Virchows Archiv

, Volume 460, Issue 6, pp 577–585 | Cite as

Performance characteristics of Pap test, VIA, VILI, HR-HPV testing, cervicography, and colposcopy in diagnosis of significant cervical pathology

  • Adhemar Longatto-FilhoEmail author
  • Paulo Naud
  • Sophie FM Derchain
  • Cecília Roteli-Martins
  • Sílvio Tatti
  • Luciano Serpa Hammes
  • Luis Otavio Sarian
  • Mojca Eržen
  • Margherita Branca
  • Jean Carlos de Matos
  • Renata Gontijo
  • Marina Y. S. Maeda
  • Temístocles Lima
  • Silvano Costa
  • Stina Syrjänen
  • Kari Syrjänen
Original Article


We sought to evaluate the performance of diagnostic tools to establish an affordable setting for early detection of cervical cancer in developing countries. We compared the performance of different screening tests and their feasibility in a cohort of over 12,000 women: conventional Pap smear, liquid-based cytology, visual inspection with acetic acid (VIA), visual inspection with Iodine solution (VILI), cervicography, screening colposcopy, and high-risk human papillomavirus (HPV) testing (HR-HPV) collected by physician and by self-sampling. HR-HPV assay collected by the physician has the highest sensitivity (80 %), but high unnecessary referrals to colposcopy (15.1 %). HR-HPV test in self-sampling had a markedly lower (57.1 %) sensitivity. VIA, VILI, and cervicography had a poor sensitivity (47.4, 55, and 28.6 %, respectively). Colposcopy presented with sensitivity of 100 % in detecting CIN2+, but the lowest specificity (66.9 %). Co-testing with VIA and VILI Pap test increased the sensitivity of stand-alone Pap test from 71.6 to 87.1 % and 71.6 to 95 %, respectively, but with high number of unnecessary colposcopies. Co-testing with HR-HPV importantly increased the sensitivity of Pap test (to 86 %), but with high number of unnecessary colposcopies (17.5 %). Molecular tests adjunct to Pap test seems a realistic option to improve the detection of high-grade lesions in population-based screening programs.


Cancer prevention Pap test Hybrid capture Colposcopy Screening program 



This study has been supported by the European Commission, INCO-DEV Programme (contract# ICA4-CT-2001-10013). The generous contribution of DIGENE Corporation (USA) donating the HCII tests at our disposal is gratefully acknowledged.

Conflict of interest

The authors declare that any conflict of interest, mainly financial agreement with companies whose products, are alluded to in the paper.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Adhemar Longatto-Filho
    • 1
    • 2
    • 3
    Email author
  • Paulo Naud
    • 4
  • Sophie FM Derchain
    • 5
  • Cecília Roteli-Martins
    • 6
  • Sílvio Tatti
    • 7
  • Luciano Serpa Hammes
    • 4
    • 8
  • Luis Otavio Sarian
    • 5
  • Mojca Eržen
    • 9
  • Margherita Branca
    • 10
  • Jean Carlos de Matos
    • 4
  • Renata Gontijo
    • 5
  • Marina Y. S. Maeda
    • 11
  • Temístocles Lima
    • 6
  • Silvano Costa
    • 12
  • Stina Syrjänen
    • 13
  • Kari Syrjänen
    • 14
  1. 1.Life and Health Sciences Research Institute (ICVS), School of Health SciencesUniversity of MinhoBragaPortugal
  2. 2.ICVS/3B’s—PT Government Associate LaboratoryBragaPortugal
  3. 3.Laboratory of Medical Investigation (LIM) 14, Faculty of MedicineUniversity of São PauloSão PauloBrazil
  4. 4.Hospital de Clinicas de Porto AlegrePorto AlegreBrazil
  5. 5.Universidade Estadual de CampinasCampinasBrazil
  6. 6.Hospital Leonor Mendes de Barros (HLMB)São PauloBrazil
  7. 7.First Chair Gynecology Hospital de ClinicasBuenos AiresArgentina
  8. 8.Institute of Education and ResearchHospital Moinhos de VentoPorto AlegreBrazil
  9. 9.SIZE Diagnostic CenterLjubljanaSlovenia
  10. 10.Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of HealthNational Institute of Health (ISS)RomeItaly
  11. 11.Adolfo Ltz InstiuteSão PauloBrazil
  12. 12.Department of Obstetrics and GynecologyS.Orsola-Malpighi HospitalBolognaItaly
  13. 13.Department of Oral PathologyUniversity of TurkuTurkuFinland
  14. 14.Department of Oncology and RadiotherapyTurku University HospitalTurkuFinland

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