title: Performance characteristics of Pap test, VIA, VILI, HR-HPV testing, cervicography, and colposcopy in diagnosis of significant cervical pathology.
abstract: We sought to evaluate the performance of diagnostic tools to establish an affordable setting for early detection of cervical cancer in developing countries. We compared the performance of different screening tests and their feasibility in a cohort of over 12,000 women: conventional Pap smear, liquid-based cytology, visual inspection with acetic acid (VIA), visual inspection with Iodine solution (VILI), cervicography, screening colposcopy, and high-risk human papillomavirus (HPV) testing (HR-HPV) collected by physician and by self-sampling. HR-HPV assay collected by the physician has the highest sensitivity (80 %), but high unnecessary referrals to colposcopy (15.1 %). HR-HPV test in self-sampling had a markedly lower (57.1 %) sensitivity. VIA, VILI, and cervicography had a poor sensitivity (47.4, 55, and 28.6 %, respectively). Colposcopy presented with sensitivity of 100 % in detecting CIN2+, but the lowest specificity (66.9 %). Co-testing with VIA and VILI Pap test increased the sensitivity of stand-alone Pap test from 71.6 to 87.1 % and 71.6 to 95 %, respectively, but with high number of unnecessary colposcopies. Co-testing with HR-HPV importantly increased the sensitivity of Pap test (to 86 %), but with high number of unnecessary colposcopies (17.5 %). Molecular tests adjunct to Pap test seems a realistic option to improve the detection of high-grade lesions in population-based screening programs.
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. longatto@ecsaude.uminho.pt
authors.forename: Adhemar
authors.initials: A
authors.lastname: Longatto-Filho
authors.forename: Paulo
authors.initials: P
authors.lastname: Naud
authors.forename: Sophie Fm
authors.initials: SF
authors.lastname: Derchain
authors.forename: Cecília
authors.initials: C
authors.lastname: Roteli-Martins
authors.forename: Sílvio
authors.initials: S
authors.lastname: Tatti
authors.forename: Luciano Serpa
authors.initials: LS
authors.lastname: Hammes
authors.forename: Luis Otavio
authors.initials: LO
authors.lastname: Sarian
authors.forename: Mojca
authors.initials: M
authors.lastname: Eržen
authors.forename: Margherita
authors.initials: M
authors.lastname: Branca
authors.forename: Jean Carlos
authors.initials: JC
authors.lastname: de Matos
authors.forename: Renata
authors.initials: R
authors.lastname: Gontijo
authors.forename: Marina Y S
authors.initials: MY
authors.lastname: Maeda
authors.forename: Temístocles
authors.initials: T
authors.lastname: Lima
authors.forename: Silvano
authors.initials: S
authors.lastname: Costa
authors.forename: Stina
authors.initials: S
authors.lastname: Syrjänen
authors.forename: Kari
authors.initials: K
authors.lastname: Syrjänen
mesh_terms: D019342:Acetic Acid; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology*; D015331:Cohort Studies; D003127:Colposcopy / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D006801:Humans; D007454:Iodides; D008403:Mass Screening; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
chemical_list: D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution