Accuracy of liquid based versus conventional cytology: Overall results of new technologies for cervical cancer screening: Randomised controlled trial

Guglielmo Ronco, Jack Cuzick, Paola Pierotti, Maria Paola Cariaggi, Paolo Dalla Palma, Carlo Naldoni, Bruno Ghiringhello, Paolo Giorgi-Rossi, Daria Minucci, Franca Parisio, Ada Pojer, Maria Luisa Schiboni, Catia Sintoni, Manuel Zorzi, Nereo Segnan, Massimo Confortini

Research output: Contribution to journalArticle

Abstract

Objective: To compare the accuracy of conventional cytology with liquid based cytology for primary screening of cervical cancer. Design: Randomised controlled trial. Setting: Nine screening programmes in Italy. Participants: Women aged 25-60 attending for a new screening round: 22 466 were assigned to the conventional arm and 22 708 were assigned to the experimental arm. Interventions: Conventional cytology compared with liquid based cytology and testing for human papillomavirus. Main outcome measure: Relative sensitivity for cervical intraepithelial neoplasia of grade 2 or more at blindly reviewed histology, with atypical cells of undetermined significance or more severe cytology considered a positive result. Results: In an intention to screen analysis liquid based cytology showed no significant increase in sensitivity for cervical intraepithelial neoplasia of grade 2 or more (relative sensitivity 1.17, 95% confidence interval 0.87 to 1.56) whereas the positive predictive value was reduced (relative positive predictive value v conventional cytology 0.58, 0.44 to 0.77). Liquid based cytology detected more lesions of grade 1 or more (relative sensitivity 1.68, 1.40 to 2.02), with a larger increase among women aged 25-34 (P for heterogeneity 0.0006), but did not detect more lesions of grade 3 or more (relative sensitivity 0.84, 0.56 to 1.25). Results were similar when only low grade intraepithelial lesions or more severe cytology were considered a positive result. No evidence was found of heterogeneity between centres or of improvement with increasing time from start of the study. The relative frequency of women with at least one unsatisfactory result was lower with liquid based cytology (0.62, 0.56 to 0.69). Conclusion: Liquid based cytology showed no statistically significant difference in sensitivity to conventional cytology for detection of cervical intraepithelial neoplasia of grade 2 or more. More positive results were found, however, leading to a lower positive predictive value. A large reduction in unsatisfactory smears was evident. Trial registration: Current Controlled Trials ISRCTN81678807.

Original languageEnglish
Pages (from-to)28-31
Number of pages4
JournalBritish Medical Journal
Volume335
Issue number7609
DOIs
Publication statusPublished - Jul 7 2007

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Early Detection of Cancer
Uterine Cervical Neoplasms
Cell Biology
Randomized Controlled Trials
Technology
Cervical Intraepithelial Neoplasia
Italy
Histology
Outcome Assessment (Health Care)
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

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Accuracy of liquid based versus conventional cytology : Overall results of new technologies for cervical cancer screening: Randomised controlled trial. / Ronco, Guglielmo; Cuzick, Jack; Pierotti, Paola; Cariaggi, Maria Paola; Palma, Paolo Dalla; Naldoni, Carlo; Ghiringhello, Bruno; Giorgi-Rossi, Paolo; Minucci, Daria; Parisio, Franca; Pojer, Ada; Schiboni, Maria Luisa; Sintoni, Catia; Zorzi, Manuel; Segnan, Nereo; Confortini, Massimo.

In: British Medical Journal, Vol. 335, No. 7609, 07.07.2007, p. 28-31.

Research output: Contribution to journalArticle

Ronco, G, Cuzick, J, Pierotti, P, Cariaggi, MP, Palma, PD, Naldoni, C, Ghiringhello, B, Giorgi-Rossi, P, Minucci, D, Parisio, F, Pojer, A, Schiboni, ML, Sintoni, C, Zorzi, M, Segnan, N & Confortini, M 2007, 'Accuracy of liquid based versus conventional cytology: Overall results of new technologies for cervical cancer screening: Randomised controlled trial', British Medical Journal, vol. 335, no. 7609, pp. 28-31. https://doi.org/10.1136/bmj.39196.740995.BE
Ronco, Guglielmo ; Cuzick, Jack ; Pierotti, Paola ; Cariaggi, Maria Paola ; Palma, Paolo Dalla ; Naldoni, Carlo ; Ghiringhello, Bruno ; Giorgi-Rossi, Paolo ; Minucci, Daria ; Parisio, Franca ; Pojer, Ada ; Schiboni, Maria Luisa ; Sintoni, Catia ; Zorzi, Manuel ; Segnan, Nereo ; Confortini, Massimo. / Accuracy of liquid based versus conventional cytology : Overall results of new technologies for cervical cancer screening: Randomised controlled trial. In: British Medical Journal. 2007 ; Vol. 335, No. 7609. pp. 28-31.
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AU - Cariaggi, Maria Paola

AU - Palma, Paolo Dalla

AU - Naldoni, Carlo

AU - Ghiringhello, Bruno

AU - Giorgi-Rossi, Paolo

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AU - Parisio, Franca

AU - Pojer, Ada

AU - Schiboni, Maria Luisa

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N2 - Objective: To compare the accuracy of conventional cytology with liquid based cytology for primary screening of cervical cancer. Design: Randomised controlled trial. Setting: Nine screening programmes in Italy. Participants: Women aged 25-60 attending for a new screening round: 22 466 were assigned to the conventional arm and 22 708 were assigned to the experimental arm. Interventions: Conventional cytology compared with liquid based cytology and testing for human papillomavirus. Main outcome measure: Relative sensitivity for cervical intraepithelial neoplasia of grade 2 or more at blindly reviewed histology, with atypical cells of undetermined significance or more severe cytology considered a positive result. Results: In an intention to screen analysis liquid based cytology showed no significant increase in sensitivity for cervical intraepithelial neoplasia of grade 2 or more (relative sensitivity 1.17, 95% confidence interval 0.87 to 1.56) whereas the positive predictive value was reduced (relative positive predictive value v conventional cytology 0.58, 0.44 to 0.77). Liquid based cytology detected more lesions of grade 1 or more (relative sensitivity 1.68, 1.40 to 2.02), with a larger increase among women aged 25-34 (P for heterogeneity 0.0006), but did not detect more lesions of grade 3 or more (relative sensitivity 0.84, 0.56 to 1.25). Results were similar when only low grade intraepithelial lesions or more severe cytology were considered a positive result. No evidence was found of heterogeneity between centres or of improvement with increasing time from start of the study. The relative frequency of women with at least one unsatisfactory result was lower with liquid based cytology (0.62, 0.56 to 0.69). Conclusion: Liquid based cytology showed no statistically significant difference in sensitivity to conventional cytology for detection of cervical intraepithelial neoplasia of grade 2 or more. More positive results were found, however, leading to a lower positive predictive value. A large reduction in unsatisfactory smears was evident. Trial registration: Current Controlled Trials ISRCTN81678807.

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