A comparison of four screening methods for cervical neoplasia.

OBJECTIVE: To evaluate the sensitivity and accuracy of 4 screening methods for cervical neoplasia. METHODS: Cervical samples from 450 women were evaluated for human papillomavirus DNA with a second-generation hybridization assay. Visual inspection, colposcopy, and liquid-based cytology were also performed for 273 of these women. The sensitivity, specificity, efficiency, positive predictive value (PPV), negative predictive value (NPV), Youden index, and kappa value of the different screening methods were compared. RESULTS: Liquid-based cytology was superior in specificity (98.63%) and PPV (92.86%) to visual inspection and colposcopy, while human papillomavirus DNA testing was superior in sensitivity (88.89%) and NPV (97.10%) to visual inspection and colposcopy. The best concordance with histologic findings was achieved by using both liquid-based cytology and viral DNA hybridization. CONCLUSION: Visual inspection and colposcopy should not be used when screening for early stage cervical lesions. The DNA hybridization assay is the best choice in primary screening, if available. Screening should begin at the age of 20 years.