title: Reflex human papillomavirus deoxyribonucleic acid testing in women with abnormal Papanicolaou smears.
abstract: OBJECTIVE
  The study examined interrelationships between sensitivity and specificity of "reflex human papillomavirus deoxyribonucleic acid testing" from liquid-based cervical cytologic specimens by means of receiver operator characteristics curves.
  
  
  METHODS
  A cohort study was performed on 265 women evaluated by colposcopy because of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion found on Papanicolaou smear.
  
  
  RESULTS
  At a positive threshold of 0.2 pg/ml (1000 copies of human papillomavirus per test), human papillomavirus deoxyribonucleic acid testing detected 86% of women with cervical intraepithelial neoplasia and 93% of women with high-grade cervical intraepithelial neoplasia with a specificity of 30%. Decreasing the sensitivity of the human papillomavirus test to 1 pg/ml (5000 copies of human papillomavirus per test) improved the specificity of a positive result to 44% but decreased the clinical sensitivity to 78% for cervical intraepithelial neoplasia grade 2 or 3. Relationships between sensitivity and specificity were influenced by patient age and referral diagnosis. For example, limiting the analysis to only women with a referral for atypical squamous cells of undetermined significance found on Papanicolaou smear and a positive human papillomavirus test threshold of 0.5 pg/ml produced a sensitivity of 90% for cervical intraepithelial neoplasia grade 2 or 3 and a test specificity of 55%.
  
  
  CONCLUSIONS
  Human papillomavirus deoxyribonucleic acid testing of residual cellular material from liquid cytologic specimens appears to be more appropriate for older women (>30 years old) and women with atypical squamous cells of undetermined significance, as opposed to low-grade squamous intraepithelial lesion, on their Papanicolaou smears.
authors.affiliation: Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, New York 10032, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Wright
authors.forename: A
authors.initials: A
authors.lastname: Lorincz
authors.forename: D G
authors.initials: DG
authors.lastname: Ferris
authors.forename: R M
authors.initials: RM
authors.lastname: Richart
authors.forename: A
authors.initials: A
authors.lastname: Ferenczy
authors.forename: I
authors.initials: I
authors.lastname: Mielzynska
authors.forename: L
authors.initials: L
authors.lastname: Borgatta
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology* / Q000821:virology*; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology
chemical_list: D004279:DNA, Viral