SCREENING FOR CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 2 3 - VALIDITYOF CYTOLOGIC STUDY, CERVICOGRAPHY, AND HUMAN PAPILLOMAVIRUS DETECTION/

OBJECTIVE: A commercial test for human papillomavirus detection (hybri d capture assay) was examined for its potential value to augment the s ensitivity of cytologic study or cervicography for screening for cervi cal intraepithelial neoplasia grade 2/3. STUDY DESIGN: In a cohort of 967 women with a mean age of 37.1 years who underwent routine cytologi c screening, cytologic examination, cervicography, and testing for hig h-risk human papillomavirus by the hybrid capture assay were compared for their ability to detect cervical intraepithelial neoplasia grade 2 /3. Cervical punch biopsy specimens were taken in 20.5% (198/967) pati ents because they had an atypical or positive cervigram or abnormal cy tologic results in the primary screening smears. The data were analyze d by two-tailed chi(2) and Fisher's exact test. RESULTS: Thirty-eight patients were diagnosed with cervical intraepithelial neoplasia grade 2/3 (prevalence 3.9%) by histologic study. Cytologic study identified 29%, cervicography 45%, and testing for high-risk human papillomavirus 50% of cervical intraepithelial neoplasia grade 2/3. When combined, d etection of high-risk human papillomavirus or cervicography augmented sensitivity of cytologic study to 58% (p = 0.01) with positive predict ive values of 23% and 17%, respectively. Results of the different tech niques should be interpreted in relationship to each other and not as absolute values because collection of specimens for cytologic study wa s done with cotton swabs, which may be suboptimal for screening but is general practice in Germany. CONCLUSIONS: Screening for cervical intr aepithelial neoplasia grade 2/3 can significantly be improved by human papillomavirus testing with the hybrid capture assay.