title: Endocervical cytobrush for the detection of cervical dysplasia before large loop excision of the transformation zone (LLETZ).
abstract: BACKGROUND
  We aimed to identify the number of histologically verified cervical intraepithelial neoplasia (CIN)/cervical cancer lesions detected by endocervical cytobrush (EC) which have been missed by repeat PAP smear and colposcopy before large loop excision of the transformation zone (LLETZ).
  
  
  METHODS
  A retrospective cohort study of 1,676 consecutive patients in a colposcopy clinic undergoing repeat PAP smear, colposcopy, biopsy, and subsequent LLETZ.
  
  
  RESULTS
  Data were available for 1,421 patients. EC identified 31/1,367 (2.2%) cases of CIN and/or cervical cancer missed by repeat PAP smear and colposcopy. Compared to repeat PAP smear and colposcopy, the combination of repeat PAP smear, colposcopy and EC increased the positive predictive value (PPV) (89.6% vs. 98.9%, p=0.07), but this difference was not statistically significant. Sensitivity (93.1% vs. 93.9%; p=0.8), specificity (27.7% vs. 27.7%; p=1.0), and negative predictive value (NPV) (11.9% vs. 13.1%, p=0.9) were also not significantly different. The number needed to screen (NNS) for identifying one additional case of CIN and/or invasive cancer by EC was 45. In a multivariate analysis, presence of CIN/cervical cancer in the LLETZ specimen and human papilloma virus infection, but not age, visibility of the transformation zone or presence of an endovcervical lesion were independently associated with the likelihood of CIN and/or invasive cancer detected by EC.
  
  
  CONCLUSIONS
  Adding EC to repeat PAP smear and colposcopy identifies 2.2% more cases of CIN and/or cervical cancer, but does not significantly increase the sensitivity, specificity, PPV or NPV of repeat PAP smear and colposcopy.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria. clemens.tempfer@meduniwien.ac.at
authors.forename: Clemens
authors.initials: C
authors.lastname: Tempfer
authors.forename: Stephan
authors.initials: S
authors.lastname: Polterauer
authors.forename: Christoph
authors.initials: C
authors.lastname: Grimm
authors.forename: Eva-Katrin
authors.initials: EK
authors.lastname: Bentz
authors.forename: Alexander
authors.initials: A
authors.lastname: Reinthaller
authors.forename: Lukas A
authors.initials: LA
authors.lastname: Hefler
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods; D019092:Conization / Q000379:methods; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014626:Vaginal Smears