Conventional Pap Smear and Liquid-Based Cytology as Screening Tools in Low-Resource Settings in Latin America
| Autor: | Silvio Tatti, Margherita Branca, Mojca Erzen, Adhemar Longatto-Filho, Sophie Françoise Mauricette Derchain, Jean Carlos de Matos, Kari Syrjänen, Luis Otávio Sarian, Paulo Naud, Temístocles P. Lima, Marina Yoshiê Sakamoto Maeda, Luciano Serpa Hammes, Cecilia Roteli-Martins, Renata Clementino Gontijo, Stina Syrjänen |
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| Rok vydání: | 2005 |
| Předmět: |
Gynecology
Colposcopy Cervical cancer medicine.medical_specialty Histology medicine.diagnostic_test business.industry General Medicine Cervical intraepithelial neoplasia medicine.disease Pathology and Forensic Medicine Predictive value of tests Liquid-based cytology medicine Pap test Cervicography business Mass screening |
| Zdroj: | Acta Cytologica. 49:500-506 |
| ISSN: | 1938-2650 0001-5547 |
| DOI: | 10.1159/000326195 |
| Popis: | Objective To evaluate the performance of the conventional Pap test and liquid-based cytology (LBC) in an ongoing multicenter trial testing optional screening tools (cytolosy, screening colposcopy, visual inspection with acetic acid, visual inspection with Lugol's Iodine, cervicography and Hybrid Capture II [HCII] (Digene Brazil, Sno Paulo, Brazil) conventional and self-sampling), for cervical cancer in Brazil and Argentina. Study Design A cohort of 12,107 women attending four clinics (Campinas, Sao Paulo, Porto Alegre, Buenos Aires) were randomized into the 8 diagnostic arms. Women testing positive with any of the tests were referred for colposcopy, and cervical biopsies were used as the gold standard to assess performance characteristics of the diagnostic tests. Conventional Pap smears were sampled by all clinics (n=10,240), and LBC (Autocyte® PREP, [TriPath Imaging, Burlington, North Carolina, U.S.A.], n = 320, and DNA-Citoliq® [Digene Brazil], n=1,346) was performed by 1 of the clinics. Results Conventional Pap smears showed no squamous intraepithelial lesions (normal) in 8,946 (87.4%) and I.BC in 1.373 (82.4%). Using high grade squamous intraepithelial lesions (HSIL) as the cutoff, Pap smears predicted high grade (cervical intraepithelial neoplasia [CIN] 3) with OR 63.0 (95% CI, 36.90-107.70), standard error (SE) 59%. SP 97.8%, positive predictive value (PPV) 68.1% and negative predictive value (NPV) 96.7%. The same figures for Autocyte® PREP were: OR 9.0 (95% CI, 2.43-33.24), sensitivity (SE) 33.3%, specificity (SP) 100%, PPV 100% and negative PV (NPV) 88.8%. DNA-Citoliq® detected CIN 3 as follows: OR 11.8 (95% CI 2.60-53.26), SE 40.0%, SP 94.6%, PPV 40.0% and NPV 94.6%. Lowering the cut-off to low grade squamous intraepithelial lesions increased SE and NPV but compromised SP and PPV. The detection rates for high grade lesions after an atypical squamous cells of undetermined significance diagnosis were similar with the 3 techniques. Conclusion In our settings, the 3 methods of cervical cytology were slightly different in performance. The conventional Pap smear had the highest SE, while.Autocyte® PREP had 100% SP and PPV in detecting CIN 3 with the HSIL cutoff. All 3 tests had lower SE but higher SP as compared to HCII. |
| Databáze: | OpenAIRE |
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