Results Results Results Results Results Results Results
16
Cumulative Hands-on Time for Maintenance Based on 96 Tests Per Day, 20 Days Per Month
2:30
5:00
7:30
10:00
12:30
15:00
17:30
20:00
22:30
m2000 Viper XTR cobas 4800 Tigris Panther 0:00
Daily maintenance Weekly maintenance
Monthly maintenance
17
(h:m
m)
575 Women (SCVS)
FVU cobas 4800 Aptima
RealTime Qx
* * * * *
*spiked with C. trachomatis
X 4 assays
18
Objectives
• Determine the analytical sensitivity of each assay for detection of C. trachomatis in vaginal swab samples and urine
• Test each sample with a CT spike to detect inhibitors
• Calculate sensitivities and specificities based on a Patient Infected Status (PIS)
19
Determination of Analytical Sensitivity
AC2 CT/GC
CT/NG RT m2000
CT/GC ProbeTec Qx
cobas 4800 CT/NG
Dilution of CT SCVS FVU SCVS FVU SCVS FVU SCVS FVU
10-5 10/10 10/10 10/10 10/10 10/10 10/10 10/10 10/10
10-6 10/10 10/10 4/10 6/10 10/10 4/10 4/10 10/10
10-7 10/10 10/10 0/10 0/10 2/10 0/10 0/10 6/10
10-8 6/10 4/10 0/10 0/10 0/10 0/10 0/10 0/10
10-9 0/10 0/10 0/10 0/10 0/10 0/10 0/10 0/10
Probit LOD50 -8.1 -7.9 -5.9 -6.1 -6.7 -5.9 -5.9 -7.1
% Inhibitors 0.3 0.5 0.0 0.0 4.5 2.3 0.0 0.0
20
575 patients 54 PIS +ve 53 VS + 48 FVU +
Patient Infected Status (PIS) = positive in at least 2 assays
21
Comparison of Sensitivity and Specificity ���of SCVS for C. trachomatis
22
Sensitivity and Specificity for C. trachomatis FVU Excluding 4 Urine-Negative Women (%)
47/49 44/46 40/48 40/49 43/49
23
• AC2 on Panther or Tigris identified more Chlamydia infections than the other assays
• Vaginal swabs were superior to urine • Panther and Tigris had substantially less hands-on time
for 96 and 192 tests • All platforms produced 192 test results in a normal
workday except for m2000, which were generated into the next work shift
• Viper had the shortest time to results (96/192 tests), but highest daily maintenance
• The “non-batching” Panther allowed continuous access to reagents and samples with greater workflow efficiency
24
We did it: One Laboratory’s Experience
Robyn Thon, M.S. , M(ASCP) Columbia St. Mary’s – Milwaukee Hospital Laboratory
Decision ! Can we implement molecular testing
at Columbia St. Mary’s?
Key Issues ! Space? ! Who? ! What? ! How? ! Price/Savings? ! Training?
Space ! Did we have the facilities at our
disposal to even consider molecular testing?
! In the past, the recommendation was to have two separate rooms or areas available for work flow and cleanliness.
! Did we have the space? ! With the Panther, there is no need for
separate work areas.
Sample handling DNA preparation
Clean room Stock solutions
Laboratory Mixing site
Thermocycler Amplification
Detection Documentation
Molecular Laboratory of the PAST!
Who? ! Who would be involved in doing the
testing? ! Did they have the level of expertise
necessary or could they learn? ! Where does this testing fit the best? ! Could it be done without adding
FTE’s?
What? ! What testing did we want to perform? ! Were there any that were high
volume? ! Were there multiple tests on the same
platform? ! Did any cross disciplines?
Current GC/Chlam Diagnostic Tests: ! Non-amplified ! Hologic/Gen-Probe Aptima (TMA) ! Qiagen Hybrid Capture 2 ! Roche Cobas 4800 (PCR) ! B-D ProbeTec Qx (SDA) ! Culture ! Antigen Detection Tests: EIA, DFA
How?
How (cont.) ! We determined it would be best to
invite three vendors in for presentations.
◦ quality (sensitivity/specificity) ◦ functional ease ◦ collection devices
How (cont.) ! Each of the three vendors presented
an equally good product ◦ So we had to determine, which one we
liked best. ◦ We involved the techs in the selection
process. ◦ We went on site visits.
Price? ! We worked with each of the vendors to
get their lowest price. ! Performing in house vs. send out
testing ◦ Approx cost $20/test in house vs. $40/test
to send out. ◦ Based on volume this would approximate
a $80,000/year savings.
We chose the Panther
Training? ! We determined that we would train all
staff. ◦ Both first and second shift ◦ Proficiency/Competency ◦ Scheduling
Success? ! Test volume has increased generating
greater savings. ! We have continued to bring in more
testing. ! With our success, we felt comfortable
bringing in additional platforms. ! Staff satisfaction with more testing
knowledge.
Questions/Comments? ! Robyn Thon ◦ [email protected] ◦ 414.291.1412