title: HPV DNA testing with cytology triage in cervical cancer screening: Influence of revealing HPV infection status.
abstract: BACKGROUND
  Knowledge of cervical human papillomavirus (HPV) status might influence a cytotechnician's assessment of cellular abnormalities. The authors compared original cytotechnicians' Papanicolaou (Pap) readings for which HPV status was concealed with Pap rereads for which HPV status was revealed separately for 3 screening populations.
  
  
  METHODS
  Previously collected cervical Pap smears and clinical data were obtained from the Canadian Cervical Cancer Screening Trial (study A), the Democratic Republic of Congo Community-Based Screening Study (study B), and the Brazilian Investigation into Nutrition and Cervical Cancer Prevention (study C). Smears were reread with knowledge of HPV status for all HPV-positive women as well as a sample of HPV-negative women. Diagnostic performance of Pap cytology was compared between original readings and rereads.
  
  
  RESULTS
  A total of 1767 Pap tests were reread. Among 915 rereads for HPV-positive women, the contrast between "revealed" and "concealed" Pap readings demonstrated revisions from negative to positive results for 109 women (cutoff was atypical squamous cells of undetermined significance or worse) and 124 women (cutoff was low-grade squamous intraepithelial lesions [LSIL] or worse). For a disease threshold of cervical intraepithelial neoplasia of grade 2 or worse, specificity significantly declined at the atypical squamous cells of undetermined significance cutoff for studies A (86.6% to 75.3%) and C (42.5% to 15.5%), and at the LSIL cutoff for study C (61.9% to 37.6%). Sensitivity remained nearly unchanged between readings, except in study C, in which reread performance was superior (91.3% vs 71.9% for the LSIL cutoff).
  
  
  CONCLUSIONS
  A reduction in the diagnostic accuracy of Pap cytology was observed when revealing patients' cervical HPV status, possibly due to a heightened awareness of potential abnormalities, which led to more false-positive results.
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada.
authors.forename: Lyndsay Ann
authors.initials: LA
authors.lastname: Richardson
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada.
authors.forename: Mariam
authors.initials: M
authors.lastname: El-Zein
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada.
authors.forename: Agnihotram V
authors.initials: AV
authors.lastname: Ramanakumar
authors.affiliation: Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.|Public Health Laboratory, St. John's, Newfoundland and Labrador, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Ratnam
authors.affiliation: Department of Obstetrics and Gynaecology, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Ghislain
authors.initials: G
authors.lastname: Sangwa-Lugoma
authors.affiliation: Laboratory of Medical Investigation 14, Faculty of Medicine, University of Sao Paulo, FMUSP, Sao Paulo, Brazil.|Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal.|Life and Health Sciences Research Institute/3B's-PT Government Associate Laboratory, Braga/Guimaraes, Portugal.|Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil.
authors.forename: Adhemar
authors.initials: A
authors.lastname: Longatto-Filho
authors.affiliation: Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Marly Augusto
authors.initials: MA
authors.lastname: Cardoso
authors.affiliation: Department of Microbiology and Infectious Diseases, Montreal University Medical Center, Montreal, Quebec, Canada.
authors.forename: Francois
authors.initials: F
authors.lastname: Coutlée
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
mesh_terms: D004279:DNA, Viral / Q000032:analysis; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D030361:Papillomavirus Infections; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology*; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral
keywords: Papanicolaou test; cervical cancer; human papillomavirus (HPV); screening