Cross-sectional study of patient- and physician-collected cervical cytology and human papillomavirus.
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.
Garcia
Francisco
F
Department of Obstetrics & Gynecology, Arizona Cancer Center, Tucson, Arizona, USA. fcisco@u.arizona.edu
Barker
Bel
B
Santos
Carlos
C
Brown
Elena Mendez
EM
Nuño
Thomas
T
Giuliano
Anna
A
Davis
John
J
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*