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  • kcam57 kcam57 Dec 30, 2007 5:17 PM Flag

    Pap Smears

    Not that it matters all that much now...

    In this month's Green Journal..

    Liquid Compared With Conventional Cervical Cytology: A Systematic Review and Meta-analysis

    "Liquid-based cervical cytology is neither more sensitive nor more specific for detection of high-grade cervical intraepithelial neoplasia compared with the conventional Pap test. "

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    • wow, pretty damning, and it's by Arbyn and the European folks...doesn't bode well for lbp as the next step in the EU


      <<In 2007, only eight studies and one well-conducted randomized trial are available that allow unbiased evaluation of the accuracy of liquid-based cytology for histologically confirmed CIN 2 or worse. Pooling of these studies indicated that liquid-based cytology is neither more sensitive nor more specific than conventional Pap and these findings were rather consistent over study design, clinical settings, and liquid-based cytology systems.>>

      and sawaya:

      <<The review reveals a surprising lack of high-quality studies performed in screening settings. The recent landmark Italian randomized trial, however, is an exception and deserves focused attention.4 Over 45,000 women aged 25–60 years were randomized to either liquid-based or conventional cytology. Colposcopy was performed in all women with atypical squamous cells of undetermined significance or worse. In comparing these techniques head-to-head, two important clinical questions were answered. First, liquid-based tests were more likely to be interpreted as abnormal and equivocal. Second, despite more positive tests, liquid-based cytology did not lead to detection of more high-grade cervical intraepithelial neoplasia (CIN). In other words, all extra-positive tests appeared to be falsely positive. Arbyn's meta-analysis of summary data showed similar results.>>

      <<Although navigating the ever-mounting morass of new information is daunting, clinicians should be aware that help is available. For example, the U.S. Preventive Services Task Force systematically reviews evidence and issues recommendations that are designed to maximize benefits and minimize harms. Of note, the Preventive Services Task Force considers evidence about liquid-based cytology and HPV testing to be insufficient to make a recommendation.9 However, evidence from large-scale randomized trials using HPV testing for screening is emerging.>>

      and the preliminary conclusions of the one study cited by arbyn and sawaya that was done properly, the ronco study:

      <<CONCLUSIONS: HPV testing, if used as screening test, should be applied alone, with cytology triage essential in younger women but preferable at all ages. Follow-up data will allow analysis of the safety of prolonging screening intervals and the relative persistence of lesions detected with different methods.>>

      horse is out of the barn in the US but eventually, as we predicted long ago, the EU will likely move to hpv reflex pap...but who knows when!!!

    • Also has a lead editorial on the subject by none other than Dr. Sawaya..

      He of course, manages to bad mouth HPV testing as well, but does grudgingly acknowledge the "emerging" literature on using HPV as a screening test.

      I bet he still uses a typewriter<gg>

      • 1 Reply to kcam57
      • lol, can't wait to read does and it doesn't matter i doesn't matter because lbp is soc here no matter what now, in part because of great sales and marketing, but also because of convenience and less sblb's which isn't trivial, and testing out of the vial

        it does matter because if you want to prove you're using the most sensitive test you better, grudgingly, admit that you have to dwp

        happy new year to you KC and to one and all of the old everyone a healthy and fulfilling 2008!

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