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Review: newer technologies improve sensitivity in detecting uterine cervical lesions but at a substantially increased cost

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 QUESTION: In adult women at average risk for cervical cancer, what is the accuracy of the conventional Papanicolaou (Pap) test and of new technologies (thin layer cytology, computer rescreening, and algorithm based decision making) in detecting cervical cancer and cervical intraepithelial neoplasia?

Data sources

Studies were identified by searching Medline, CancerLIT, HealthSTAR, CINAHL, EMBASE/Excerpta Medica, and EconLIT; scanning recent issues of selected journals; and contacting manufacturers of automated cytologic devices and relevant professional societies.

Study selection

Studies were selected if cervical cytology was evaluated as a screening test, the reference standard was histology or colposcopy, and sensitivity and specificity (or relative true positive and false positive rates) could be calculated. Cytology was an acceptable reference standard if the studies also included an independent panel of cytology specialists to arrive at a consensus diagnosis and a 2 arm prospective study design was used. The …

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  • Source of funding: Agency for Health Care Policy and Research.

  • For correspondence: Director, Center for Practice and Technology Assessment, Agency for Health Care Policy and Research, 6010 Executive Boulevard, Suite 300, Rockville, MD 20852, USA. Fax +1 919 286 5601.