Comparison of human papillomavirus DNA polymerase chain reaction with cervical cytology as a screening test for the detection of cervical intraepithelial neoplasia

Abstract

Objective：To evaluate the result of the human papillomavirus (HPV) DNA polymerase chain reaction (PCR) in comparison with cervical cytology for the detection of cervical intraepithelial neoplasia (CIN) and invasive cancer, and to establish the more economic and effective screening method for CIN and invasive cancer. Methods：HPV DNA PCR test and cervical cytology were applied to 476 women, who were referred for abnormal cytology from April 2004 to March 2005 at National Health Insurance Corporation Ilsan Hospital. The results of both procedures were compared with the results of the histological diagnosis and we calculated and compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of cytology, HPV DNA PCR, and their combination, respectively. Results：The sensitivity, specificity, PPV and NPV for the detection of CIN or higher lesion were 98.3%, 64.4%, 82.4%, and 95.7% for HPV DNA PCR; 82.9%, 72.9%, 83.8% and 71.7% for cytology; 100%, 48.6%, 76.7%, and 100% for the combination test. The sensitivity and NPV value of cytology showed statistically significant differences (p＜0.05) compared with those of HPV PCR and combination test. The PPV value of combination test showed statistically significant difference compared with those of cytology and HPV PCR. The specificity of three tests were alike (p＞0.05). The sensitivity of three tests for the detection of CIN 2, 3 or higher lesion showed no statistically significant differences. Conclusion：The routine application of HPV DNA PCR or combination test as a screening tools for the detection of CIN and invasive cancer seems to be inappropriate in view of effectiveness. But the HPV DNA PCR can be used as a valuable adjunct to cervical cytology for the triage of women with minimal abnormality in her cytology to determine the treatment and follow-up plan.