title: Pooled analysis of the performance of liquid-based cytology in population-based cervical cancer screening studies in China.
abstract: BACKGROUND
  Liquid-based cytology (LBC) has been widely used for cervical cancer screening. Despite numerous studies and systematic reviews, to the authors' knowledge few large studies to date have focused on biopsy-confirmed cervical lesions and controversy remains concerning its diagnostic accuracy. The objective of the current study was to assess LBC for detecting biopsy-confirmed cervical intraepithelial neoplasia (CIN) and cancer.
  
  
  METHODS
  A pooled analysis of LBC using data from 13 population-based, cross-sectional, cervical cancer screening studies performed in China from 1999 to 2008 was performed. Participants (n = 26,782) received LBC and human papillomavirus testing. Women found to be positive on screening were referred for colposcopy and biopsy. The accuracy of LBC for detecting biopsy-confirmed CIN of type 2 or worse (CIN2+) as well as CIN type 3 or worse (CIN3+) lesions was analyzed.
  
  
  RESULTS
  Of 25,830 women included in the analysis, CIN2+ was found in 107 of 2612 with atypical squamous cells (4.1%), 142 of 923 with low-grade squamous intraepithelial neoplasia (15.4%), 512 of 784 with high-grade squamous intraepithelial neoplasia (65.3%), 29 of 30 with squamous cell carcinoma (96.7%), 4 of 27 with atypical glandular cells (14.8%), and 85 of 21,454 with normal cytology results (0.4%). No invasive cancers were found to have atypical squamous cells, atypical glandular cells, or cytologically normal slides. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of LBC for detecting CIN2+ were 81.0%, 95.4%, 38.3%, 99.3 %, and 94.9%, respectively. Although Hybrid Capture 2 was more sensitive than LBC, the specificity, positive predictive value, and overall accuracy of LBC were higher than those of Hybrid Capture2 at 85.2%, 18.6%, and 85.5%, respectively.
  
  
  CONCLUSIONS
  The results of the current study indicate that the performance of LBC can effectively predict the risk of existing CIN2+ and may be a good screening tool for cervical cancer prevention in a developing country.
authors.affiliation: Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Qin-Jing
authors.initials: QJ
authors.lastname: Pan
authors.forename: Shang-ying
authors.initials: SY
authors.lastname: Hu
authors.forename: Xun
authors.initials: X
authors.lastname: Zhang
authors.forename: Pu-wa
authors.initials: PW
authors.lastname: Ci
authors.forename: Wen-hua
authors.initials: WH
authors.lastname: Zhang
authors.forename: Hui-qin
authors.initials: HQ
authors.lastname: Guo
authors.forename: Jian
authors.initials: J
authors.lastname: Cao
authors.forename: Fang-hui
authors.initials: FH
authors.lastname: Zhao
authors.forename: Alice
authors.initials: A
authors.lastname: Lytwyn
authors.forename: You-lin
authors.initials: YL
authors.lastname: Qiao
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology; D002584:Cervix Uteri / Q000166:cytology; D002681:China / Q000453:epidemiology; D003127:Colposcopy; D003430:Cross-Sectional Studies; D003584:Cytological Techniques; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D014626:Vaginal Smears; D055815:Young Adult
keywords: cervical cancer; liquid-based cytology; pool analysis; population-based; screening
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