Performance of Pap smear and human papilloma virus testing in the follow-up of women with cervical intraepithelial neoplasia grade 1 managed conservatively.
BACKGROUND
Conservative management (follow-up) of cervical intraepithelial neoplasia grade 1 (CIN1) is acceptable, but evidence on performance of follow-up tools, such as Pap smear and human papilloma virus (HPV) test, is still needed.


METHODS
A cohort of 78 women with histologically confirmed CIN1, referred because of atypical squamous cell or low-grade squamous intraepithelial lesion in their Pap smear, was enrolled between August 2000 and September 2002 and was prospectively followed-up at 6 and 12 months, until September 2003. Follow-up examinations included Pap test and Hybrid Capture II (HCII) with high-risk HPV, colposcopy, and cervical biopsies in patients with persistent abnormalities. Odds ratios and performance indicators (with 95% confidence interval) were calculated for HPV and Pap test results in detecting biopsy-confirmed CIN during the follow-up.


RESULTS
Thirty-seven (47%) of the women were HPV-positive at baseline. At first follow-up visit, 30 women had persistent CIN1 and one woman progressed to CIN2; 15 patients had CIN1 and one patient CIN2 at the second follow-up visit. Women with persistent CIN1 (or progression) during follow-up had a significantly higher HPV detection rate and abnormal Pap tests, compared to women with regressive disease. Cytology had a far better sensitivity in detecting CIN than HCII at the first follow-up visit (81 versus 52%, respectively), whereas both examinations had equivalent sensitivities at the second follow-up visit (69 and 56%, respectively). Cytology had a superior negative predictive value at the first follow-up visit and better positive predictive value, in addition, at the second visit.


CONCLUSIONS
Because cytological abnormalities correlated generally better with the persistence of biopsy-confirmed CIN1 in this follow-up protocol, HCII test is the second-hand option to Pap test, but the use of both Pap and HCII together seems an unnecessary waste of resources.
Santos
André Luis Ferreira
AL
Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Rome, Italy.
Derchain
Sophie Françoise Mauricette
SF
Sarian
Luis Otávio
LO
Martins
Marcos Roberto
MR
Morais
Sirlei Siani
SS
Syrjänen
Kari Juhani
KJ
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis*; D011247:Pregnancy; D012307:Risk Factors; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000628:therapy / Q000821:virology*