Comparison of Conventional Pap Smear, Colposcopy, and HPV Testing in Diagnosis of CIN

Abstract

To access prevalence of repeated smears in routine health screening and comparison of its outcome with colposcopy, and HPV testing in early diagnosis of cervical neoplasia. Cross-sectional study. Cervical screening of 1200 healthy patients 21 years and above was carried out at health camp. Conventional Pap staining was done in all cases. Abnormal cases were subjected to further testing. The result of conventional Pap smear, repeat Pap smear, HPV test, and colposcopy was compared in repeated smears. Sensitivity specificity and area under curve (AUC) were calculated with 95% CI with standard histopathology. 31.08% (N = 373) cases were followed by a repeat Pap smear. Sensitivity for conventional Pap smear in detecting CIN was found to be 82.93% and specificity was 84.76%,while sensitivity and specificity for colposcopy were 99.8% and 96.19%, respectively. Sensitivity for HPV in detecting CIN was 48.94%. AUC for Pap was 0.851, 95% CI (0.783–0.905). AUC for colposcopy was 0.981, 95% CI (0.943–0.996). In a routine health camp, as many as 31.08% of cases were repeated. 12.4% of patient’s Pap was repeatedly abnormal which shows a high prevalence of undetected cervical pathology in population. Our study also shows colposcopy has more sensitivity and specificity in detecting CIN as compared to repeat Pap smear in cases of inflammatory reactive and ASCUS cases. HPV, however, has low sensitivity in comparison with both methods.