Predictive Capability of HPV and Pap Tests in Screening for Cervical Cancer over a Three-Year Follow-up

Abstract

Keywords► uterine cervical neoplasm ► prevention and control ► mass screening ► papanicolaou ► HPV ► cohort study AbstractPurpose To compare the predictive capability of HPV and Pap smear tests for screening pre-cancerous lesions of the cervix over a three-year follow-up, in a population of users of the Brazilian National Health System (SUS). Methods This is a retrospective cohort study of 2,032 women with satisfactory results for Pap smear and HPV tests using second-generation hybrid capture, made in a previous study. We followed them for 36 months with data obtained from medical records, the Cervix Cancer Information System (SISCOLO), and the Mortality Information System (SIM). The outcome was a histological diagnosis of cervical intraepithelial neoplasia grade 2 or more advanced lesions (CIN2þ). We constructed progression curves of the baseline test results for the period, using the Kaplan-Meier method, and estimated sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios for each test. Results A total of 1,440 women had at least one test during follow-up. Progression curves of the baseline test results indicated differences in capability to detect CIN2þ (p < 0.001) with significantly greater capability when both tests were abnormal, followed by only a positive HPV test. The HPV test was more sensitive than the Pap smear (88.7% and 73.6%, respectively; p < 0.05) and had a better negative likelihood ratio (0.13 and 0.30, respectively). Specificity and positive likelihood ratio of the tests were similar. Conclusions These findings corroborate the importance of HPV test as a primary cervical cancer screening.

Acurácia Da Citologia Vaginal E Colposcopia Para Diagnóstico De Neoplasia Intraepitelial Cervical No Cican-Bahia

“…Nos últimos anos, a acurácia da citologia e da colposcopia têm sido posta em dúvida, em virtude da grande variabilidade da sensibilidade e especificidade 26 . Por isso, precisa--se descobrir melhores formas de rastreamento desta doença, talvez por meio da criação de um score de risco para o câncer do colo uterino em que se incluam, aspectos epidemiológicos dos pacientes, resultado da citologia, da colposcopia e do do PCR para HPV (27)(28)(29)(30) . Assim poderia existir uma caracterização melhor das pacientes de maior risco para o desenvolvimento da doença e manter uma vigilância rigorosa delas, com o intuito de diagnosticar a doença ainda em estágios iniciais.…”