Mark Schiffman|Rolando Herrero|Allan Hildesheim|Mark E. Sherman|M. Concepción Bratti|Sholom Wacholder|Mario Alfaro|Martha L. Hutchinson|Jorge Morales|Mitchell Greenberg|Attila T. Lörincz
HPV DNA Testing in Cervical Cancer Screening
National Cancer Institute|International Agency For Research On Cancer|National Institutes of Health|Costa Rican Department of Social Security|National Institutes of Health|Costa Rican Department of Social Security|Women & Infants Hospital of Rhode Island|Costa Rican Department of Social Security
human papillomaviruses hpvs known cause cervical cancer worldwide utility hpv dna testing cervical cancer prevention determinedto provide comprehensive data screening performance hpv testing common carcinogenic types different levels analytic sensitivitylaboratory analysis conducted 19931995 using 3 cytologic techniques cervicography followed colposcopic examination women abnormal cervical finding detect highgrade intraepithelial lesions cancer reference standard clinically significant disease hpv testing performed subsequently masking regarding clinical findingsguanacaste province costa rica region high ageadjusted incidence cervical cancerof 11742 randomly selected women 8554 nonpregnant sexually active women without hysterectomies underwent initial hpv dna testing using original hybrid capture tube test stratified subsample 1119 specimens retested using analytically sensitive second generation assay hybrid capture ii testreceiver operating characteristic analysis detection cervical highgrade intraepithelial lesions cancer hpv dna testing based different cut points positivityan analytic sensitivity 10 pgml using second generation assay would permitted detection 884 138 highgrade lesions cancers 12 cancers hpvpositive colposcopic referral 123 women papanicolaou testing using atypical squamous cells undetermined significance cut point referral resulted 777 sensitivity 942 specificity 69 referred specificity second generation assay positivity highgrade lesions cancer 890 338 remaining hpv dnapositive subjects lowgrade equivocal microscopically evident lesions higher detection threshold 10 pgml used original assay sensitivity 748 specificity 934 lower levels detection second generation assay 1 pgml proved clinically nonspecific without gains diagnostic sensitivityin study population cut point 10 pgml using second generation assay permitted sensitive detection cervical highgrade lesions cancer yielding apparently optimal tradeoff high sensitivity reasonable specificity test test perform best settings sensitive detection highgrade lesions cancer paramount hpv prevalence varies population hpv testing positive predictive value detection highgrade lesions cancer vary accordingly implications utility relative cervical cancer screening methods