title: Combining human papillomavirus testing or cervicography with cytology to detect cervical neoplasia.
abstract: BACKGROUND
  Cervicography and oncogenic human papillomavirus (HPV) testing have been proposed for improving the accuracy of cervical cancer screening.
  
  
  OBJECTIVE
  To examine whether cervicography and HPV testing can improve beyond chance the detection of cervical intraepithelial neoplasia (CIN) 2 or 3 in women with atypical cells of undetermined significance or low-grade squamous intraepithelial lesions on cytology.
  
  
  METHODS
  Cross-sectional analysis. Oncogenic HPV testing by Hybrid Capture II assay or cervicography combined with cytology was compared with the reference standard of colposcopy with directed biopsy.
  
  
  METHODS
  Community family practices.
  
  
  METHODS
  Three hundred four women with low-grade cytologic abnormality.
  
  
  METHODS
  The gain in accuracy for detecting histologic CIN 2 or 3 or carcinoma. Because an adjunct test may improve sensitivity by chance alone, the sensitivity or specificity if the second test performed randomly was estimated.
  
  
  RESULTS
  Cervical intraepithelial neoplasia 2 or 3 was found in 11.8% (36/304) of the women and invasive squamous cell carcinoma in 0.3% (1/304). The sensitivity of cytology for detecting CIN 2 or 3 was 73.0% and increased by 21.6% to 94.6% with the addition of a cervigram showing a low-grade lesion or higher or a positive HPV test result. These gains were reduced to 8.1% and 10.8% above the sensitivities expected if the additional tests performed randomly. The corresponding specificities decreased from 49.1% to 32.2% and 33.0%. There was insufficient power to determine whether observed sensitivities were statistically significantly higher than the expected sensitivities.
  
  
  CONCLUSIONS
  Adjunctive HPV testing or cervicography may provide similar gains in sensitivity, but they can appear misleadingly large if chance increases are not taken into account.
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. mhoward@mcmaster.ca
authors.forename: Michelle
authors.initials: M
authors.lastname: Howard
authors.forename: John W
authors.initials: JW
authors.lastname: Sellors
authors.forename: Alice
authors.initials: A
authors.lastname: Lytwyn
authors.forename: Paula
authors.initials: P
authors.lastname: Roth
authors.forename: James B
authors.initials: JB
authors.lastname: Mahony
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy / Q000379:methods*; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*