Summary High-risk human papillomaviruses (HR-HPV) are the necessary cause of cervical carcinomas. To determine whether HPR-HPV DNA detection in primary routine screening could represent a sensitive and reliable technique for the detection of high-grade squamous intraepithelial lesions (HGSIL), laboratory analysis using 2 cytologic techniques (conventional and liquid-based), HPV testing with Hybrid Capture II assay (HC-II), followed by colposcopic examination of women with abnormal cervical finding and/or persistent HR-HPV infection, was conducted in 7932 women who had routine cervical examination. The sensitivity of HPV testing for detecting a histologically proven HGSIL was 100%, higher than that of conventional (68.1%) and liquid-based (87.8%) cytology. The low specificities of 85.6% and 87.3% of HPV testing slightly increased to 88.4% and 90.1% if HPV testing was reserved for woman >30 years old. The quantitative approach provided by the HC-II assay for the assessment of the viral load was not reliable for predicting HGSIL in normal smears. HR-HPV testing could be proposed in primary screening in association with cytology. With conventional cytology it significantly improves the detection of HGSIL. With the use of the same cervical scrape for HPV testing and liquid-based cytology, HR-HPV testing would allow to select positive samples treated in a second time for cytology which gives a good specificity.

Hybrid Capture II (HC-II) is a commercial human papillomavirus (HPV) detection test designed to detect 18 HPV types divided into high-risk and low-risk groups. We have tested 1647 scrapes from 1518 unselected women attending routine cytological screening by this assay for the detection of histologically proven high-grade lesions. The reliability of this test was also evaluated on 117 fresh cone biopsy samples. HPV DNA has been detected in 400 scrapes (24.3%), 296 containing a high-risk HPV (18.0%). All the smears evocative of high-grade lesions were positive for high-risk HPV, and high-risk HPV were detected in all the 34 cases presenting a histologically proven high-grade lesion and in 68 (97.1%) of the 70 cone biopsy samples showing a high-grade lesion or an invasive carcinoma. Thus, the sensitivity was superior to the sensitivity of cytology (85.3%). Nevertheless, the quantitative approach provided by the HC-II assay for the assessment of the viral load could not clearly distinguish among cases with or without high-grade lesions. Thus this assay is recommended for the screening of high-grade lesions on a large scale, in association with classic cytology. © 1999 Cancer Research Campaign

The length of the uterine cervix, measured by transvaginal sonography, is a better predictor of the risk of Cesarean section than the Bishop score after induction of labor for medical reasons. In women with an unfavorable Bishop score, a cervical length of < 26 mm is associated with a lower risk of Cesarean section and a shorter duration of labor.

Key words: hybrid capture; human papillomavirus; cervical intraepithelial neoplasia; cytologic screeningHigh-risk human papillomaviruses (HR-HPV) have now been conclusively demonstrated to be the causative agents of cervical cancer. 1-3 Indeed, it has been reported that 99.7% of all cervical squamous cell carcinomas contain HR-HPV. 4 Infections with HR-HPV are associated with a relative risk of between 8 and 11 for the development of squamous intraepithelial lesions (SIL) 5 and only low-grade SIL that contain HR-HPVs progress to high-grade disease. 6 While most authors agree that moderate and severe dysplasias should be managed regardless of HPV type as most of them contain HR-HPV, HPV testing may be useful for triaging women with a cytological diagnosis of atypical squamous cells of undetermined significance (ASCUS) in their cervical smears and for the follow-up of women treated for CIN. [7][8][9][10][11][12][13] In the same way, there is an increasing interest in using HR-HPV DNA detection either alone or in addition to the classic cytological examination as a method for primary screening for cervical preneoplastic and neoplastic lesions.Six years ago, a commercial HPV detection test, Hybrid Capture-II (HC-II), was introduced. 14 HC-II is a non radioactive, easy to perform, relatively rapid (5 hr of handling), liquid hybridization assay designed to detect 18 HPV types divided into high-risk (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68) and low-risk (types 6, 11, 42, 43 and 44) groups. The first studies have been particularly promising, showing a good agreement with PCR results, with a detection of HR-HPV DNA in more than 90% of high grade SIL (HGSIL). [15][16][17][18][19] This test has been proposed to be used routinely on large series of women to improve the sensitivity and negative predictive value of cytological screening for SIL. Although the sensitivity of this test is higher than that of cytology, its specificity remains low. This is largely explained by the numerous transient HR-HPV infections and the high prevalence of HR-HPV infection in women with normal smears. For example, in our study that explored the use of this assay for primary screening of 7,932 women explored in primary screening with this assay, we found that a total of 773 women (11.9%) out of 7,339 women with smears within normal limits presented with an HR-HPV infection. 15 Numerous studies in the literature using Polymerase Chain Reaction (PCR) for the detection of HR-HPV have emphasized that the persistence of HR-HPV infection is significantly associated with progressive disease. 20 -24 Moreover a high viral load may be considered as a risk factor and preferentially observed in potentially progressive and high-grade lesions. [25][26][27][28] This parameter can be semi-quantitatively evaluated by the relative light unit values provided by the HC-II assay. Thus, the detection of a recurrent HR-HPV infection with a baseline high viral load may be a useful discriminating test to select the population of women at risk for...