Detection of high-grade cervical dysplasia: impact of age and Bethesda system terminology.
Pap smear, colposcopy, and biopsy results were collected from 1988-1993 at a group of family planning clinics. Positive predictive values and likelihood ratios were calculated for diagnosis of high-grade lesions based on age and Pap smear results. One thousand and forty-seven colposcopies were logged; 771 had a biopsy or endocervical curettage. Seventy-nine (10%) were high-grade lesions. If only human papillomavirus (HPV) was reported on the Pap smear, the likelihood of a high-grade biopsy was lowest (positive predictive value, 4.5%; likelihood ratio, 0.4). Women under age 25 were less likely to have high-grade biopsies (positive predictive value, 7.3%; likelihood ratio 0.7). Repeat Pap smears for atypical cells of undetermined significance (ASCUS) and low grade squamous intra-epithelial lesion (LGSIL) showing only HPV in women under age 30 would have reduced the immediate colposcopy rate by 60% and delayed diagnosis by 23% of high-grade lesions. Consideration of patient age and whether HPV is the only Pap smear finding may reduce referral for immediate colposcopy.
Melnikow
J
J
Department of Family and Community Medicine, University of California, Davis 95817, USA. jamelnikow@ucdavis.edu
Nuovo
J
J
Paliescheskey
M
M
Stewart
G K
GK
Howell
L
L
Green
W
W
D000328:Adult; D000367:Age Factors; D001706:Biopsy; D003127:Colposcopy / Q000379:methods; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000209:etiology; D002578:Uterine Cervical Dysplasia / Q000145:classification / Q000175:diagnosis* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears