title: Follow-up and clinical significance of unsatisfactory liquid-based Papanicolaou tests.
abstract: BACKGROUND
  To the authors' knowledge, few studies to date have examined adherence to recommended guidelines for follow-up and outcomes after an unsatisfactory Papanicolaou (Pap) test (UPT) with liquid-based technologies.
  
  
  METHODS
  Within 4 US health plans, the median time to follow-up and the percentage of patients with follow-up testing by 120 days was calculated after a UPT. Multivariable analyses evaluated the association between clinical factors and follow-up testing. The authors compared the risk of a diagnosis of cervical intraepithelial neoplasia of type 2 or worse (CIN2+) after a UPT with the risk after a satisfactory Pap test while controlling for study site, test year, and other covariates.
  
  
  RESULTS
  A total of 634,644 Pap tests performed between 2004 and 2010 were included in the current study. Of 1442 UPTs, 53.4% had follow-up testing within 120 days; follow-up differed across the health plans (P<.001) and was found to be higher among patients aged <50 years (57.2% vs 48.8%; P = .01) and those with positive human papillomavirus (HPV) results (84.6% vs 53.9; P <.01). The risk of CIN2+ was similar for patients with both unsatisfactory and satisfactory Pap tests. However, after a UPT, the variables of age <50 years, having no previous history of Pap testing, having a history of a previous abnormal Pap test, and positive HPV status were all found to be risk factors for CIN2+; a positive HPV test was found to be the strongest risk factor for developing CIN2+. A negative HPV test result was protective for a CIN2+ diagnosis.
  
  
  CONCLUSIONS
  Various clinical factors associated with the risk of CIN2+ appear to influence the receipt of follow-up after a UPT. HPV test results in patients with UPTs might be used in follow-up strategies; specifically, a negative test result might reduce the urgency for repeat Pap testing.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan and Reliant Medical Group, Worcester, Massachusetts; Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Owens
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Daniel
authors.initials: D
authors.lastname: Peterson
authors.forename: Aruna
authors.initials: A
authors.lastname: Kamineni
authors.forename: Sheila
authors.initials: S
authors.lastname: Weinmann
authors.forename: Tyler
authors.initials: T
authors.lastname: Ross
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Williams
authors.forename: Azadeh
authors.initials: A
authors.lastname: Stark
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Adams
authors.forename: Chyke A
authors.initials: CA
authors.lastname: Doubeni
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
keywords: Papanicolaou test; SurePath; ThinPrep; conventional; liquid-based; unsatisfactory