The sensitivity of Pap cytology and HPV testing to detect incident cervical cancer: prior testing results in 178 patients with invasive cervical cancer at a large general hospital in China.

Background: Prior screening results in women diagnosed with cervical carcinoma are only reported in the literature in small numbers. We wish to examine a larger number of prior testing results in women with cervical carcinoma from China to better understand the strengths and weaknesses of Pap (Papanicolaou) cytology and human papillomavirus (HPV) testing.

Methods: In our study, 178 patients with histologically diagnosed cervical carcinoma and Pap cytology and/or HPV testing in the year prior to diagnosis were retrospectively studied. Pap cytology was performed using liquid-based preparations and HPV testing was done with mostly Hybrid Capture 2 but also included other methods.

Results: In our study, 82.0% of women were symptomatic at presentation with vaginal bleeding or abnormal vaginal discharge. HPV testing was negative in 9.8% of women in the short period before diagnosis of cervical cancer and Pap cytology had a higher rate of false negative results at 16.7%. Adenocarcinoma showed a higher negative testing rate than squamous cell carcinoma did with both cytology and HPV testing. Only 1 of 78 patients (1.3%) having both tests showed a double negative result. Negative high-risk HPV testing was noted in 2 of 9 squamous cell carcinoma patients with routine gynecological examination.

Conclusions: Both Pap cytology and HPV testing have higher rates of prior negative results in women with cervical carcinoma. When testing is performed using both methods, the greatest number of cervical carcinomas can be detected. These results should also be considered when making screening recommendations with the understanding that HPV testing alone will miss at least a proportion of women with incident cervical carcinoma.