A comparison of the human papillomavirus test and Papanicolaou smear as a second screening method for women with minor cytological abnormalities

Authors

  • Sonia Andersson,

    Corresponding author
    1. From the Division of Obstetrics and Gynecology, Institute for Clinical Science, Karolinska University Hospital, Huddinge, Karolinska Institute, Stockholm,
      *Sonia Andersson
      Division of Obstetrics and Gynaecology
      Institute for Clinical Science
      Karolinska University Hospital
      Huddinge
      Karolinska Institute
      141 86 Stockholm
      Sweden
      e-mail: sonia.andersson@telia.com
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  • Lena Dillner,

    1. Department of Medical Microbiology, Lund University, University Hospital Malmö, and
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  • Kristina Elfgren,

    1. From the Division of Obstetrics and Gynecology, Institute for Clinical Science, Karolinska University Hospital, Huddinge, Karolinska Institute, Stockholm,
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  • Miriam Mints,

    1. From the Division of Obstetrics and Gynecology, Institute for Clinical Science, Karolinska University Hospital, Huddinge, Karolinska Institute, Stockholm,
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  • Maria Persson,

    1. Division of Obstetrics and Gynecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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  • Eva Rylander

    1. Division of Obstetrics and Gynecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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*Sonia Andersson
Division of Obstetrics and Gynaecology
Institute for Clinical Science
Karolinska University Hospital
Huddinge
Karolinska Institute
141 86 Stockholm
Sweden
e-mail: sonia.andersson@telia.com

Abstract

Background.  Of the estimated one million Papanicolaou (pap) smears performed annually in Sweden, about 4% show any degree of abnormality. Approximately, 1% of these cases contain moderate or severe atypia (high-grade squamous intraepithelial lesions) and the rest contain low-grade atypia. Recommendations for the management of minor abnormalities vary in various parts of Sweden. Generally, a second Pap smear is obtained 4–6 months after the first one showing low-grade atypia. The aim of this study is to compare the sensitivity of human papilloma virus (HPV)-DNA testing for the detection of cervical intraepithelial neoplasia (CIN) 2–3 with that of a second Pap smear in women, who had low-grade atypia in their first Pap smear.

Methods.  Women with low-grade atypia in the Stockholm area, detected at a population-based cytology screening, were enrolled. A repeat Pap smear, HPV test, and colposcopically directed biopsies were obtained. For the detection of HPV, Hybrid Capture II (HC II) was used.

Results.  The HPV-DNA test was positive in 66% of the 177 participating women. The sensitivity of the second Pap smear and HPV-DNA test to detect CIN 2–3 was 61 (95% CI = 45–74) and 82% (95% CI = 67–91), respectively. The positive and negative predictive values of HPV testing were 27 (95% CI = 18–35) and 89% (95% CI = 80–97), respectively.

Conclusions.  In Sweden, a second Pap smear is often obtained for the follow-up of women with low-grade atypia. The results of our study show that compared to the second Pap smear, HPV testing with HC II is a more sensitive method for detecting high-grade lesions.

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