Value of Conventional Pap Smear, Liquid-Based Cytology, Visual Inspection and Human Papillomavirus Testing as Optional Screening Tools Among Latin American Women <35 and ≥35 Years of Age: Experience from the Latin American Screening Study

Objective To compare performance of conventional Pap test, liquid-based cytology (LBC) and visual inspection. with acetic acid (VLA), as well as human papillomavirus (HPP) testing in, 2 subcohorts of women, <35 and >= 35 years of age. Study Design Performance indicators were calculated using colposcopic biopsies as the gold standard; all results were corrected for verification bias using maximum likelihood. Results Both conventional Pap test and Hybrid Capture 2 (HC2) assay Performed significantly better among older women than younger; no difference was observed in performance of LBC and VIA, both infierior to Pap and HC2. The Pap test was more specific than HC2 in both subcohorts; HC2 had the highest sensitivity. For individual tests, the best balance between sensitivity and specificity was obtained for HC2 assay corrected for verification bias in the older women's subcohort; this was further improved by the combined use of the Pap test and HC2. Conclusion Age of the target population is an important determinant of the performance of different screening tests. The choice of optimal test for women < 35 and >= 35 years of age depends on whether the highest positive predictive value (Pap test) Conclusion Age of the target population is an important determinant of the performance of different screening tests. The choice of optimal test for women < 35 and >= 35 years of age depends on whether the highest positive predictive value (Pap test) or the best SE/SP balance (HC2) is used as the selection criterion. (Acta Cytol 2008;52:641-653)