title: Cross-sectional study of patient- and physician-collected cervical cytology and human papillomavirus.
abstract: OBJECTIVE
  To compare the performance of patient- and physician-obtained cytology and human papillomavirus (HPV) testing for the detection of high-grade cervical intraepithelial neoplasia.
  
  
  METHODS
  A cross-sectional study was performed involving 334 women seen at three colposcopy clinics (Tucson, Arizona; Hermosillo, Mexico; and Lima, Peru). All women used a cytobrush to self-collect specimens for cervical cytology and HPV testing. Subjects subsequently underwent physician collection for cytology and HPV, followed by a complete colposcopic evaluation with directed biopsy. Cytology was processed using thin-layer technology, and HPV was determined using the polymerase chain reaction technique. Test performance characteristics were determined using the histopathologic diagnosis as the reference standard and designating high-grade cervical intraepithelial neoplasia as clinically significant disease for the purpose of the analysis.
  
  
  RESULTS
  The sensitivity of patient-collected cytology was significantly lower (55.0%) and specificity was significantly better (84.1%) than those of physician-directed sampling (85.2% and 73.4%, respectively). Patient-collected HPV had significantly lower sensitivity (49.0%) than physician sampling (82.2%), although specificity did not significantly differ.
  
  
  CONCLUSIONS
  Patient collection is a feasible although inferior alternative to physician-collected cervical cytology and HPV testing.
authors.affiliation: Department of Obstetrics & Gynecology, Arizona Cancer Center, Tucson, Arizona, USA. fcisco@u.arizona.edu
authors.forename: Francisco
authors.initials: F
authors.lastname: Garcia
authors.forename: Bel
authors.initials: B
authors.lastname: Barker
authors.forename: Carlos
authors.initials: C
authors.lastname: Santos
authors.forename: Elena Mendez
authors.initials: EM
authors.lastname: Brown
authors.forename: Thomas
authors.initials: T
authors.lastname: Nuño
authors.forename: Anna
authors.initials: A
authors.lastname: Giuliano
authors.forename: John
authors.initials: J
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods*; D002578:Uterine Cervical Dysplasia / Q000473:pathology*