HPV DNA testing improves CIN2+ risk stratification and detection of CIN2+ in delayed triage of ASCUS and LSIL. A population‐based follow‐up study from Western Norway

• Published in: Cancer medicine (Malden, MA) MA), 2014-02, Vol.3 (1), p.182-189
• Main Authors: Budal, Elisabeth B., Haugland, Hans K., Skar, Robert, Mæhle, Bjørn O., Bjørge, Tone, Vintermyr, Olav K.
• Format: Article
• Language: English
• Subjects: Adult; Aged; ASCUS; cervical cancer; delayed triage; DNA, Viral - isolation & purification; Female; Follow-Up Studies; HPV; Humans; LSIL; Middle Aged; Norway; Original Research; Papillomaviridae - genetics; Papillomaviridae - pathogenicity; Papillomavirus Infections - genetics; Papillomavirus Infections - pathology; Papillomavirus Infections - virology; Pregnancy; Triage; Uterine Cervical Dysplasia - diagnosis; Uterine Cervical Dysplasia - pathology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Vaginal Smears
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.171

In Norway, 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 Western Norway. 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 (CIN2+). Overall sensitivity for detection of CIN2+ with HPV testing and cytology was 96% and 72%, respectively. The sensitivity for detection of CIN2+ was not affected by age, but the specificity of the HPV test increased with age. Thus, for the age groups 50 years, the specificity of a positive HPV test to detect CIN2+ was 47%, 71%, and 82%, respectively. Positive predictive values for CIN2+ 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 CIN2+. Fifty‐six percent of CIN2+ 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 CIN2+ risk and increased CIN2+ detection and at an earlier time point than with triage by cytology alone. The effect of implementing human papillomavirus (HPV) testing in delayed triage of ASCUS and low‐grade squamous intraepithelial lesions (LSIL) was studied in a cohort of women from Western Norway. An improved stratification of CIN2+ risk and selection of more clinical relevant lesions was reported on. Also, more CIN2+ was recovered and CIN2+ detected at an earlier time point.