title: Prediction of cervical intraepithelial neoplasia grade 2-3 using risk assessment and human papillomavirus testing in women with atypia on papanicolaou smears.
abstract: OBJECTIVE
  To determine whether human papillomavirus (HPV) DNA testing and risk assessment can predict cervical intraepithelial neoplasia (CIN) 2-3 on biopsies in women with atypia on Papanicolaou smears.
  
  
  METHODS
  One hundred ninety-five consenting women were referred for colposcopy because of atypia on Papanicolaou smears between September 1997 and April 1999. Before colposcopy, women completed risk assessments and had cervical swabs collected for HPV testing using the Hybrid Capture-II assay (Digene Corporation, Silver Spring, MD). Associations of demographic and clinical variables were assessed by chi(2) analysis, and logistic regression was used to assess factors associated with CIN 2-3. The cost-effectiveness of routine colposcopy versus reflex HPV testing by either conventional or liquid-based Papanicolaou smear media was compared.
  
  
  RESULTS
  Cervical intraepithelial neoplasia was diagnosed in 70 of 195 women (35.9%), 55 (28.2%) with CIN 1 and 15 (7.7%) with CIN 2-3. High-risk HPV types were detected in 31.3% of all subjects, 36.4% of those with CIN 1, and 93.3% of those with CIN 2-3. By logistic regression, CIN 2-3 was associated only with detection of high-risk HPV (odds ratio 110.08, 95% confidence interval 8.35, 999. 00). The sensitivity of high-risk HPV for detecting CIN 2-3 was 93. 3%, specificity 73.9%, positive predictive value 23.0%, and negative predictive value 99.3%. The cost of reflex HPV testing using conventional smear or liquid-based media was less than routine colposcopy ($4809 and $4308, respectively, versus $4875 per case detected).
  
  
  CONCLUSIONS
  Triage based on HPV testing would result in referral of approximately 31% of patients to colposcopy and appears to be a sensitive and cost-effective alternative to colposcopy.
authors.affiliation: Departments of Public Health, Denver Health and Hospital Authority, Colorado 80204-4507, USA. jshlay@dhha.org
authors.forename: J C
authors.initials: JC
authors.lastname: Shlay
authors.forename: T
authors.initials: T
authors.lastname: Dunn
authors.forename: T
authors.initials: T
authors.lastname: Byers
authors.forename: A E
authors.initials: AE
authors.lastname: Barón
authors.forename: J M
authors.initials: JM
authors.lastname: Douglas
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D014412:Tumor Virus Infections / Q000473:pathology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears / Q000191:economics