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HPV testing helps stratify cervical cancer risk when Pap smear is equivocal
  NEW YORK (Reuters Health) - Testing for human papillomavirus (HPV) DNA is better than a repeat Pap smear at assessing the malignant potential of equivocal cytologic results, according to findings from a new study.
The findings are based on a meta-analysis of data from 15 recent studies that looked at HPV DNA testing and repeat Pap testing as a way to clarify smears showing atypical squamous cells of undetermined significance (ASCUS). The report is published in the Journal of the National Cancer Institute for February 18.
Dr. Marc Arbyn, from the Scientific Institute of Public Health in Brussels, Belgium, and colleagues found that HPV testing was 84.4% sensitive and 72.9% specific in identifying cases of cervical intraepithelial neoplasia of grade II or higher.
When the analysis was limited to the eight studies that used the recently developed Hybrid Capture II assay, the sensitive rose to 94.8%, while the specificity dropped to 67.3%.
In comparison, the sensitivity of repeat Pap testing was just 81.8% with a specificity of 57.6%. Depending on the cytologic threshold used, however, the specificity of repeat testing sometimes exceeded that of HPV testing.
"The Hybrid Capture II assay is a better triage method than repeat cytology for women with ASCUS," the researchers conclude.
The results are "helpful in solidifying our understanding of HPV DNA testing and repeat cytology in the triage of equivocal Pap tests and in directing the course of future research," Dr. Diane Solomon and Dr. Mark Schiffman, from the National Institutes of Health in Rockville, Maryland, note in a related editorial.
Still, there is the hope that new markers of cancer risk will be identified that are even better predictors than cytology or HPV DNA testing, they add.
J Natl Cancer Inst 2004;96:250-251,280-293.


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