Screening for cervical intraepithelial neoplasia grade 2/3: Validity of cytologic study, cervicography, and human papillomavirus detection☆,☆☆,★,★★
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MATERIAL AND METHODS
We studied 967 nonpregnant women with a mean age of 37.1 years (range 15 to 76 years) who had no history of conization, hysterectomy, or cervical intraepithelial neoplasia or atypical cytologic results in a cervical smear within 1 year before examination. These women underwent routine screening by two gynecologist (V.S. and R.K.) between August 1992 and October 1993. On examination, first a Dacron-tipped swab was applied to the ectocervix and endocervix and to the posterior vaginal vault to
RESULTS
The presence of high-risk HPVs was age dependent, with a peak at 20 to 25 years (Fig. 1). In women <35 years old (42/444, 9.5%) the prevalence of high-risk HPVs was significantly higher than in older women (18/523, 3.4%) (p = 0.0003). The highest rate of suspicious or pathologic cervigrams and cytologic smears was observed in the age group of 20 to 30 years. The prevalence of histologically confirmed cervical intraepithelial neoplasia grade 2/3 in women <35 years old (30/444, 6.8%) was
COMMENT
We found a higher prevalence of cervical intraepithelial neoplasia grade 2/3 than expected (38 vs 20 cases). The prevalence of cervical intraepithelial neoplasia measured by cytologic study in a population with a fairly equal age distribution is approximately 1% (483/55,854, 0.84%).13 This is similar to the prevalence found in our study cohort by cytologic study (11/967, 1.1%) showing a comparable age profile (Fig. 1). Augmenting cytologic study by cervicography increases cervical
Acknowledgements
We thank Volker Schneider, MD, Freiburg, Germany, for histologic evaluation of all biopsy material.
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Cited by (93)
Screening capacity and cost-effectiveness of the human papillomavirus test versus cervicography as an adjunctive test to Pap cytology to detect high-grade cervical dysplasia
2019, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :However, those studies were conducted among selected populations in developed countries and the findings were inconsistent with our study. Schneider et al. analyzed 967 German women with a mean age of 37.1 years who underwent routine Pap cytology, cervicography, and the HPV test using the hybrid capture assay method to detect CIN2+ lesions [12]. They reported that the sensitivity of Pap and cervicography co-testing was comparable to that of Pap and HPV co-testing (both 58%), while the specificity of Pap and cervicography co-testing was lower than Pap and HPV co-testing (88% versus 92%).
Molecular targets in gynaecological cancers
2007, PathologyPrimary cervical cancer screening by self-sampling of human papillomavirus DNA in internal medicine outpatient clinics
2004, Annals of OncologyCitation Excerpt :Considering only Internal Medicine and Family Practice clinic visits, 70% had been seen at least once and 42% had been seen three or more times in the 3 years preceding their diagnosis. Previous studies have demonstrated the usefulness of adjunctive human papillomavirus DNA testing as a complement to cytology in primary screening [7–10]. Patient-obtained vaginal samples (self-sampling) for analysis of HPV DNA has a sensitivity for detection of high-grade cervical lesions and invasive cancer that is equivalent or even superior to that of a Pap smear [11, 12].
Management of women who test positive for high-risk types of human papillomavirus: The HART study
2003, LancetCitation Excerpt :Regression of HPV (positive becoming negative) within 6–12 months occurred in 45% of women who were initially negative on cytology, and 35% of women initially borderline on cytology. Our results show that HPV testing for a group of high-risk virus types is a more sensitive primary screening technique than cytology for detecting high-grade CIN, confirming the findings of other studies.2,4–12 Therefore, use of HPV testing in addition to cytology would improve the detection rate of high-grade CIN and should prevent more cancers than use of cytology alone.
Human papillomavirus and cervical cytology in adolescents
2004, Adolescent Medicine Clinics
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From the Department of Gynecology, Friedrich Schiller University,aand private practice.b
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Supported by the Cancer Society Baden Württemberg.
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Reprint requests: A. Schneider, MD, MPH, Department of Gynecology, Friedrich Schiller University, Bachstr. 18, 07740 Jena, Germany.
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0002-9378/96 $5.00 + 0 6/1/70441