Cervicography and HPV DNA Testing as Triage Criteria for Women with Abnormal Pap Smear by Primary Care Clinicians

Park, Young Se

Abstract

OBJECTIVE
The aim of this study was to determine the predictive values of cervicography and HPV DNA test for histologic CIN diagnoses among women with abnormal cervical cytology so as to use as an intermediate triage criteria by primary care clinicians.
METHODS
All 129 patients with abnormal cervical cancer screening tests underwent simultaneous or consecutive cervicography, HPV DNA test, colposcopically directed punch biopsy and/or LEEP. The results of single or combination screening tests were compared with final histopathologic findings. 71 among 129 patients were referred from other clinics, and remainders from mine between July 2000 and June 2001.
RESULTS
Sensitivity/Specificity/PPV/NPV/Efficiency and FPR/FNR of single or combination tests were calculated. Following results were obtained. 1) Sensitivity : Triple combined test was 100%, double combined test by cytologic test plus either cervicography or HPV DNA test (97.8%), cytologic test (94.6%), HPV DNA test (88.4%), and cervicography (56.0%) followed. 2) Specificity : Cervicography was 61.1%, HPV DNA test (45.9%), cytologic test (30.6%), double combined test by cytologic test plus HPV DNA test (22.9%), double combined test by cytologic test plus cervicography (8.3%), and triple combined test (7.9%) followed. 3) PPV : No statistically significant differences were shown among single, double and triple combined tests, and it ranged between 72.2% and 80.8%. 4) NPV : Triple combined test was 100%, double combined test by cytologic test plus HPV DNA test (80.0%), HPV DNA test (68.0%), double combined test by cytologic test plus cervicography (60.0%), and cervicography (34.9%) followed. 5) Efficiency : Larger than 70% of efficiency in all screening methods (either single or combined) except single cervicography (57.4%). 6) FPR : Triple combined test was 92.1%, double combined test by cytologic test plus cervicography (91.7%), double combined test by cytologic test plus HPV DNA test (78.4%), cytologic test (69.4%), HPV DNA test (54.1%), and cervicography (38.9%) followed. 7) FNR : Cervicography was 44.1%, HPV DNA test (8.7%), cytologic test (5.4%), double combined test by cytologic test plus cervicography (2.2%), double combined test by cytologic test plus HPV DNA test (1.1%), and triple combined test (0%) followed.
CONCLUSION
Even though the optimal clinical management of cervical cytologic abnormality remains still problematic, this study demonstrates that additional HPV DNA test and/or cervicography have much value in predicting histologic CIN diagnoses. Primary care clinicians can easily perform these tests at their clinics as an intermediate triage criteria to prevent overreferral for colposcopy without compromising the detection of significant disease underlying cytologic atypia.