title: Value of conventional pap smear, liquid-based cytology, visual inspection and human papillomavirus testing as optional screening tools among latin american women <35 and > or =35 years of age: experience from the Latin American Screening Study.
abstract: OBJECTIVE
  To compare performance of conventional Pap test, liquid based cytology (LBC) and visual inspection with acetic acid (VIA), as well as human papillomavirus (HPV) testing in 2 subcohorts of women, <35 and > or =35 years of age.
  
  
  METHODS
  Performance indicators were calculated using colposcopic biopsies as the gold standard; all results were corrected for verification bias using maximum likelihood.
  
  
  RESULTS
  Both conventional Pap test n d Hybrid Capture 2 (HC2) assay performed significantly better among older women than younger; no difference was observed in performance of LBC and VIA, both inferior to Pap and HC2. The Pap test was more specific than HC2 in both subcohorts; HC2 had the highest sensitivity. For individual tests, the best balance between sensitivity and specificity was obtained for HC2 assay corrected for verification bias in the older women's subcohort; this was further improved by the combined use of the Pap test and HC2.
  
  
  CONCLUSIONS
  Age of the target population is an important determinant of the performance of different screening tests. The choice of optimal test for women <35 and > or =35 years of age depends on whether the highest positive predictive value (Pap test).
authors.affiliation: Department of Oncology and Radiotherapy, Turku University Hospital, Finland. kari.syrjanen@tyks.fi
authors.forename: Kari
authors.initials: K
authors.lastname: Syrjänen
authors.forename: Sophie
authors.initials: S
authors.lastname: Derchain
authors.forename: Cecilia
authors.initials: C
authors.lastname: Roteli-Martins
authors.forename: Adhemar
authors.initials: A
authors.lastname: Longatto-Filho
authors.forename: Luciano S
authors.initials: LS
authors.lastname: Hammes
authors.forename: Luis
authors.initials: L
authors.lastname: Sarian
mesh_terms: D019342:Acetic Acid / Q000494:pharmacology; D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000821:virology*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007454:Iodides; D007843:Latin America / Q000453:epidemiology; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D014626:Vaginal Smears / Q000379:methods*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology
chemical_list: D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution