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Comparison of papanicolaou smear and human papillomavirus (HPV) test as cervical screening tools: can we rely on HPV test alone as a screening method? An 11-year retrospective experience at a single institution

Authors
  • Kang, Myunghee
  • Ha, Seung Yeon
  • Cho, Hyun Yee
  • Chung, Dong Hae
  • Kim, Na Rae
  • An, Jungsuk
  • Lee, Sangho
  • Seok, Jae Yeon
  • Jeong, Juhyeon
Type
Published Article
Journal
Journal of Pathology and Translational Medicine
Publisher
The Korean Society of Pathologists and the Korean Society for Cytopathology
Publication Date
Jan 15, 2020
Volume
54
Issue
1
Pages
112–118
Identifiers
DOI: 10.4132/jptm.2019.11.29
PMID: 31964113
PMCID: PMC6986973
Source
PubMed Central
Keywords
License
Unknown

Abstract

Background The decrease in incidence of cervical dysplasia and carcinoma has not been as dramatic as expected with the development of improved research tools and test methods. The human papillomavirus (HPV) test alone has been suggested for screening in some countries. The National Cancer Screening Project in Korea has applied Papanicolaou smears (Pap smears) as the screening method for cervical dysplasia and carcinoma. We evaluated the value of Pap smear and HPV testing as diagnostic screening tools in a single institution. Methods Patients co-tested with HPV test and Pap smear simultaneously or within one month of each other were included in this study. Patients with only punch biopsy results were excluded because of sampling errors. A total of 999 cases were included, and the collected reports encompassed results of smear cytology, HPV subtypes, and histologic examinations. Results Sensitivity and specificity of detecting high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC) were higher for Pap smears than for HPV tests (sensitivity, 97.14%; specificity, 85.58% for Pap smears; sensitivity, 88.32%; specificity, 54.92% for HPV tests). HPV tests and Pap smears did not differ greatly in detection of low-grade squamous intraepithelial lesion (85.35% for HPV test, 80.31% for Pap smears). When atypical glandular cells were noted on Pap smears, the likelihood for histologic diagnosis of adenocarcinoma following Pap smear was higher than that of high-risk HPV test results (18.8 and 1.53, respectively). Conclusions Pap smears were more useful than HPV tests in the diagnosis of HSIL, SCC, and glandular lesions.

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