Crude and corrected diagnostic indexes for cytology alone, HPV testing, and their combination in primary screening of cervical lesions ascertained by colposcopy and histologya
| Screening test | Definition of positive result | Uncorrected (relative) estimatesb | Corrected estimatesb | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sensitivity | Specificity | PPV | NPV | Sensitivity | Specificity | PPV | NPV | |||||||||||
| A. CIN-I or worse lesions | ||||||||||||||||||
| Pap cytology | ASCUS or worse | 45.0 | 64.0 | 46.9 | 62.2 | 14.2 | 92.9 | 45.2 | 72.4 | |||||||||
| LSIL or worse | 28.4 | 84.1 | 55.8 | 62.4 | 8.4 | 97.3 | 56.0 | 72.0 | ||||||||||
| HSIL or worse | 7.1 | 94.6 | 48.0 | 59.0 | 2.0 | 99.1 | 48.3 | 71.0 | ||||||||||
| HPV test | Positive | 62.1 | 66.1 | 56.5 | 71.2 | 20.8 | 93.3 | 56.3 | 74.0 | |||||||||
| Combination | HPV+ or ≥ ASCUS | 78.1 | 45.2 | 50.2 | 74.5 | 26.3 | 88.9 | 49.4 | 74.5 | |||||||||
| HPV+ or ≥ LSIL | 70.4 | 59.8 | 55.3 | 74.1 | 23.3 | 92.2 | 55.4 | 74.4 | ||||||||||
| HPV+ or ≥ HSIL | 63.9 | 63.6 | 55.4 | 71.4 | 21.3 | 92.9 | 55.4 | 74.1 | ||||||||||
| B. CIN-II/III or worse lesions | ||||||||||||||||||
| Pap cytology | ASCUS or worse | 55.9 | 61.8 | 11.7 | 93.9 | 40.2 | 91.6 | 10.7 | 98.4 | |||||||||
| LSIL or worse | 38.2 | 80.5 | 15.1 | 93.5 | 26.8 | 96.2 | 15.0 | 98.1 | ||||||||||
| HSIL or worse | 20.6 | 95.2 | 28.0 | 93.0 | 14.2 | 99.1 | 28.1 | 97.9 | ||||||||||
| HPV test | Positive | 85.3 | 58.0 | 15.6 | 97.7 | 68.1 | 90.6 | 15.4 | 99.1 | |||||||||
| Combination | HPV+ or ≥ ASCUS | 97.1 | 38.5 | 12.5 | 99.3 | 76.3 | 85.9 | 12.0 | 99.3 | |||||||||
| HPV+ or ≥ LSIL | 97.1 | 51.3 | 15.3 | 99.5 | 76.3 | 89.3 | 15.2 | 99.3 | ||||||||||
| HPV+ or ≥ HSIL | 91.2 | 56.1 | 15.9 | 98.6 | 72.0 | 90.3 | 15.7 | 99.2 | ||||||||||
a The colposcopical diagnosis was used if no histological information was available.
b Relative to lesion grade diagnosed: any CIN or worse in A and only CIN-II/III or worse in B. Corrected estimates control for the verification bias caused by preferential colposcopy referral of positive cases.