Measuring sensitivity in gynecologic cytology: A review

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Abstract
The sensitivity of gynecologic cytology has been measured in several different ways. The current review summarizes the major sources of bias and the results of these efforts. In the current study, a review of the literature was conducted. The major sources of bias in measuring the sensitivity of gynecologic cytology are a lack of reproducibility, bias in the review process, bias in case selection, selection and correction of the gold standard, and the value of surrogate markers. Despite these sources of variation, the sensitivity of the Papanicolaou (Pap) smear is relatively stable, ranging from 50-75% if a single consistent threshold is used, to up to 94% if either Autopap-directed rescreening or thin-layer methods are used to diagnose high-grade squamous intraepithelial lesions using a threshold of atypical squamous cells of undetermined significance. Methods for the routine evaluation of sensitivity currently are not available and may be difficult to devise. The sensitivity of the Pap smear in study situations is well known. Whether these reflect performance in real life is not known, and methods to compare performance in real life are not available.