Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening

Abstract

Objectives To compare the sensitivity, specificity, and interobserver reliability of conventional cervical smear tests, monolayer cytology, and human papillomavirus testing for screening for cervical cancer. Design Cross sectional study in which the three techniques were performed simultaneously with a reference standard (colposcopy and histology). Setting Public university and private practices in France, with complete independence from the suppliers. Participants 828 women referred for colposcopy because of previously detected cytological abnormalities and 1757 women attending for routine smears. Main outcome measures Clinical readings and optimised interpretation (two blind readings followed, if necessary, by consensus). Sensitivity, specificity, and weighted computed for various thresholds of abnormalities. Results Conventional cervical smear tests were more often satisfactory (91% v 87%) according to the Bethesda system, more reliable (weighted 0.70 v 0.57), and had consistently better sensitivity and specificity than monolayer cytology. These findings applied to clinical readings and optimised interpretations, low and high grade lesions, and populations with low and high incidence of abnormalities. Human papillomavirus testing associated with monolayer cytology, whether systematic or for atypical cells of undetermined significance, performed no better than conventional smear tests. Conclusions Monolayer cytology is less reliable and more likely to give false positive and false negative results than conventional cervical smear tests for screening for cervical cancer.

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

“…3 Among the studies with an adequate reference standard such as colposcopy/biopsy, women are often selectively followed based on any previous detection of cytological abnormality or the presence of other risk factors for cervical disease. Besides the current study, only 2 studies to date (a Costa Rican study of 8,636 women from a population-based sample 26 and a French study of 1,757 women attending public and private clinics for routine cytologic screening 27 ) have avoided selective follow-up of high-risk or cytologically positive women and applied a definitive clinical reference standard to either a random sample of women with normal screening test results or the entire sample of women. This is critical to allowing the comparative sensitivity and specificity for LBC and conventional cytology to be calculated.…”

Interobserver agreement in the interpretation of anal intraepithelial neoplasia

“…[22][23][24][25] Two studies of cervical cytology showed that agreement was similar whether liquid-based or conventional cytology preparations were used. 26,27 Few studies have evaluated the reliability of anal specimen reporting. [17][18][19] Scholefield et al 17 circulated 30 cytology slides with material obtained from the perianal skin to 6 pathologists and reported point estimates of pairwise agreement ranging from 0.65 (moderate) to 1.00 (perfect).…”

Evidence-Based Cervical Cancer Screening: The Modern Evolution of the Pap Smear

“…Recent studies have challenged this notion, and to date, the question remains largely unanswered (20,70,71). A systematic review of 56 published studies that included over 1 million slides recently addressed the current literature on this subject (19).…”