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Evaluation of Sensitivity and Specificity of Pap Smear, LBC and HPV in Screening of Cervical Cancer

  • Sangeeta Pankaj
  • Anita Kumari
  • Simi Kumari
  • Vijayanand Choudhary
  • Jaya Kumari
  • Anjili Kumari
  • Syed Nazneen
Original Article
  • 47 Downloads

Abstract

Background

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.

Objectives

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.

Results

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.

Conclusion

LBC has been found to be more superior to conventional smears only with respect to lesser number of unsatisfactory smears.

Keywords

Pap smear Liquid-based cytology HPV DNA Common female cancer Sensitivity and specificity 

Notes

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.

Ethical Approval

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

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.

References

  1. 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. 2.
    WHO guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls and women. WHO, 2013, p. 2.Google Scholar
  3. 3.
    Mallath MK, et al. The growing burden of cancer in India: epidemiology and social context. Lancet Oncol. 2014;15:e205–12.CrossRefPubMedGoogle Scholar
  4. 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
  5. 5.
    Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer. Lancet. 2013;382(9895):889–999.CrossRefPubMedGoogle Scholar
  6. 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
  7. 7.
    Sankaranarayanan R. Screening for cancer in low- and middle-income countries. Ann Glob Health. 2014;80:412–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine. 2012;30(Suppl. 5):F88–99.CrossRefPubMedGoogle Scholar
  9. 9.
    Ronco G, Dillner J, Elfstrom KM, Tunesi S, Snijders PJ, Arbyn M, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: followup of four European randomised controlled trials. Lancet. 2014;383:524–32.CrossRefGoogle Scholar
  10. 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
  11. 11.
    Moyer VA. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;156:880–91.CrossRefGoogle Scholar
  12. 12.
    Committee on Practice Bulletins. – Gynecology: ACOG Practice Bulletin Number 131: Screening for cervical cancer. Obstet Gynecol. 2012;120:1222–38.Google Scholar
  13. 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. 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
  15. 15.
    Nanda K, McCrory D, Myers E, Bastian LA, Hasselblad V, Hickey JD, Matchar DB. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med. 2000;132:810–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Grapsa D, Ioakim-Liossi A, Stergiou E, Petrakakou E, Nicolopoulou-Stamati P, Patsouris E, et al. Additional slides from residual ThinPrep Pap tests: of potential diagnostic benefit in equivocal cases? Diagn Cytopathol. 2012;40:856–60.CrossRefPubMedGoogle Scholar
  17. 17.
    Halford JA, Batty T, Boost T, Duhig J, Hall J, Lee C, et al. Comparison of the sensitivity of conventional cytology and the ThinPrep Imaging for 1,083 biopsy confirmed high-grade squamous lesions. Diagn Cytopathol. 2010;38:318–26.PubMedGoogle Scholar
  18. 18.
    Sharma J, Toi PC, Siddaraju N, Sundareshan M, Habeebullah S. A comparative analysis of conventional and SurePath liquid-based cervicovaginal cytology: a study of 140 cases. J Cytol Indian Acad Cytol. 2016;33(2):80–4.CrossRefGoogle Scholar
  19. 19.
    Singh VB, Gupta N, Nijhawan R, Srinivasan R, Suri V, Rajwanshi A. Liquid-based cytology versus conventional cytology for evaluation of cervical Pap smears: experience from the first 1000 split samples. Indian J Pathol Microbiol. 2015;58:17–21.CrossRefPubMedGoogle Scholar
  20. 20.
    Arbyn M, Sasieni P, Meijer CJ, Clavel C, Koliopoulos G, Dillner J. Chapter 9: clinical applications of HPV testing: a summary of meta-analyses. Vaccine. 2006;24:S78–89.CrossRefGoogle Scholar
  21. 21.
    Sangrajrang S, Laowahutanont P, Wongsena M, Muwonge R, Karalak A, Imsamran W, Senkomago V, Sankaranarayanan R. Comparative accuracy of Pap smear and HPV screening in Ubon Ratchathani in Thailand. Papillomavirus Res. 2017;3:30–5.CrossRefPubMedGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2018

Authors and Affiliations

  • Sangeeta Pankaj
    • 1
  • Anita Kumari
    • 1
  • Simi Kumari
    • 1
  • Vijayanand Choudhary
    • 2
  • Jaya Kumari
    • 1
  • Anjili Kumari
    • 1
  • Syed Nazneen
    • 1
  1. 1.Gynecological Oncology, RCCIndira Gandhi Institute of Medical SciencesPatnaIndia
  2. 2.PathologyIndira Gandhi Institute of Medical SciencesPatnaIndia

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