An Intelligent Clinical Decision Support System for Patient-Specific Predictions to Improve Cervical Intraepithelial Neoplasia Detection
Table 19
Performance of type “AND” combinations between two tests in detecting CIN2+.
Combinations of medical tests
Cytology cutoff
Sensitivity (%)
Specificity (%)
PPV (%)
NPV (%)
Youden’s index
Pap test and HPV DNA
ASCUS+
90.7
69.3
45.1
96.4
0.60
Pap test and HPV DNA
LSIL+
85.1
76.5
50.2
94.9
0.62
Pap test and HPV DNA
HSIL+
67.1
96.5
84.4
91.3
0.64
Pap test and HR-HPV DNA
ASCUS+
88.8
73.4
48.1
95.9
0.62
Pap test and HR-HPV DNA
LSIL+
83.2
79.6
53.2
94.5
0.63
Pap test and HR-HPV DNA
HSIL+
65.2
96.9
85.4
90.9
0.62
Pap test and NASBA
ASCUS+
76.4
91.2
70.7
93.3
0.68
Pap test and NASBA
LSIL+
72.0
92.6
73.0
92.3
0.65
Pap test and NASBA
HSIL+
59.6
98.1
89.7
89.7
0.58
Pap test and FLOW
ASCUS+
91.9
85.3
63.5
97.4
0.77
Pap test and FLOW
LSIL+
85.1
87.2
64.9
95.5
0.72
Pap test and FLOW
HSIL+
67.7
96.9
85.8
91.5
0.65
Pap test and p16
ASCUS+
57.1
92.9
69.2
88.6
0.50
Pap test and p16
LSIL+
55.3
93.8
71.2
88.3
0.49
Pap test and p16
HSIL+
48.4
98.1
87.6
87.3
0.47
HPV DNA and NASBA
75.2
91.4
70.8
93.0
0.67
HPV DNA and FLOW
87.0
86.7
64.5
96.0
0.74
HPV DNA and p16
56.5
94.8
75.2
88.7
0.51
HR-HPV DNA and NASBA
74.5
91.7
71.4
92.8
0.66
HR-HPV DNA and FLOW
85.1
87.7
65.9
95.5
0.73
HR-HPV DNA and p16
55.3
95.5
77.4
88.5
0.51
NASBA and FLOW
73.9
92.4
73.0
92.7
0.66
NASBA and p16
48.4
97.4
83.9
87.2
0.46
FLOW and p16
55.3
97.2
84.8
88.7
0.53
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.
