Reflex human papillomavirus deoxyribonucleic acid testing in women with abnormal Papanicolaou smears

Jr Wright, A. Lorincz, Daron Gale Ferris, R. M. Richart, A. Ferenczy, I. Mielzynska, L. Borgatta

Research output: Contribution to journalArticle

112 Scopus citations

Abstract

OBJECTIVE: The study examined interrelationships between sensitivity and specificity of 'reflex human papillomavirus deoxyribonucleic acid testing' from liquid-based cervical cytologic specimens by means of receiver operator characteristics curves. STUDY DESIGN: A cohort study was performed on 265 women evaluated by colposcopy because of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion found on Papanicolaou smear. RESULTS: At a positive threshold of 0.2 pg/ml (1000 copies of human papillomavirus per test), human papillomavirus deoxyribonucleic acid testing detected 86% of women with cervical intraepithelial neoplasia and 93% of women with high-grade cervical intraepithelial neoplasia with a specificity of 30%. Decreasing the sensitivity of the human papillomavirus test to 1 pg/ml (5000 copies of human papillomavirus per test) improved the specificity of a positive result to 44% but decreased the clinical sensitivity to 78% for cervical intraepithelial neoplasia grade 2 or 3. Relationships between sensitivity and specificity were influenced by patient age and referral diagnosis. For example, limiting the analysis to only women with a referral for atypical squamous cells of undetermined significance found on Papanicolaou smear and a positive human papillomavirus test threshold of 0.5 pg/ml produced a sensitivity of 90% for cervical intraepithelial neoplasia grade 2 or 3 and a test specificity of 55%. CONCLUSIONS: Human papillomavirus deoxyribonucleic acid testing of residual cellular material from liquid cytologic specimens appears to be more appropriate for older women (>30 years old) and women with atypical squamous cells of undetermined significance, as opposed to low-grade squamous intraepithelial lesion, on their Papanicolaou smears.

Original languageEnglish (US)
Pages (from-to)962-966
Number of pages5
JournalAmerican Journal of Obstetrics and Gynecology
Volume178
Issue number5
DOIs
Publication statusPublished - Jan 1 1998
Externally publishedYes

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Keywords

  • Cervical intraepithelial neoplasia
  • Cytology
  • Human papillomavirus

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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