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Screening for Cervical Cancer in High-Risk Populations: DNA Pap Test or Hybrid Capture II Test Alone?

Miranda Pereira, Sônia Maria B.Sc.; Castelo, Adauto M.D., Ph.D.; Makabe, Sérgio M.D.; Utagawa, Maria Lúcia B.Sc.; Di Loreto, Celso M.D.; Sakamoto Maeda, Marina Yoshiê M.Sc.; Marques, José A M.D.; Santoro, Carmen L. F M.D.; Filho, Adhemar Longatto M.Sc., Ph.D., P.M.I.A.C.; Das Dores, Gerson Botacini M.D., Ph.D.

International Journal of Gynecological Pathology: January 2006 - Volume 25 - Issue 1 - p 38-41
doi: 10.1097/01.pgp.0000177122.71309.72

Summary: This study was designed to evaluate whether Hybrid Capture II (HC2) test alone refer women to colposcopy as appropriately as DNA Papanicolaou (Pap) test, in the context of a high-risk group of women using the recently validated DNACitoliq® LBC system. Women with suspected cervical disease were included in this cross-sectional study at a tertiary center in São Paulo, Brazil, for further workup. All women had cervical material collected for LBC and HC2 for high-risk human papillomavirus (hrHPV)-DNA test. Irrespective of cytology and HC2 results, colposcopy, and cervical biopsy when applicable, was systematically performed. All tests were performed blindly. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of both methods were computed in relation to histology. A total of 1,080 women were included: 36.4% (393/1080) had ACUS+, 10.2% (110/1080) were high-grade squamous intraepithelial lesions (HSIL) or cancer. Mean age was 33.5 years. All women underwent colposcopy, and cervical biopsies were performed in 38.4% (415/1080): 33% (137/415) of the biopsies were negative, 14.4% (155/415) were low-grade squamous intraepithelial lesions (LSIL), 10.7% (116/415) were HSIL, and 0.6% (7/415) were cancer. HC2 sensitivity to diagnose biopsy-proven HSIL was 100%. Because all HSIL cases had a positive HC2 test, sensitivity could not be improved by adding LBC. Specificity and positive and negative predictive values of DNA Pap were not significantly different from HC2 test alone when considering LSIL+ histology as “gold standard” and HSIL+ histology. As a screening strategy for women with high-risk for cervical cancer, DNA Pap test does not seem to add substantially to HC2 alone in terms of appropriately referring to colposcopy.

From the Division of Pathology (S.M.M.P., M.L.U., C.D., M.Y.S.M., A.L.F.), Adolfo Lutz Institute, São Paulo Brazil; Division of Infectious Disease (A.C.), Federal University of São Paulo (UNIFESP); Perola Byignton Hospital (S.M., J.A.M., C.L.F.S.), São Paulo, Brazil; São Paulo, Brazil; University of Minho (A.L.F.), School of Health Sciences, Braga, Portugal; and Digene Brasil (G.B.D.), São Paulo, Brasil.

Address correspondence and reprint requests to Adhemar Longatto Filho, M.Sc., Adolfo Lutz Institute, Pathology Division, Dr. Arnaldo Avenue, 355 - Cerqueira Cezar 01246-902, São Paulo, SP, Brazil.

©2006International Society of Gynecological Pathologists