Open AccessHPV DNA testing improves CIN 2+ risk stratification and detection of CIN 2+ in delayed triage of ASCUS and LSIL . A population‐based follow‐up study from W estern N orway
Author(s) -
Budal Elisabeth B.,
Haugland Hans K.,
Skar Robert,
Mæhle Bjørn O.,
Bjørge Tone,
Vintermyr Olav K.
Publication year - 2014
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.171
Subject(s) - ascus (bryozoa) , triage , medicine , cervical intraepithelial neoplasia , cytology , gynecology , colposcopy , population , obstetrics , cervical cancer , cancer , pathology , biology , emergency medicine , botany , ascospore , spore , environmental health
In N orway, Pap smears with atypical squamous cells of uncertain significance ( ASCUS ) and low‐grade squamous intraepithelial lesions ( LSIL ) are triaged after 6 months. The aim of the study was to evaluate effects of implementing human papillomavirus ( HPV ) test (2005) in delayed triage of ASCUS and LSIL in a cohort of women from W estern N orway. After a survey of 119,469 cervical Pap smears during 2005–2007, a total of 1055 women with an index ASCUS or LSIL were included in the study and followed up for 3–6 years with respect to progression into cervical intraepithelial neoplasia grade 2 or worse ( CIN 2+). Overall sensitivity for detection of CIN 2+ with HPV testing and cytology was 96% and 72%, respectively. The sensitivity for detection of CIN 2+ was not affected by age, but the specificity of the HPV test increased with age. Thus, for the age groups <34 years, 34–50 years, and >50 years, the specificity of a positive HPV test to detect CIN 2+ was 47%, 71%, and 82%, respectively. Positive predictive values for CIN 2+ in women with positive cytology, positive HPV test, negative cytology, negative HPV test, or negative HPV and cytology tests were 52%, 41%, 8%, 1.5%, and 0.4%, respectively. HPV testing resulted in a net 22% increased detection of CIN 2+. Fifty‐six percent of CIN 2+ was detected at an earlier time point with HPV testing in triage. Implementation of HPV testing in delayed triage of ASCUS and LSIL improved the stratification of CIN 2+ risk and increased CIN 2+ detection and at an earlier time point than with triage by cytology alone.