Skip to main content
Log in

Complementary Procedures in Cervical Cancer Screening in Low Resource Settings

  • Original Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Objective

To evaluate the efficacy of pap smear, HPV DNA testing and colposcopy and to determine the approach for cervical cancer screening in low resource settings.

Methods

Eight hundred non pregnant married women above 30 years of age were studied and subjected to pap smear examination. Hysterectomised women were excluded from the study. Selected patients were followed by HPV DNA testing by Hybrid Capture II method, colposcopy and biopsy. Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV), diagnostic accuracy and kappa value (k) were calculated for each screening test.

Result

Out of eight hundred women with mean age 36.5 ± 5.94 years undergoing pap smear, ASCUS was found in 66(8.25%), ASC-H in 2(0.25%), LSIL in 48(6%), HSIL in 8(1%), inflammatory in 540(67.5%). Out of 260 women who underwent HPV DNA testing, 120 (46.15%) had abnormal cytology and/or positive HPV DNA test (Group I, n = 120) and 140(53.8%) had dual negative results (Group II, n = 140) HPV DNA test was found positive in 64 women (53.3%) in Group I. Sensitivity and specificity of pap smear was 69.2 and 63.72% while for HPV DNA testing was 92.3 and 84% respectively. PPV and NPV of pap smear, HPV DNA testing and colposcopy was 18, 40, 76.4% and 94.7, 98.9, 100% respectively. Diagnostic accuracy of pap smear (k = 0.14), HPV DNA test (k = 0.70) and colposcopy (k = 0.81) was 64.29, 84.9, and 96.8% respectively. Combining pap smear & HPV DNA testing (k = 0.25) increased the sensitivity and NPV to 100%.

Conclusion

Sensitivity and diagnostic accuracy of HPV DNA test is more than that of pap smear and the test is not influenced by inflammatory conditions of vagina. In low resource settings, women with ASCUS and LSIL on cervical cytology should be subjected to HPV DNA test and only if found positive should be referred for colposcopy thereby reducing colposcopy referrals. Women with HSIL should be directly subjected to colposcopy guided biopsy. Using this approach, most of the preinvasive cervical lesion will be detected but few cases will still be missed among inflammatory smears, if HPV DNA testing is not supplemented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lin C, Tseng C, Lai C, et al. High-risk HPV DNA detection by hybrid capture II. J Reprod Med. 2000;45:345–50.

    PubMed  CAS  Google Scholar 

  2. Clavel C, Masure M, Bory J, et al. Hybrid capture II-based human papillomavirus detection, a sensitive test to detect in routine high grade cervical lesions: a preliminary study on 1518 women. Br J Cancer. 1999;80(9):1306–11.

    Article  PubMed  CAS  Google Scholar 

  3. Petry K, Menton S, Menton M, et al. Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: results for 8466 patients. Br J Cancer. 2003;88:1570–7.

    Article  PubMed  Google Scholar 

  4. Ratnam S, Franco EL, Ferenczy A. Human papillomavirus testing for primary screening of cervical cancer precursors. Cancer Epidemiol, Biomark Prev. 2000;9:941–51.

    Google Scholar 

  5. Kumar K, Iyer VK, Bhatla N, et al. Comparative evaluation of smear cytology & hybrid capture II for the diagnosis of cervical cancer. Indian J Med Res. 2007;126:39–44.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ragini Mehrotra.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Katyal, S., Mehrotra, R. Complementary Procedures in Cervical Cancer Screening in Low Resource Settings. J Obstet Gynecol India 61, 436–438 (2011). https://doi.org/10.1007/s13224-011-0067-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-011-0067-y

Keywords

Navigation