Conventional Pap Smear and Liquid-Based Cytology as Screening Tools in Low-Resource Settings in Latin America
Acta Cytologica - ACTA CYTOL 01/2005; 49:500-506. DOI: 10.1159/000326195
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ABSTRACT: We sought to evaluate the performance of diagnostic tools to establish an affordable setting for early detection of cervical cancer in developing countries. We compared the performance of different screening tests and their feasibility in a cohort of over 12,000 women: conventional Pap smear, liquid-based cytology, visual inspection with acetic acid (VIA), visual inspection with Iodine solution (VILI), cervicography, screening colposcopy, and high-risk human papillomavirus (HPV) testing (HR-HPV) collected by physician and by self-sampling. HR-HPV assay collected by the physician has the highest sensitivity (80 %), but high unnecessary referrals to colposcopy (15.1 %). HR-HPV test in self-sampling had a markedly lower (57.1 %) sensitivity. VIA, VILI, and cervicography had a poor sensitivity (47.4, 55, and 28.6 %, respectively). Colposcopy presented with sensitivity of 100 % in detecting CIN2+, but the lowest specificity (66.9 %). Co-testing with VIA and VILI Pap test increased the sensitivity of stand-alone Pap test from 71.6 to 87.1 % and 71.6 to 95 %, respectively, but with high number of unnecessary colposcopies. Co-testing with HR-HPV importantly increased the sensitivity of Pap test (to 86 %), but with high number of unnecessary colposcopies (17.5 %). Molecular tests adjunct to Pap test seems a realistic option to improve the detection of high-grade lesions in population-based screening programs.Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 05/2012; 460(6):577-85. · 2.56 Impact Factor
- Acta Cytologica - ACTA CYTOL. 01/2009; 53:548-557.
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ABSTRACT: The performance of cervical cancer (CC) screening can be improved by combining Pap smear with human papillomavirus (HPV) testing or visual methods, addressing local demographic, clinical and economic characteristics. To examine the performance of standalone and combined screening tools in populations with variable prevalence of cervical intraepithelial neoplasia (CIN) and CC. Merged data-sets from the Latin American Screening Study and New Independent States cohorts provided results for 15,000 women, screened using Pap smear, HPV testing and visual inspection with acetic acid, in Brazil, Argentina, Russia, Belarus and Latvia. Bayesian correction for verification bias was used. At CIN2+ cut-off, HPV detection alone was the most sensitive technique. There was an improvement (88.5% to 92.7%) in Hybrid Capture 2 (HC2) sensitivity among women ≥35 years old. Using HPV detection alone was the least specific screening tool, regardless of the age group (69.9% [95% CI 66.5-72.8%] and 86.4% [95% CI 84.6-88.2%], in < or ≥35 years, respectively). Of the test combinations, Pap smear (LSIL threshold) with HC2 had the highest specificity (98.7%; 95% CI 98.3-99.0%). However, in women ≥35 years, the sensitivity of Pap alone was superior to that of the combination. The Pap test is a highly specific screening option in populations with medium-range CC prevalence. Combined testing for HPV in this scenario may yield slightly better positive predictive values in women ≥35 years of age with LSIL, but at a high incremental cost.Journal of Medical Screening 01/2010; 17(4):195-203. · 2.72 Impact Factor
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