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6. The validity of the currently available HPV tests in identifying HSIL and higher-grade cancers. Standard testing systems have been shown to perform with higher sensitivity than expert cytology in detecting prevalent CIN3 / HSIL or higher-grade cancers. In contrast, the specificity of the HPV test is lower than cytology in young age groups (<30), though it is comparable in the older age groups. The sensitivity and specificity of HPV testing may be lower in populations with high rates of human immunodefiency virus (HIV) infection.

The different definitions and schemes might have contributed to some misclassification, observer variation, different thresholds for referral and some difficulties in comparing the results across the studies. The necessity of uniformly reproducible categories for reporting the results of VIA has been increasingly appreciated. A consensus is currently emerging that the visualization of dense acetowhite lesions with sharp borders located in the transformation zone, close to the squamocolumnar junction, constitutes a positive VIA test outcome.

In contrast, recall of women for diagnostic investigation and treatment is necessary for cervical cytology. The investigation and follow-up algorithms for women with a positive VIA test have, to date, generally involved colposcopy and biopsy. If abnormal cervical tissue is identified during colposcopy, the region with the greatest abnormality is biopsied using a sharp punch biopsy forceps. Single or multiple biopsy specimens may be obtained. Treatment is then provided by excision or destruction (ablation) of the abnormal cervical tissue, after results of the biopsy are available.

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Cervical Cancer Screening in Developing Countries by World Health Organization
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