A comparison of the human papillomavirus test and Papanicolaou smear as a second screening method for women with minor cytological abnormalities

Authors: Andersson, Sonia1; Dillner, Lena2; Elfgren, Kristina1; Mints, Miriam1; Persson, Maria3; Rylander, Eva3

Source: Acta Obstetricia et Gynecologica Scandinavica, Volume 84, Number 10, October 2005 , pp. 996-1000(5)

Publisher: Informa Healthcare

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Of the estimated one million Papanicolaou (pap) smears performed annually in Sweden, about 4% show any degree of abnormality. Approximately, 1% of these cases contain moderate or severe atypia (high-grade squamous intraepithelial lesions) and the rest contain low-grade atypia. Recommendations for the management of minor abnormalities vary in various parts of Sweden. Generally, a second Pap smear is obtained 4–6 months after the first one showing low-grade atypia. The aim of this study is to compare the sensitivity of human papilloma virus (HPV)-DNA testing for the detection of cervical intraepithelial neoplasia (CIN) 2–3 with that of a second Pap smear in women, who had low-grade atypia in their first Pap smear. Methods. 

Women with low-grade atypia in the Stockholm area, detected at a population-based cytology screening, were enrolled. A repeat Pap smear, HPV test, and colposcopically directed biopsies were obtained. For the detection of HPV, Hybrid Capture II (HC II) was used. Results. 

The HPV-DNA test was positive in 66% of the 177 participating women. The sensitivity of the second Pap smear and HPV-DNA test to detect CIN 2–3 was 61 (95% CI = 45–74) and 82% (95% CI = 67–91), respectively. The positive and negative predictive values of HPV testing were 27 (95% CI = 18–35) and 89% (95% CI = 80–97), respectively. Conclusions. 

In Sweden, a second Pap smear is often obtained for the follow-up of women with low-grade atypia. The results of our study show that compared to the second Pap smear, HPV testing with HC II is a more sensitive method for detecting high-grade lesions.

Keywords: CIN; HPV; Pap smear; screening

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.0001-6349.2005.00702.x

Affiliations: 1: Division of Obstetrics and Gynecology, Institute for Clinical Science, Karolinska University Hospital, Huddinge, Karolinska Institute, Stockholm, 2: Department of Medical Microbiology, Lund University, University Hospital Malmö, and 3: Division of Obstetrics and Gynecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

Publication date: October 1, 2005

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