title: Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening.
abstract: OBJECTIVE
  To compare the sensitivity, specificity, and interobserver reliability of conventional cervical smear tests, monolayer cytology, and human papillomavirus testing for screening for cervical cancer.
  
  
  METHODS
  Cross sectional study in which the three techniques were performed simultaneously with a reference standard (colposcopy and histology).
  
  
  METHODS
  Public university and private practices in France, with complete independence from the suppliers.
  
  
  METHODS
  828 women referred for colposcopy because of previously detected cytological abnormalities and 1757 women attending for routine smears.
  
  
  METHODS
  Clinical readings and optimised interpretation (two blind readings followed, if necessary, by consensus). Sensitivity, specificity, and weighted kappa computed for various thresholds of abnormalities.
  
  
  RESULTS
  Conventional cervical smear tests were more often satisfactory (91% v 87%) according to the Bethesda system, more reliable (weighted kappa 0.70 v 0.57), and had consistently better sensitivity and specificity than monolayer cytology. These findings applied to clinical readings and optimised interpretations, low and high grade lesions, and populations with low and high incidence of abnormalities. Human papillomavirus testing associated with monolayer cytology, whether systematic or for atypical cells of undetermined significance, performed no better than conventional smear tests.
  
  
  CONCLUSIONS
  Monolayer cytology is less reliable and more likely to give false positive and false negative results than conventional cervical smear tests for screening for cervical cancer.
authors.affiliation: Département de Biostatistique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Cochin-Port Royal, Université Paris V, Paris, France. coste@cochin.univ-paris5.fr
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Béatrix
authors.initials: B
authors.lastname: Cochand-Priollet
authors.forename: Patricia
authors.initials: P
authors.lastname: de Cremoux
authors.forename: Catherine
authors.initials: C
authors.lastname: Le Galès
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cartier
authors.forename: Vincent
authors.initials: V
authors.lastname: Molinié
authors.forename: Sylvain
authors.initials: S
authors.lastname: Labbé
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Vacher-Lavenu
authors.forename: Philippe
authors.initials: P
authors.lastname: Vielh
mesh_terms: D003127:Colposcopy; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis / Q000379:methods / Q000592:standards; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D015588:Observer Variation; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears / Q000379:methods* / Q000592:standards; D002578:Uterine Cervical Dysplasia / Q000517:prevention & control* / Q000821:virology
chemical_list: D004279:DNA, Viral