Value of conventional pap smear, liquid-based cytology, visual inspection and human papillomavirus testing as optional screening tools among latin american women <35 and > or =35 years of age: experience from the Latin American Screening Study

Abstract

Objective: To compare performance of conventional Pap test, liquid based cytology (LBC) and visual inspection with acetic acid (VIA), as well as human papillomavirus (HPV) testing in 2 subcohorts of women, <35 and > or =35 years of age.

Study design: Performance indicators were calculated using colposcopic biopsies as the gold standard; all results were corrected for verification bias using maximum likelihood.

Result: Both conventional Pap test n d Hybrid Capture 2 (HC2) assay performed significantly better among older women than younger; no difference was observed in performance of LBC and VIA, both inferior to Pap and HC2. The Pap test was more specific than HC2 in both subcohorts; HC2 had the highest sensitivity. For individual tests, the best balance between sensitivity and specificity was obtained for HC2 assay corrected for verification bias in the older women's subcohort; this was further improved by the combined use of the Pap test and HC2.

Conclusion: Age of the target population is an important determinant of the performance of different screening tests. The choice of optimal test for women <35 and > or =35 years of age depends on whether the highest positive predictive value (Pap test).