Girianelli Vania Reis, Thuler Luiz Claudio Santos, Azevedo e Silva Gulnar
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
Universidade Federal do Estado do Rio de Janeiro, UNIRIO, Rio de Janeiro, RJ, Brazil.
Rev Bras Ginecol Obstet. 2016 Mar;38(3):147-53. doi: 10.1055/s-0036-1580712. Epub 2016 Mar 29.
To compare the predictive capability of HPV and Pap smear tests for screening pre-cancerous lesions of the cervix over a three-year follow-up, in a population of users of the Brazilian National Health System (SUS).
This is a retrospective cohort study of 2,032 women with satisfactory results for Pap smear and HPV tests using second-generation hybrid capture, made in a previous study. We followed them for 36 months with data obtained from medical records, the Cervix Cancer Information System (SISCOLO), and the Mortality Information System (SIM). The outcome was a histological diagnosis of cervical intraepithelial neoplasia grade 2 or more advanced lesions (CIN2+). We constructed progression curves of the baseline test results for the period, using the Kaplan-Meier method, and estimated sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios for each test.
A total of 1,440 women had at least one test during follow-up. Progression curves of the baseline test results indicated differences in capability to detect CIN2+ (p < 0.001) with significantly greater capability when both tests were abnormal, followed by only a positive HPV test. The HPV test was more sensitive than the Pap smear (88.7% and 73.6%, respectively; p < 0.05) and had a better negative likelihood ratio (0.13 and 0.30, respectively). Specificity and positive likelihood ratio of the tests were similar.
These findings corroborate the importance of HPV test as a primary cervical cancer screening.
在巴西国家卫生系统（SUS）的使用者群体中，比较人乳头瘤病毒（HPV）检测和巴氏涂片检测在三年随访期内筛查宫颈癌前病变的预测能力。
这是一项回顾性队列研究，研究对象为2032名在之前一项研究中进行第二代杂交捕获法HPV检测和巴氏涂片检测且结果满意的女性。我们通过医疗记录、宫颈癌信息系统（SISCOLO）和死亡信息系统（SIM）获取的数据，对她们进行了36个月的随访。结局指标是宫颈上皮内瘤变2级或更高级别病变（CIN2+）的组织学诊断。我们使用Kaplan-Meier方法构建了该时期基线检测结果的进展曲线，并估计了每项检测的敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比。
共有1440名女性在随访期间至少进行了一次检测。基线检测结果的进展曲线表明，在检测CIN2+方面存在差异（p < 0.001），当两项检测均异常时检测能力显著更强，其次是仅HPV检测呈阳性。HPV检测比巴氏涂片更敏感（分别为88.7%和73.6%；p < 0.05），且阴性似然比更好（分别为0.13和0.30）。两项检测的特异性和阳性似然比相似。
这些发现证实了HPV检测作为宫颈癌初筛的重要性。
