Accuracy of the Papanicolaou Test in Screening for and Follow‐up of Cervical Cytologic Abnormalities: A Systematic Review

Ann Intern Med 2000;132:810–9 Commissioned by the federal Agency for Healthcare Research and Quality, this meta-analysis reviewed articles comparing Pap testing with a reference standards, such as histology, colposcopy, repeat cytology, or combinations these techniques. These data were used to complete 2 × 2 tables to calculate indices of accuracy. Many studies were derived from colposcopy clinics; patients without prior abnormal smears have a lower prevalence of abnormality. In the 12 studies with least biased estimates, Pap test sensitivity ranged from 30–87% and specificity from 86–100%. Results varied depending on the threshold designation of abnormality for cytology (ASCUS vs. LGSIL vs. HGSIL) and for comparison test (CIN1 vs. CIN2–3). Comment: As the authors point out, the utility of cytologic screening in cervical cancer prevention lies not in the accuracy of a single smear, since sensitivity is less than ideal, but in the accuracy of lifetime screening. A single smear should not be relied on to determine the presence or absence of disease. (LSM)