Referral compliance, outcome and predictors of CIN after repeated borderline cervical smears in the Netherlands

Siebers, Albertus G.; Massuger, Leon F.A.G.; Bulten, Johan

doi:10.1111/j.1365-2303.2007.00427.x

Cited by 1 publication

(2 citation statements)

References 35 publications

(119 reference statements)

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“…A complete evaluation of the cervical transformation zone was required for negative diagnosis. Conventional Pap smear specimens were immunostained for CA-IX as described previously [5,7,11,12]. The presence of any of 13 high-risk HPV (H-HPV) DNA types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, or 68) was detected using HC2 (Digene Corp., Gaithersburg, MD).…”

Section: Methodsmentioning

confidence: 99%

“…It is not clear, however, how to identify them. After a diagnosis of AGC-NOS, additional screening is needed to distinguish between those women who have a SCL from those who do not in order to avoid an unnecessarily high referral rate and over-treatment of healthy women [7]. Our Gynecologic Oncology Group study, GOG-0171, found that additional screening for high-risk HPV (H-HPV) infection by Hybrid Capture II (HC2) among women with AGC-NOS in the U.S. produced an estimated 97% sensitivity, 87% specificity, 99% negative predictive value (NPV), and a positive predictive value (PPV) of only 77%, when treating histological diagnosis as the truth.…”

Section: Purposementioning

confidence: 99%

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A modified Latent Class Model assessment of human papillomavirus-based screening tests for cervical lesions in women with atypical glandular cells: a Gynecologic Oncology Group study

Carter

Kang

Darcy

et al. 2012

Cancer Causes Control

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Purpose Absent gold standard diagnoses, we estimate age-specific false-positive and false-negative prediction rates of HPV-, cytology- and histology-based tests for significant cervical lesions (SCL) in U.S. women with AGC-NOS Pap smear diagnoses. Methods Modified Latent Class Model (LCM) analyses, with prevalence of SCL modeled as a function of age, were applied to GOG-0171 study data (n=122). The accuracies of several HPV-based tests, including Hybrid Capture II high-risk HPV (HC2 H-HPV); carbonic anhydrase IX (CA-IX) and invasive histological diagnosis were compared. 1-PPV and 1-NPV were written as functions of sensitivity, specificity and prevalence to obtain age-specific false-positive and false-negative rates. Results The histology-based test was nearly perfect (sensitivity=1.00, CI=0.98-1.00; specificity=0.99, CI=0.96-1.00). Otherwise, HC2 H-HPV performed best (sensitivity=1.00, CI=1.00-1.00; specificity=0.87, CI=0.79-0.94). The false-positive detection rates (1-PPV) for HC2 H-HPV were high (>17%) at each age, while those of the histological diagnoses were low (<5% at ages≤60 and <17% overall ages). False negative prediction rates (1-NPV) for HC2 H-HPV were < 0.11% at each age and were uniformly lower than those of other tests, including the histology-based test (<0.25%). CA-IX together with HC2 H-HPV did not improve performance. Conclusions Women with negative HC2 H-HPV can safely forego invasive treatment (i.e., cone or LEEP biopsy, hysterectomy) in favor of observational follow-up. Additional biomarkers must be found for use in combination with HC2 H-HPV to reduce false-positive rates. This novel application of a modified Latent Class Model (LCM) exemplifies methods for potential use in future cancer screening studies when gold standard diagnoses are not available.

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Section: Methodsmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%