Accuracy of the Papanicolaou Test in Screening for and Follow-up of Cervical Cytologic Abnormalities: A Systematic Review

Nanda, K; McCrory, DC; Er, Myers; Bastian, La; Hasselblad, V; Hickey, J; Matchar, David B.

doi:10.1046/j.1526-0976.2001.51012-12.x

Cited by 356 publications

(471 citation statements)

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“…Cytology is not a diagnostic test and its sensitivity to detect cervical neoplasia has been found to vary considerably. 21,22 Also, it performs particularly poorly in low-resource settings, similar to the ones where these downstaging studies have been performed. 23,24 In the study by Sujathan et al, 16 only 2.2% of the women were subjected to colposcopy and biopsy; in the studies by Wesley et al 19 and Nene et al, 18 around 1% of women underwent biopsy and none had colposcopy.…”

Section: Discussionmentioning

confidence: 93%

Evaluation of downstaging in the detection of cervical neoplasia in Kolkata, India

Basu

Sankaranarayanan

Mandal

et al. 2002

Intl Journal of Cancer

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Unaided visual inspection or "downstaging" has been suggested as a potential alternative method for cervical cancer screening in developing countries. Our study was designed to evaluate the accuracy of downstaging to detect cervical neoplasia in a low-resource setting. A total of 6,399 women aged 30 -64 years were screened with downstaging by trained nonmedical health workers. Two thresholds were used to define positive downstaging: "low threshold" when any visible abnormality on the cervix was considered positive and "high threshold" when selected abnormalities such as bleeding on touch, bleeding erosion, hypertrophied oedematous cervix, congested stippled cervix and growth or ulcer constituted the positive test. All women underwent a colposcopy examination. Biopsies were directed when colposcopy revealed abnormal lesions. True disease status was defined as histologically proven moderate dysplasia and worse lesions. Since all the participants received a diagnostic (reference) investigation (biopsy and/or colposcopy), sensitivity, specificity and predictive values were estimated directly. Low-and high-threshold downstaging were positive in 1,585 (24.8%) and 460 (7.2%) women, respectively. Cytology screening for cervical cancer has been successful in reducing the incidence of and mortality from cervical cancer in many developed countries. 1-3 On the other hand, cervical cancer incidence and mortality rates have either remained unchanged or slowly declined in many low-resource developing countries. 4 -7 The primary reason for this is that most of these countries and regions lack effective cervical cancer screening programmes. Some of them have implemented cytology-based screening programmes nationally or regionally that have had very little impact on the incidence and mortality from cervical cancer. 7-9 The prerequisites for the success of cytology-based screening programmes are high coverage of the target population, preparation of goodquality cytology smears, well-equipped laboratory service with internal and external quality-control measures, adequate numbers of well-trained technical personnel, stringent quality assurance, efficient referral system and treatment and follow-up of those with precursor lesions, most of which are not feasible in underdeveloped countries. Therefore, the need for a relatively inexpensive and low-technology alternative to detect cervical neoplasia in low-resource settings has long been felt.Naked-eye visualization of the cervix (without application of acetic acid) by trained health workers has been considered as an option for low-resource countries to detect cervical cancer early and to improve the survival from the disease. 10,11 This approach, known as downstaging or unaided visual inspection (UVI), has been defined as "the detection of the disease in an earlier stage when still curable, by nurses and other nonmedical health workers using a speculum for visual inspection of the cervix". 11Here we report the findings from a cross-sectional study that evaluated the performance of d...

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Section: Discussionmentioning

confidence: 93%

Evaluation of downstaging in the detection of cervical neoplasia in Kolkata, India

Basu

Sankaranarayanan

Mandal

et al. 2002

Intl Journal of Cancer

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“…Cervical cancer is potentially preventable by screening and treatment of high grade cervical intraepithelial neoplasia (CIN) [1]. Conventional cervical cytology when used as a single test has a reported specificity of 95-98% but a sensitivity of only 50% [2]. The effectiveness of the cervical programme therefore relies on multiple opportunities at identifying and treating CIN.…”

Section: Introductionmentioning

confidence: 99%

The detection of cervical intraepithelial neoplasia by electrical impedance spectroscopy: The effects of acetic acid and tissue homogeneity

Balasubramani¹,

Brown²,

Healey³

et al. 2009

Gynecologic Oncology

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“…1,2 Nonetheless, the accuracy of this important screening tool remains controversial, with several large meta-analyses suggesting that both the sensitivity and specificity of cervical cytology is relatively low (30% to 87% sensitivity, 86% to 100% specificity). [3][4][5] As an alternative to conventional cytology, liquid based-cytology (LBC) was introduced in the mid-1990s. The purported advantages of LBC include a possible increase in the detection of high-grade cervical intraepithelial neoplasia (CIN 2,3 ), a reduction in the number of unsatisfactory and ''satisfactory-but-limited-by'' specimens, and providing residual cellular material for subsequent molecular testing (e.g., testing for ''high-risk'' types of HPV DNA).…”

mentioning

confidence: 99%

Direct comparison of liquid‐based and conventional cytology in a South African screening trial

Taylor

Kuhn

Dupree

et al. 2005

Intl Journal of Cancer

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Our study directly compares the performance of liquid-based (LBC) and conventional cytology for detecting high-grade cervical intraepithelial neoplasia and cancer (CIN 21) in high-risk, previously unscreened women. As part of a larger randomized clinical trial assessing the efficacy and safety of a ''screen and treat'' program for cervical cancer prevention, 5,652 South African women, aged 35 to 65 years, were screened using either ThinPrep or conventional Papanicolaou cytology. The cytology method used (i.e., ThinPrep or conventional) was rotated on a 6-month basis for the duration of the study. Directly following collection of the cytology specimen, all women underwent colposcopy with endocervical curettage and biopsy of all colposcopic abnormalities. Assessment of cytology and histology results was blinded and results were compared using histology-confirmed CIN as the ''gold standard.'' The accuracy of LBC and conventional cytology was statistically equivalent, although the sensitivity of conventional cytology was at least 5 percentage points higher at all cutoff levels. For example, at a cytology cutoff level of low-grade squamous intraepithelial lesion, the sensitivity of LBC was 60.3% for CIN21 vs. 69.1% for conventional cytology and specificity was 94.1% and 94.5%, respectively. LBC specimens were significantly less likely to be ''satisfactory-but-limited-by'' (6.5% vs. 27.9%) but significantly more likely to be unsatisfactory (2.2% vs. 0.8%). Thus, in this high-risk population, the sensitivity of LBC is no greater than the sensitivity of conventional cytology. Because of the higher unit cost of LBC, low resource settings should carefully consider the potential benefits and drawbacks of LBC before adopting this new technology. ' 2005 Wiley-Liss, Inc.Key words: cervical cytology; papanicolaou (Pap) smear; liquidbased cytology; cervical intraepithelial neoplasia Conventional cytology, i.e., the Papanicolaou smear, has been the mainstay of cervical cancer screening since the 1960s and is credited with successfully reducing the incidence and mortality of invasive cervical cancer in many developed countries. 1,2 Nonetheless, the accuracy of this important screening tool remains controversial, with several large meta-analyses suggesting that both the sensitivity and specificity of cervical cytology is relatively low (30% to 87% sensitivity, 86% to 100% specificity). [3][4][5] As an alternative to conventional cytology, liquid based-cytology (LBC) was introduced in the mid-1990s. The purported advantages of LBC include a possible increase in the detection of high-grade cervical intraepithelial neoplasia (CIN 2,3 ), a reduction in the number of unsatisfactory and ''satisfactory-but-limited-by'' specimens, and providing residual cellular material for subsequent molecular testing (e.g., testing for ''high-risk'' types of HPV DNA). On the other hand, the unit cost of LBC methods is substantially more than that of conventional cytology. The substantial increase in unit cost is of particular concern in less-developed...

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Accuracy of the Papanicolaou Test in Screening for and Follow-up of Cervical Cytologic Abnormalities: A Systematic Review

Cited by 356 publications

References 0 publications

Evaluation of downstaging in the detection of cervical neoplasia in Kolkata, India

Evaluation of downstaging in the detection of cervical neoplasia in Kolkata, India

The detection of cervical intraepithelial neoplasia by electrical impedance spectroscopy: The effects of acetic acid and tissue homogeneity

Direct comparison of liquid‐based and conventional cytology in a South African screening trial

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