title: Comparison of human papillomavirus DNA tests, liquid-based cytology and conventional cytology for the early detection of cervix uteri cancer.
abstract: To compare the performance of human papillomavirus DNA tests (samples collected by a healthcare professional and self-collected) and liquid-based cytology with conventional cytology in the detection of cervix uteri cancer and its precursor lesions. A cross-sectional study was carried out in 1777 women living in poor communities in Rio de Janeiro State, Brazil. Eligibility criteria included ages 25-59 years and not having had a Papanicolau test within at least 3 years prior to the study. Cytology (conventional or liquid-based) and human papillomavirus DNA (collected by a healthcare professional or self-collected) tests were performed using samples collected in a single visit. Women with abnormalities in at least one test and a systematic sample of 70 women with negative test results were referred to a colposcopic examination. Test readings were double-masked, and the outcome of interest was high-grade squamous intraepithelial lesion or worse. The pathology report was used as the gold standard. The prevalence of high-grade squamous intraepithelial lesion or worse was 2.0%. Human papillomavirus DNA test collected by a health professional alone or combined with conventional cytology had the highest sensitivity (91.4 and 97.1%, respectively). The highest specificity was found for conventional cytology (91.6%) and for a human papillomavirus DNA test collected by a healthcare professional (90.2%). On the basis of only test performance, the use of human papillomavirus DNA tests, alone or combined with cytology, would seem to be recommended. Its population-wide implementation, however, is conditional on a cost-effectiveness analysis.
authors.affiliation: Brazilian National Cancer Institute, Rua dos Inválidos, Rio de Janeiro, RJ, Brazil.
authors.forename: Vania R
authors.initials: VR
authors.lastname: Girianelli
authors.forename: Luiz Claudio S
authors.initials: LC
authors.lastname: Thuler
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.forename: Alexandre
authors.initials: A
authors.lastname: Donato
authors.forename: Lucilia M G
authors.initials: LM
authors.lastname: Zardo
authors.forename: José A
authors.initials: JA
authors.lastname: Lozana
authors.forename: Olimpio F
authors.initials: OF
authors.lastname: Almeida Neto
authors.forename: Aurenice C L
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Jorge H
authors.initials: JH
authors.lastname: Matos
authors.forename: Valeska
authors.initials: V
authors.lastname: Figueiredo
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000166:cytology* / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis
chemical_list: D004279:DNA, Viral