DETECTION OF HIGH-GRADE CERVICAL DYSPLASIA - IMPACT OF AGE AND BETHESDA SYSTEM TERMINOLOGY

Pap smear, colposcopy, and biopsy results were collected from 1988-199 3 at a group of family planning clinics. Positive predictive values an d likelihood ratios were calculated for diagnosis of high-grade lesion s based on age and Pap smear results. One thousand and forty-seven col poscopies were logged; 771 had a biopsy or endocervical curettage. Sev enty-nine (10%) were high-grade lesions. If only human papillomavirus (HPV) was reported on the Pap smear, the likelihood of a high-grade bi opsy was lowest (positive predictive value, 4.5%; likelihood ratio, 0. 4). Women under age 25 were less likely to have high-grade biopsies (p ositive predictive value, 7.3%; likelihood ratio 0.7). Repeat Pap smea rs for atypical cells of undetermined significance (ASCUS) and low gra de squamous intra-epithelial lesion (LGSIL) showing only HPV in women under age 30 would have reduced the immediate colposcopy rate by 60% a nd delayed diagnosis of 23% of high-grade lesions. Consideration of pa tient age and whether HPV is the only Pap smear finding may reduce ref erral for immediate colposcopy. (C) 1997 Wiley-Liss, Inc.