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Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic
K Nanda1, D C McCrory, E R Myers
1Duke University Medical Center and Durham Veterans Affairs Medical Center, North Carolina 27705, USA. knanda@fhi.org
Annals of Internal Medicine
|May 20, 2000
Summary
The conventional Papanicolaou (Pap) test for cervical cancer screening shows moderate accuracy, with significant variability and bias in studies. New cytologic methods lack sufficient data for evaluation.
Area of Science:
- Gynecologic Oncology
- Diagnostic Cytopathology
- Evidence Synthesis
Background:
- Cervical cancer screening relies heavily on Papanicolaou (Pap) testing.
- Evaluating the accuracy of conventional and novel Pap testing methods is crucial for effective screening programs.
Purpose of the Study:
- To systematically evaluate the diagnostic accuracy of conventional and newer Papanicolaou (Pap) testing methods for detecting cervical cancer and its precursors.
- To identify limitations in existing research and guide future study design.
Main Methods:
- A systematic literature search was conducted through October 1999, including MEDLINE and EMBASE.
- Studies comparing Pap testing methods (conventional, computer-assisted, monolayer cytology) against reference standards (histology, colposcopy, cytology) were included.
- Data extraction involved independent review by two researchers using 2x2 tables.
Main Results:
- Ninety-four studies on conventional Pap tests and three on monolayer cytology met inclusion criteria; no computerized screening studies were included.
- Estimates for sensitivity and specificity of conventional Pap tests varied widely across studies.
- In the least biased studies, conventional Pap test sensitivity ranged from 30% to 87%, and specificity from 86% to 100%.
Conclusions:
- High-quality data are insufficient to determine the accuracy of new cytologic methods for cervical screening.
- Most studies on conventional Pap tests suffer from significant bias, indicating only moderate accuracy.
- Future research should utilize robust reference standards, and cost-effectiveness models should incorporate conservative estimates of Pap test sensitivity.
