Costa S, Sideri M, Syrjänen K, Terzano P, De Nuzzo M, De Simone P, Cristiani P, Finarelli A C, Bovicelli A, Zamparelli A, Bovicelli L
Department of Obstetrics and Gynecology, University of Bologna, Italy.
Acta Cytol. 2000 May-Jun;44(3):310-8. doi: 10.1159/000328471.
The sensitivity of the Pap smear (PAP) continues to be the subject of debate. During the past several years, cervicography (CER) and HPV DNA testing have been suggested as optional tools in the screening of cervical cancer precursors.
The performance characteristics of PAP, CER and HPV DNA testing (hybrid capture test [HCT]) in all potential combinations were evaluated in a series of 1,030 women (aged 16-70, median, 33), subjected to colposcopy (COLPO) as the reference tool.
Of the 992 evaluable cases, 402/992 (41%) had positive COLPO (i.e., an abnormal transformation zone). Of them, 298 women underwent directed punch biopsy, while of the COLPO negative patients, 18/93 positive by at least one of the three tests had endocervical curettage. Of the 402 COLPO positive women, 146 (36%) remained negative on all tests, whereas 256 (64%) had at least one positive test. There were 84 cervical intraepithelial neoplasia (CIN) 2 and 3 lesions and 6 invasive carcinomas. Of the former, 10 were detected by PAP alone, 4 by CER alone and 3 by HCT alone. Three of the 6 carcinomas were HCT negative. The predictive value (PPV) of a positive test was 45% for PAP, 51% for CER and 48% for HCT. The combinations of PAP with CER (for PAP negative cases) and PAP with HCT were more sensitive for CIN 2 and 3 (95% and 94%, respectively) as compared with PAP alone but were associated with a significant decrease in specificity (44% and 46% vs. 57%, respectively). However, both combinations retained a PPV (43%) similar to that of PAP alone (45%).
The potential combinations of PAP with CER and with HCT were more sensitive in detecting CIN 2 and 3 as compared with PAP alone and retained a PPV similar to that of PAP.
巴氏涂片（PAP）的敏感性仍然是一个有争议的话题。在过去几年中，宫颈图像检查（CER）和人乳头瘤病毒（HPV）DNA检测已被建议作为筛查宫颈癌前病变的可选工具。
以阴道镜检查（COLPO）作为参考工具，对1030名年龄在16至70岁（中位数为33岁）的女性进行了一系列检测，评估了PAP、CER和HPV DNA检测（杂交捕获试验[HCT]）在所有可能组合中的性能特征。
在992例可评估病例中，402/992（41%）阴道镜检查结果为阳性（即转化区异常）。其中，298名女性接受了直接活检，而在阴道镜检查阴性的患者中，18/93至少一项检测呈阳性的患者接受了宫颈管刮除术。在402例阴道镜检查阳性的女性中，146例（36%）所有检测均为阴性，而256例（64%）至少有一项检测呈阳性。共有84例宫颈上皮内瘤变（CIN）2级和3级病变以及6例浸润癌。在前者中，10例仅通过PAP检测出，4例仅通过CER检测出，3例仅通过HCT检测出。6例癌中有3例HCT检测为阴性。检测阳性的预测值（PPV），PAP为45%，CER为51%，HCT为48%。与单独使用PAP相比，PAP与CER（针对PAP阴性病例）以及PAP与HCT的组合对CIN 2级和3级的检测更敏感（分别为95%和94%），但特异性显著降低（分别为44%和46%，而单独使用PAP时为57%）。然而，两种组合的PPV（43%）与单独使用PAP时的PPV（45%）相似。
与单独使用PAP相比，PAP与CER以及PAP与HCT的潜在组合在检测CIN 2级和3级病变时更敏感，且保留了与PAP相似的PPV。
