title: The risk of false-positive histology according to the reason for colposcopy referral in cervical cancer screening: a blind revision of all histologic lesions found in the NTCC trial.
abstract: All cervical intraepithelial neoplasia (CIN) diagnoses identified during the New Technologies for Cervical Cancer trial (ISRCTN81678807) were blindly reviewed by 2 pathologists. Original diagnoses based on colposcopy-guided biopsies were compared with those made by the reviewers who had access to all clinical histologic samples (including postsurgical). Cases downgraded from CIN 2+ by the reviewers were considered indicative of unnecessary treatments. The analyses are presented according to the molecular (high-risk human papillomavirus [HPV]) and/or cytologic diagnosis used to refer the women for colposcopy. We reviewed 812 CIN 1 and 364 CIN 2 + diagnoses. The specificity of colposcopy-guided biopsy was 98% and the sensitivity, 84%. The probability of unnecessary treatment was 27% for women with atypical squamous cells of undetermined significance cytologic findings and 8% for women with low-grade squamous intraepithelial lesion or worse, 10% for HPV+ and positive cytologic findings, and 16% for HPV+ alone. The positive predictive value of the first-level screening test was inversely associated with probability of a histologic false-positive result (P = .015). In screening, a low positive predictive value of the colposcopy-referring test may result in unnecessary treatments.
authors: Pathology Unit, S. Chiara Hospital of Trento, Trento, Italy.
authors: Paolo
authors: P
authors: Dalla Palma
authors: Paolo
authors: P
authors: Giorgi Rossi
authors: Guido
authors: G
authors: Collina
authors: Anna Maria
authors: AM
authors: Buccoliero
authors: Bruno
authors: B
authors: Ghiringhello
authors: Maurizio
authors: M
authors: Lestani
authors: Gianlibero
authors: G
authors: Onnis
authors: Daniela
authors: D
authors: Aldovini
authors: Giuseppe
authors: G
authors: Galanti
authors: Gianpiero
authors: G
authors: Casadei
authors: Mirella
authors: M
authors: Aldi
authors: Vincenzo
authors: V
authors: Gomes
authors: Pamela
authors: P
authors: Giubilato
authors: Guglielmo
authors: G
authors: Ronco
mesh_terms: D000328:Adult; D003127:Colposcopy; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008403:Mass Screening; D030361:Papillomavirus Infections / Q000473:pathology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000601:surgery; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000601:surgery