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Conventional cervical smears were better than monolayer cytology or human papillomavirus testing for detecting cervical intraepithelial neoplasia

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 QUESTION: In women referred for colposcopy or presenting for routine smears, is monolayer cytology (MLC) or human papillomavirus (HPV) testing more accurate than the conventional cervical smear (CCS) test for detecting cervical neoplasia?


Blinded comparison of the CCS test, MLC, and HPV testing with colposcopy and histology as the reference standard.


2 university centres and 2 private practices in France.


828 women (mean age 38 y) who had been referred for colposcopy and 1757 women (mean age 33 y) who presented for routine smears.

Description of tests and diagnostic standard

All women were evaluated by the 3 methods (CCS test, MLC, and HPV testing), and by colposcopy followed by biopsy if abnormalities were detected. After the CCS test, the remaining portion of the sample was used for the monolayer slide and for …

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  • Sources of funding: Direction Générale de la Santé and Programme Hospitalier de Recherche Clinique, French Ministry of Health and Association pour la Recherche sur le Cancer.

  • For correspondence: Professor J Coste, Hopital Cochin, Paris, France.coste{at}

  • Abstract and commentary also appear in ACP Journal Club.