Clinical inquiries. Is the ThinPrep better than conventional Pap smear at detecting cervical cancer?

■ EVIDENCE-BASED ANSWER Conclusions regarding the ThinPrep are difficult to make due to the complexity of cervical cancer screening and the lack of adequate outcomebased data. However, current evidence supports the following: the ThinPrep is more sensitive than the conventional Papanicolaou (Pap) smear at detecting cervical cancer (strength of recommendation [SOR]: A–, based on 1 large validating cohort study with a good reference standard and 1 systematic review). There is insufficient evidence to recommend 1 preparation over the other (SOR: B–, based on several systematic reviews that include studies with poor reference standards). The ThinPrep is a cost-effective screening tool if used at 3-year intervals (SOR: B, based on 1 systematic review and a decision analysis model). Additional advantages of the ThinPrep include being able to perform human papillomavirus (HPV) testing on the liquid. This is the preferred triage strategy for atypical squamous cells of undetermined significance (ASCUS) Pap smears (SOR: A, based on a large randomized, controlled trial).