Economic analysis of human papillomavirus triage, repeat cytology, and immediate colposcopy in management of women with minor cytological abnormalities in Sweden
Ellinor Östensson, Maria Fröberg, Anders Hjerpe, Niklas Zethraeus and Sonia Andersson Acta Obstetricia et Gynecologica 2010, 89(10): 1316–1325. doi: 10.3109/00016349.2010.512066
On page 1318, the “Material and Methods” section is incomplete since important parts of “Description of follow-up strategies for ASCUS and LSIL” were omitted. The complete version of this paragraph should have read:
Cytology means referral for a gynecological consultation including a repeat conventional cytology smear. In case of cytological abnormality, with ASCUS as the cut-off, women are referred for a second follow-up visit to a gynecologist for colposcopy with biopsy. If the follow-up Pap smear is within normal limits, the woman is referred back to the primary screening program for a new Pap smear 3 or 5 years later, depending on patient age.
HPV triage means referral for a follow-up visit to a midwife for HPV testing. HR-HPV-positive women are referred for a second follow-up visit to a gynecologist for colposcopy with biopsy. HR-HPV-negative women are referred back to the primary screening program.
Colposcopy with biopsy means immediate referral for gynecological examination including colposcopy and directed biopsies. If no colposcopically visible lesion is seen, a biopsy is taken close to the squamocolumnar junction at 12 o'clock. Sensitivity and specificity of this strategy is considered to be 100%, since it constitutes the reference examination for diagnosing CIN.
The primary end-points of these strategies are sensitivity and specificity to detect histologically confirmed CIN2+ lesions.
On page 1321, there is also a minor error in Table 4; For ASCUS/LSIL, the parameter “Prevalence of CIN2+” is present twice and the upper of these rows (below Cost of visit to physician for colposcopy with biopsy) should be omitted.
These omissions are regretted.