| HPV DNA testing for the detection of high grade cervical lesions was more sensitive than cytology alone. In addition, the screening sensitivity can be further improved by combining cytology with HPA DNA testing. |
Citation/s:
Can human papillomavirus DNA testing substitute for cytology in the detection of high grade cervical lesions?
Lead Author's name and fax: Kyung-Ju Lee et al (2004) Arch Pathol Lab Med 128 298-302
Three-part Clinical Question: Is human papillomavirus DNA testing or cytology more effective in the detection of high grade cervical lesions?
Search Terms: human papillomavirus OR HPV OR cytology / cervical lesions OR cervical intraepithelial neoplasma OR CIN / Cochrane and PubMed
The Study Patients: Women aged 14 - 88 years (average age 41.7) who were referred for abnormal cytology.
Independent, blind comparison with a reference (gold) standard. There was an appropriate spectrum of patients. The gold standard was applied regardless of the test result.
Target disorder and Gold Standard: CIN/ cytology
Diagnostic test: Human papillomavirus DNA testing
The Evidence:
| Target Disorder: CIN | |||||
|---|---|---|---|---|---|
| Test: HPV DNA | Present | Absent | |||
| Test Result | Num | Prop | Num | Prop | LR (95% CI) |
| - | 0 | 0.00 | 0 | 0.00 | |
| Positive | 183 | 0.92 | 188 | 0.48 | 1.94 (1.74 to 2.17) |
| Negative | 15 | 0.08 | 207 | 0.52 | 0.14 (0.09 to 0.24) |
| Totals: | 198 | 395 | |||
| Prevalence: 33% | (30% to 37%) | ||||
| Pre-test Odds: 0.50 | |||||
| Target Disorder: CIN | |||||
|---|---|---|---|---|---|
| Test: Cytology testing | Present | Absent | |||
| Test Result | Num | Prop | Num | Prop | LR (95% CI) |
| - | 0 | 0.00 | 0 | 0.00 | |
| Positive | 151 | 0.76 | 135 | 0.34 | 2.23 (1.91 to 2.61) |
| Negative | 47 | 0.24 | 260 | 0.66 | 0.36 (0.28 to 0.47) |
| Totals: | 198 | 395 | |||
| Prevalence: 33% | (30% to 37%) | ||||
| Pre-test Odds: 0.50 | |||||
| Target Disorder: | |||||
|---|---|---|---|---|---|
| Test: | Present | Absent | |||
| Test Result | Num | Prop | Num | Prop | LR (95% CI) |
| 0 | 0.00 | 0 | 0.00 | ||
| 0 | 0.76 | 0 | 0.34 | 2.23 (1.91 to 2.61) | |
| 0 | 0.24 | 0 | 0.66 | 0.36 (0.28 to 0.47) | |
| 0 | 0.00 | 0 | 0.00 | ||
| 0 | 0.00 | 0 | 0.00 | ||
| Totals: | 0 | 0 | |||
| Prevalence: 33% | (30% to 37%) | ||||
| Pre-test Odds: 0.50 | |||||
Comments:
Both testing procedures were administered to the population, who were referred for abnormal cytology. After histologic confirmation by either colposcopically directed biopsy or endocervical curettage, the efficiency of the diagnostic measures was evaluated (hospital pathologists inspected the samples blindly).
Appraised by: Dr Ghazal,
Birmingham Women's Hospital. 28 April 2008
Disclaimer: BWH
CATs are typically based on single studies, and therefore do not represent the
entire body of evidence on a given subject, and should not be taken as
substitutes for advice from a responsible healthcare provider.
Update by: May 2010