Comparison of pap smear, visual inspection with acetic acid, human papillomavirus DNA-PCR testing and cervicography.
OBJECTIVE
To assess the test qualities of four screening methods to detect cervical intra-epithelial neoplasia in an urban African setting.


METHODS
Six hundred fifty-three women, attending a family planning clinic in Nairobi (Kenya), underwent four concurrent screening methods: pap smear, visual inspection with acetic acid (VIA), PCR for high risk human papillomavirus (HR HPV) and cervicography. The presence of cervical intra-epithelial neoplasia (CIN) was verified by colposcopy or biopsy.


RESULTS
Sensitivity (for CIN2 or higher) and specificity (to exclude any CIN or cancer) were 83.3% (95% CI [73.6, 93.0]) and 94.6% (95% CI [92.6, 96.5]), respectively, for pap smear; 73.3% (95% CI [61.8, 84.9]) and 80.0% (95% CI [76.6, 83.4]) for VIA; 94.4% (95% CI [84.6, 98.8]) and 73.9% (95% CI [69.7, 78.2]) for HR HPV; and 72.3% (95% CI [59.1, 85.6]) and 93.2% (95% CI [90.8, 95.7]) for cervicography.


CONCLUSIONS
The pap smear had the highest specificity (94.6%) and HPV testing the highest sensitivity (94.4%). The visual methods, VIA and cervicography, were similar and showed an accuracy in between the former two tests.
De Vuyst
H
H
International Centre for Reproductive Health, Ghent University, De Pintelaan, 185, B-9000 Ghent, Belgium.
Claeys
P
P
Njiru
S
S
Muchiri
L
L
Steyaert
S
S
De Sutter
P
P
Van Marck
E
E
Bwayo
J
J
Temmerman
M
M
D019342:Acetic Acid; D000328:Adult; D000554:Ambulatory Care Facilities; D002294:Carcinoma, Squamous Cell; D002584:Cervix Uteri / Q000821:virology; D003127:Colposcopy; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D007630:Kenya; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
D004279:DNA, Viral; D007202:Indicators and Reagents; D019342:Acetic Acid