title: Lack of agreement between cervicography and cytology and the effect of human papillomavirus infection and viral load.
abstract: OBJECTIVE
  Cohort studies of the natural history of human papillomavirus (HPV) infection and cervical squamous intraepithelial lesions with repeated screening allow the comparison of different macroscopic and microscopic diagnostic methods.
  
  
  METHODS
  Concurrent visual inspection using cervicography and conventional Pap cytology tests were performed during multiple visits in a cohort of women attending a maternal and child health clinic in São Paulo, Brazil. HPV infection status at the same visits was determined by polymerase chain reaction followed by typing with specific oligonucleotide probing and viral load quantification. Information on reproductive health and hygiene habits was also collected at each visit.
  
  
  RESULTS
  Overall agreement between cervicography and cytology was low (kappa = 0.046), which increased only slightly when high oncogenic-risk HPV types (kappa = 0.120) or high viral burden (>100 copies/cell) (kappa = 0.170) was present. Analysis of reproductive health and hygiene habits revealed somewhat different risk factors for cervical lesions detected by these tests. However, presence of oncogenic HPV DNA (odds ratio = 36.0, 95% CI = 16.6-77.8) and high viral burden (odds ratio = 67.34; 95% CI = 27.1-167.0) were strongly associated with lesions detected by cytology but not by cervicography.
  
  
  CONCLUSIONS
  Although changes in the cervix (because of age, gravidity, or hormonal effects) may influence the performance of morphology-based screening tests, the lack of agreement and the different degrees of association with HPV infection measures indicate that a visual inspection method such as cervicography may detect different cervical abnormalities relative to cytology.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Nicolas F
authors.initials: NF
authors.lastname: Schlecht
authors.forename: Andrea
authors.initials: A
authors.lastname: Trevisan
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Baggio
authors.forename: Lenice
authors.initials: L
authors.lastname: Galan
authors.forename: Eliane
authors.initials: E
authors.lastname: Duarte-Franco
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Greenberg
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Rohan
authors.forename: Alex
authors.initials: A
authors.lastname: Ferenczy
authors.forename: Luisa L
authors.initials: LL
authors.lastname: Villa
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification*; D052161:Human papillomavirus 18 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D016133:Polymerase Chain Reaction; D011859:Radiography; D014621:Vagina / Q000000981:diagnostic imaging* / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods*; D019562:Viral Load
chemical_list: D004279:DNA, Viral