An Intelligent Clinical Decision Support System for Patient-Specific Predictions to Improve Cervical Intraepithelial Neoplasia Detection
Table 17
Performance of type “OR” combinations between two tests in detecting CIN2+.
Combinations of medical tests
Cytology cutoff
Sensitivity (%)
Specificity (%)
PPV (%)
NPV (%)
Youden’s index
Pap test or HPV DNA
ASCUS+
99.4
37.5
30.7
99.5
0.37
Pap test or HPV DNA
LSIL+
96.3
52.0
35.8
98.0
0.48
Pap test or HPV DNA
HSIL+
96.3
60.3
40.3
98.3
0.57
Pap test or HR-HPV DNA
ASCUS+
98.8
39.2
31.1
99.1
0.38
Pap test or HR-HPV DNA
LSIL+
95.7
54.7
37.0
97.8
0.50
Pap test or HR-HPV DNA
HSIL+
95.7
65.8
43.8
98.2
0.62
Pap test or NASBA
ASCUS+
98.8
44.2
33.0
99.2
0.43
Pap test or NASBA
LSIL+
94.4
64.6
42.6
97.7
0.59
Pap test or NASBA
HSIL+
88.8
87.4
66.2
96.6
0.76
Pap test or FLOW
ASCUS+
99.4
41.8
32.2
99.6
0.41
Pap test or FLOW
LSIL+
97.5
61.7
41.4
98.9
0.59
Pap test or FLOW
HSIL+
96.9
80.3
57.8
98.9
0.77
Pap test or p16
ASCUS+
99.4
45.3
33.5
99.6
0.45
Pap test or p16
LSIL+
92.5
66.1
43.2
97.0
0.59
Pap test or p16
HSIL+
81.4
90.2
69.7
94.6
0.72
HPV DNA or NASBA
93.8
60.3
39.6
97.2
0.54
HPV DNA or FLOW
98.1
56.6
38.6
99.1
0.55
HPV DNA or p16
93.8
59.6
39.2
97.2
0.53
HR-HPV DNA or NASBA
91.9
65.8
42.8
96.7
0.58
HR-HPV DNA or FLOW
97.5
61.5
41.3
98.9
0.59
HR-HPV DNA or p16
92.5
64.8
42.2
96.9
0.57
NASBA or FLOW
96.3
79.6
56.8
98.7
0.76
NASBA or p16
87.0
85.7
62.8
95.9
0.73
FLOW or p16
96.3
77.5
54.4
98.7
0.74
Statistical measures have been calculated using all cases of the dataset (Table 1). Histology endpoint is CIN2+ for all cases. Definition of positivity of each medical test is presented in Table 15. CIN2+: cervical intraepithelial neoplasia grade 2 or worse, HR-HPV: high-risk human papillomavirus, NASBA: nucleic acid sequence based amplification for the identification of E6/E7 mRNA of the HPV types 16, 18, 31, 33, and 45, FLOW: flow cytometric E6/E7 HPV mRNA assay, PPV: positive predictive value, and NPV: negative predictive value.
