title: Sensitivity of the Pap test in detecting high grade lesions: what should be the acceptable cytologic threshold for colposcopic referral?
abstract: OBJECTIVE
  To devise an optimal cytology threshold for colposcopy referral in resource-limited settings.
  
  
  METHODS
  Four hundred seventy-two symptomatic women 20-60 years old were screened by both cytology and colposcopy. Onsite biopsy was taken if lesions grade 1 or above were detected on colposcopy. Women found to have cervical intraepithelial neoplasia (CIN) 2 and above lesions on histopathology were stratified according to their cytologic diagnosis (atypical squamous cells of undetermined significance [ASCUS]+ threshold, low grade squamous intraepithelial lesion [LSIL]+ threshold, and high grade squamous intraepithelial lesion [HSIL]+ threshold). The comparative sensitivity, specificity and predictive values in each group were calculated, taking biopsy as the gold standard.
  
  
  RESULTS
  The sensitivity of LSIL + cytology to detect CIN 2+ lesions was 91.5% (referral load, 30.7%). While the sensitivity of ASCUS+ cytology threshold was almost the same (92.3%), the referral load was much higher (42.2%). With HSIL+ cytology threshold, though the referral load was reduced substantially (21.9%), the sensitivity also decreased, to 81.5%.
  
  
  CONCLUSIONS
  The results indicate that in order to achieve high sensitivity, the LSIL cytology threshold appears to be optimum for colposcopic referrals.
authors.affiliation: Institute of Cytology and Preventive Oncology, Noida, UP, India.
authors.forename: Pushpa
authors.initials: P
authors.lastname: Sodhani
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Veena
authors.initials: V
authors.lastname: Singh
authors.forename: Ashok
authors.initials: A
authors.lastname: Sehgal
authors.forename: Kaushik
authors.initials: K
authors.lastname: Halder
authors.forename: Aditya
authors.initials: A
authors.lastname: Parashari
mesh_terms: D000328:Adult; D003127:Colposcopy; D003581:Cytodiagnosis / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008875:Middle Aged; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D014626:Vaginal Smears / Q000379:methods / Q000592:standards; D002578:Uterine Cervical Dysplasia / Q000145:classification / Q000175:diagnosis* / Q000473:pathology*