Relevance of human papillomavirus screening in management of cervical intraepithelial neoplasia

OBJECTIVE: To evaluate the utility of human papillomavirus detection in identifying women with abnormal Papanicolaou smears who can be safely followed up with cytologic study only, we conducted a study to determine the sensitivity, specificity, and negative and positive predictive values of a Food a...

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Published in:	American journal of obstetrics and gynecology Vol. 176; no. 1; pp. 87 - 92
Main Authors:	Kaufman, Raymond H., Adam, Ervin, Icenogle, Joseph, Lawson, Herschel, Lee, Nancy, Reeves, K.O., Irwin, John, Simon, Terry, Press, Milan, Uhler, Robert, Entman, Carol, Reeves, William C.
Format:	Journal Article
Language:	English
Published:	Philadelphia, PA Elsevier Inc 01-01-1997 Elsevier
Subjects:	Adolescent Adult Aged Biological and medical sciences cervical intraepithelial neoplasia Cervical Intraepithelial Neoplasia - diagnosis Cervical Intraepithelial Neoplasia - virology DNA Probes, HPV Female Human papillomavirus Human viral diseases Humans Infectious diseases Medical sciences Middle Aged Papanicolaou Test Papillomaviridae - genetics Papillomaviridae - isolation & purification Predictive Value of Tests screening Sensitivity and Specificity Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - virology Vaginal Smears Viral diseases Viral diseases of the genital and urinary system Human papillomavirus screening cervical intraepithelial neoplasia Human Colposcopy Premalignant lesion Papovaviridae Medical screening Female genital diseases Infection Papillomavirus Virus Cervical dysplasia Viral disease Female Papanicolaou smear test Endoscopy Uterine cervix diseases
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Summary:	OBJECTIVE: To evaluate the utility of human papillomavirus detection in identifying women with abnormal Papanicolaou smears who can be safely followed up with cytologic study only, we conducted a study to determine the sensitivity, specificity, and negative and positive predictive values of a Food and Drug Administration–approved human papillomavirus test kit for detection of cervical intraepithelial neoplasia in colposcopically directed biopsy specimens. STUDY DESIGN: We enrolled women with abnormal Papanicolaou smears referred to a colposcopy clinic serving indigent patients. All 1128 women had a referral Papanicolaou smear, a clinic Papanicolaou smear, and a sample for human papillomavirus deoxyribonucleic acid test; 1075 underwent colposcopically directed biopsies and endocervical curettage. We used the HPV Profile kit for human papillomavirus testing. RESULTS: Of 486 women with low-grade squamous intraepithelial lesions on Papanicolaou smear, 35.4% had high-risk human papillomavirus deoxyribonucleic acid detected, and of 592 with high-grade lesions, 44.4% had high-risk human papillomavirus detected. Among 527 women with biopsy specimens showing cervical intraepithelial neoplasia and in 267 with cervical intraepithelial neoplasia grades 2 or 3, 38.7% and 56.2% had high-risk human papillomavirus deoxyribonucleic acid detected. However, the sensitivity of human papillomavirus deoxyribonucleic acid detection to identify biopsy-confirmed cervical intraepithelial neoplasia grades 2 or 3 was 55.7%, and the positive predictive value of the test was only 34.9%. CONCLUSION: Human papillomavirus appears to be causally associated with cervical cancer but human papillomavirus screening does not appear to be of value to identify women with abnormal Papanicolaou smears who can be safely followed up with cytologic study alone. (Am J Obstet Gynecol 1997;176:87-92.)
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9378 1097-6868
DOI:	10.1016/S0002-9378(97)80017-8