Cross-sectional study of patient- and physician-collected cervical cytology and human papillomavirus

Obstet Gynecol. 2003 Aug;102(2):266-72. doi: 10.1016/s0029-7844(03)00517-9.


Objective: To compare the performance of patient- and physician-obtained cytology and human papillomavirus (HPV) testing for the detection of high-grade cervical intraepithelial neoplasia.

Methods: A cross-sectional study was performed involving 334 women seen at three colposcopy clinics (Tucson, Arizona; Hermosillo, Mexico; and Lima, Peru). All women used a cytobrush to self-collect specimens for cervical cytology and HPV testing. Subjects subsequently underwent physician collection for cytology and HPV, followed by a complete colposcopic evaluation with directed biopsy. Cytology was processed using thin-layer technology, and HPV was determined using the polymerase chain reaction technique. Test performance characteristics were determined using the histopathologic diagnosis as the reference standard and designating high-grade cervical intraepithelial neoplasia as clinically significant disease for the purpose of the analysis.

Results: The sensitivity of patient-collected cytology was significantly lower (55.0%) and specificity was significantly better (84.1%) than those of physician-directed sampling (85.2% and 73.4%, respectively). Patient-collected HPV had significantly lower sensitivity (49.0%) than physician sampling (82.2%), although specificity did not significantly differ.

Conclusion: Patient collection is a feasible although inferior alternative to physician-collected cervical cytology and HPV testing.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cervical Intraepithelial Neoplasia / pathology*
  • Cross-Sectional Studies
  • Feasibility Studies
  • Female
  • Humans
  • Middle Aged
  • Papillomaviridae*
  • Papillomavirus Infections / diagnosis*
  • Sensitivity and Specificity
  • Tumor Virus Infections / diagnosis*
  • Uterine Cervical Neoplasms / pathology*
  • Vaginal Smears / methods*