Sensitivity of the Pap test in detecting high grade lesions: what should be the acceptable cytologic threshold for colposcopic referral?
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.
Sodhani
Pushpa
P
Institute of Cytology and Preventive Oncology, Noida, UP, India.
Gupta
Sanjay
S
Singh
Veena
V
Sehgal
Ashok
A
Halder
Kaushik
K
Parashari
Aditya
A
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*