Evaluation of Sensitivity and Specificity of Pap Smear, LBC and HPV in Screening of Cervical Cancer
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Cervical cancer ranks as the fourth leading cause of female cancer in the world, and it is the second most common female cancer in women aged 15–44 years. Strict implementation of screening programs has led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. Conventional Pap smear method has been the mainstay of most of the screening programs since decades. However, this technique is not without limitations and the sensitivity and specificity of cervical cytology are relatively low. To overcome the limitations of conventional Pap smear, liquid-based cytology was introduced in 1990s as a better tool for processing cervical samples. HPV testing alone or with cytology triage is currently increasingly being used as a primary screening approach for cervical neoplasia.
The present study was undertaken to evaluate sensitivity and specificity of conventional Pap smear, liquid-based cytology and HPV DNA in our setting.
Materials and Methods
This study was conducted in Gynecological Oncology unit at Indira Gandhi Institute of Medical Sciences, Patna, Bihar. In total, 1500 women were enrolled in this study and sample was taken for conventional cytology, liquid-based cytology and HPV DNA. The smears were studied in detail and were interpreted as per the Bethesda system of reporting Pap smears. The results were compared and analyzed statistically.
Approximately 5% patients having epithelial cell abnormalities on Pap smear, 5.33% on LBC and 6.86% had abnormal report on HPV DNA testing. Unsatisfactory smears were more commonly reported by conventional method (7.2%) than by liquid-based method (1.62%), and this difference is statistically significant. There was no difference in the detection of epithelial cell abnormalities by both the methods. Sensitivity of Pap smear, LBC and HPV DNA was 75.80%, 76.47% and 89.89%, respectively. Specificity of Pap smear, LBC and HPV DNA was 98.05%, 98.93 and 98.00%, respectively.
LBC has been found to be more superior to conventional smears only with respect to lesser number of unsatisfactory smears.
KeywordsPap smear Liquid-based cytology HPV DNA Common female cancer Sensitivity and specificity
Compliance with Ethical Standards
Conflict of interest
We declare that this manuscript is original, has not been published anywhere before and is not currently being considered for publication elsewhere. We also confirm that the authors do not have any conflict of interest associated with publication of this work, and no significant financial support/funding for this work has been received to influenced the outcome. The manuscript is read and approved and consent is given by all the authors. We give our permission to reproduce any material of the article.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.
- 1.Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.0. Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. Lyon, IARC, 2013.Google Scholar
- 2.WHO guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls and women. WHO, 2013, p. 2.Google Scholar
- 4.PR 223-Latest world cancer statistics Global cancer burden rises to 14.1 million new cases in 2012: marked increase in breast cancers must be addressed. IARC, 12 December 2013.Google Scholar
- 6.Bruni L, Barrionuevo-Rosas L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 19 April 2017.Google Scholar
- 10.Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER. ACS-ASCCP-ASCP Cervical Cancer Guideline Committee: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62:147–72.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Committee on Practice Bulletins. – Gynecology: ACOG Practice Bulletin Number 131: Screening for cervical cancer. Obstet Gynecol. 2012;120:1222–38.Google Scholar
- 13.Vicus D, Sutradhar R, Lu Y, Elit L, Kupets R, Paszat L, Investigators of the Ontario Cancer Screening Research Network. The association between cervical cancer screening and mortality from cervical cancer: a population based case–control study. Gynecol Oncol. 2014;133:167–71.CrossRefPubMedGoogle Scholar
- 14.IARC. Working group on the evaluation of carcinogenic risks to humans: human papilloma viruses. IARC Monogr Eval Carcinog Risks Hum 100(Pt B);255–313, 201.Google Scholar