Performance of Pap Smear and Human Papilloma Virus Testing in the Follow-up of Women with Cervical Intraepithelial Neoplasia Grade 1 Managed Conservatively.
From: Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Rome, Italy.
Acta obstetricia et gynecologica Scandinavica
- Publish Date: 2006
- ISSN: 0001-6349
- Volume: 85
- Issue: 4
- Pages: 444-50
- Medium: Print
- Language: English
- Citation (JAMA): Santos André Luis Ferreira, Derchain Sophie Françoise Mauricette, Sarian Luis Otávio, et al. Performance of Pap Smear and Human Papilloma Virus Testing in the Follow-up of Women with Cervical Intraepithelial Neoplasia Grade 1 Managed Conservatively.. 2006;85:444-50
Abstract
BACKGROUND: Conservative management (follow-up) of cervical intraepithelial neoplasia grade 1 (CIN1) is acceptable, but evidence on performance of follow-up tools, such as Pap smear and human papilloma virus (HPV) test, is still needed. METHODS: A cohort of 78 women with histologically confirmed CIN1, referred because of atypical squamous cell or low-grade squamous intraepithelial lesion in their Pap smear, was enrolled between August 2000 and September 2002 and was prospectively followed-up at 6 and 12 months, until September 2003. Follow-up examinations included Pap test and Hybrid Capture II (HCII) with high-risk HPV, colposcopy, and cervical biopsies in patients with persistent abnormalities. Odds ratios and performance indicators (with 95% confidence interval) were calculated for HPV and Pap test results in detecting biopsy-confirmed CIN during the follow-up. RESULTS: Thirty-seven (47%) of the women were HPV-positive at baseline. At first follow-up visit, 30 women had persistent CIN1 and one woman progressed to CIN2; 15 patients had CIN1 and one patient CIN2 at the second follow-up visit. Women with persistent CIN1 (or progression) during follow-up had a significantly higher HPV detection rate and abnormal Pap tests, compared to women with regressive disease. Cytology had a far better sensitivity in detecting CIN than HCII at the first follow-up visit (81 versus 52%, respectively), whereas both examinations had equivalent sensitivities at the second follow-up visit (69 and 56%, respectively). Cytology had a superior negative predictive value at the first follow-up visit and better positive predictive value, in addition, at the second visit. CONCLUSIONS: Because cytological abnormalities correlated generally better with the persistence of biopsy-confirmed CIN1 in this follow-up protocol, HCII test is the second-hand option to Pap test, but the use of both Pap and HCII together seems an unnecessary waste of resources.
Mesh Headings (Keywords): Adolescent, Adult, Cervical Intraepithelial Neoplasia, Cohort Studies, Disease Progression, Female, Humans, Middle Aged, Odds Ratio, Papillomavirus Infections, Pregnancy, Risk Factors, Vaginal Smears
Check for Full Text / PubMed Unique Identifier (PMID): 16612707
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