REFLEX HUMAN-PAPILLOMAVIRUS DEOXYRIBONUCLEIC-ACID TESTING IN WOMEN WITH ABNORMAL PAPANICOLAOU SMEARS

OBJECTIVE: The study examined interrelationships between sensitivity a nd specificity of ''reflex human papillomavirus deoxyribonucleic acid testing'' from liquid-based cervical cytologic specimens by means of r eceiver operator characteristics curves. STUDY DESIGN: A cohort study was performed on 265 women evaluated by colposcopy because of atypical squamous cells of undetermined significance or low-grade squamous int raepithelial lesion found on Papanicolaou smear. RESULTS: At a positiv e threshold of 0.2 pg/ml (1000 copies of human papillomavirus per test ), human papillomavirus deoxyribonucleic acid testing detected 86% of women with cervical intraepithelial neoplasia and 93% of women with hi gh-grade cervical intraepithelial neoplasia with a specificity of 30%. Decreasing the sensitivity of the human papillomavirus test to 1 pg/m l (5000 copies of human papillomavirus per test) improved the specific ity of a positive result to 44% but decreased the clinical sensitivity to 78% for cervical intraepithelial neoplasia grade 2 or 3. Relations hips between sensitivity and specificity were influenced by patient ag e and referral diagnosis. For example, limiting the analysis to only w omen with a referral for atypical squamous cells of undetermined signi ficance found on Papanicolaou smear and a positive human papillomaviru s test threshold of 0.5 pg/ml produced a sensitivity of 90% for cervic al intraepithelial neoplasia grade 2 or 3 and a test specificity of 55 %. CONCLUSION: Human papillomavirus deoxyribonucleic acid testing of r esidual cellular material from liquid cytologic specimens appears to b e more appropriate for older women (>30 years old) and women with atyp ical squamous cells of undetermined significance, as opposed to low-gr ade squamous intraepithelial lesion, on their Papanicolaou smears.