Elsevier

Obstetrics & Gynecology

Volume 102, Issue 2, August 2003, Pages 266-272
Obstetrics & Gynecology

Cross-sectional study of patient- and physician-collected cervical cytology and human papillomavirus

https://doi.org/10.1016/S0029-7844(03)00517-9Get rights and content

Abstract

Objective

To compare the performance of patient- and physician-obtained cytology and human papillomavirus (HPV) testing for the detection of high-grade cervical intraepithelial neoplasia.

Methods

A cross-sectional study was performed involving 334 women seen at three colposcopy clinics (Tucson, Arizona; Hermosillo, Mexico; and Lima, Peru). All women used a cytobrush to self-collect specimens for cervical cytology and HPV testing. Subjects subsequently underwent physician collection for cytology and HPV, followed by a complete colposcopic evaluation with directed biopsy. Cytology was processed using thin-layer technology, and HPV was determined using the polymerase chain reaction technique. Test performance characteristics were determined using the histopathologic diagnosis as the reference standard and designating high-grade cervical intraepithelial neoplasia as clinically significant disease for the purpose of the analysis.

Results

The sensitivity of patient-collected cytology was significantly lower (55.0%) and specificity was significantly better (84.1%) than those of physician-directed sampling (85.2% and 73.4%, respectively). Patient-collected HPV had significantly lower sensitivity (49.0%) than physician sampling (82.2%), although specificity did not significantly differ.

Conclusion

Patient collection is a feasible although inferior alternative to physician-collected cervical cytology and HPV testing.

Section snippets

Materials and methods

Between January 1999 and June 2000 we performed a cross-sectional study of patient- and physician-performed sampling for cervical cytology and oncogenic HPV. A total of 334 women seeking care at three colposcopy clinics (University of Arizona Health Sciences Center, Tucson, Arizona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; and ISSSTE, Hermosillo, Mexico) were enrolled in the study. The University of Arizona Human Subjects Committee approved this study, as did the

Results

Three hundred thirty-four women were enrolled into the study: 108 from Tucson, Arizona; 100 from Lima, Peru; and 126 from Hermosillo, Mexico. The mean age of women enrolled in the study was 36.9 (range 18–67, standard deviation [SD] 11.3), and the mean parity was 2.3 (range 0–10, SD 1.9). An analysis of variance revealed that mean age did not statistically differ between the three study sites (P ≥ .05), although parity was significantly higher (2.7) among women from Peru (P ≤ .01) than among

Discussion

Eighty percent of cervical cancer occurs in developing world settings, where it is responsible for 200,000–300,000 deaths each year.1 By comparison, last year in the United States there were approximately 4900 deaths from cervical cancer.2 This dramatic disparity has been attributed to the ubiquity of cytology-based screening programs in developed nations.7 Efforts to implement cytologic screening programs in the developing world have met a variety of barriers, including inadequate material

Acknowledgements

The authors express their sincere appreciation to the women in Tucson, Hermosillo, and Lima who participated in this study. They also acknowledge the contributions of the technical team (S. Vanzzini, B. Monaco, T. Fernandez, J. Wein, M. Abramsen, L. Vaught, K. Harrigill, C. Kavanagh, and K. Hatch) and the statistical review provided by J. Ranger-Moore and S. Carvajal.

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    The Population Council, Latin America Office, provided seed funding for this study. Thin-layer liquid cytology collection materials were provided at no cost by Cytyc Corp. (Boxborough, Massachusetts). This study was partially supported by grants from the National Institutes of Health (no. CA82715) and the Health Resource Services Administration (no. 316210). BB’s participation was partially underwritten by a career development grant from the University of Arizona.

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