Toni Ricardo Martins1,2, Adhemar Longatto-Filho3,4,5,6,7, Diane Cohen8, Juliana Yukari Kodaira Viscondi9, Luiz Mario Fuza1,8, Lise Cury8, Luisa Lina Villa7,10,11, José Eduardo Levi1,7, José Eluf-Neto7,8,9. 1. Institute of Tropical Medicine, Virology Laboratory, Universidade de São Paulo, São Paulo, Brazil. 2. Department of Infectious Diseases, Universidade de São Paulo School of Medicine, São Paulo, Brazil. 3. Laboratory of Medical Investigation (LIM) 14, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil. 4. Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil. 5. Liffe and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. 6. ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. 7. Instituto Nacional de Ciência e Tecnologia das Doenças do Papilomavírus Humano, São Paulo, Brazil. 8. Fundação Oncocentro de São Paulo, São Paulo, Brazil. 9. Department of Preventive Medicine. 10. Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 11. Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
Abstract
OBJECTIVES: This study aimed to evaluate the influence of prior knowledge of human papillomavirus (HPV) status in cervical cytopathology readings. METHODS: Participants comprised 2,376 women who underwent parallel cytology and HPV-DNA testing. Smears were read twice by the same team, first with previous knowledge of HPV-DNA status. RESULTS: Overall, 239 (10.2%) smears had their cytology classification altered by the HPV-informed review. Cytology readings with prior knowledge of the HPV status revealed 10.5% of abnormal smears (atypical squamous cells of undetermined significance or higher), while without prior knowledge, this rate dropped to 7.6%. When HPV status was informed, a significant increase in all categories of altered smears was observed. Cytology with prior knowledge of HPV status detected more cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) compared with blinded: 86.7% vs 60.0%. CONCLUSIONS: Our data indicate that cytology interpreted with prior knowledge of the HPV status provides higher sensitivity for CIN 2+ lesions while marginally reducing the overall specificity compared with HPV status blinded cytology.
OBJECTIVES: This study aimed to evaluate the influence of prior knowledge of human papillomavirus (HPV) status in cervical cytopathology readings. METHODS: Participants comprised 2,376 women who underwent parallel cytology and HPV-DNA testing. Smears were read twice by the same team, first with previous knowledge of HPV-DNA status. RESULTS: Overall, 239 (10.2%) smears had their cytology classification altered by the HPV-informed review. Cytology readings with prior knowledge of the HPV status revealed 10.5% of abnormal smears (atypical squamous cells of undetermined significance or higher), while without prior knowledge, this rate dropped to 7.6%. When HPV status was informed, a significant increase in all categories of altered smears was observed. Cytology with prior knowledge of HPV status detected more cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) compared with blinded: 86.7% vs 60.0%. CONCLUSIONS: Our data indicate that cytology interpreted with prior knowledge of the HPV status provides higher sensitivity for CIN 2+ lesions while marginally reducing the overall specificity compared with HPV status blinded cytology.