HPV Testing Is an Efficient Management Choice for Women With Inadequate Liquid-Based Cytology in Cervical Cancer Screening

Abstract

This study compares colposcopy referrals of 2 management strategies: oncogenic human papillomavirus (HPV)-DNA testing (Hybrid Capture 2 assay, Qiagen, Germantown, MD) and repeat cytology. In the New Technology in Cervical Cancer Trial, 22,708 subjects were randomly assigned to undergo both HPV and liquid-based cytologic testing. Women aged 35 to 60 years old with unsatisfactory cytologic findings were directly referred for colposcopy if the HPV test result was positive, and were referred for repeat cytologic examination if the HPV test result was negative; women aged 25 to 35 years old were referred for repeat cytologic examination independent of HPV test results. A positive or a second unsatisfactory cytologic examination referred women for colposcopy. Five hundred sixty women had unsatisfactory cytologic findings. Colposcopy referral was not significant and slightly higher with HPV testing than repeat cytologic test (9.8% vs 6.8%, P = .11). When cytologic testing was repeated 36.8% were unavailable for follow-up and most of the colposcopies were performed in HPV-negative women. For unsatisfactory cytologic findings, HPV triage is a more logical and efficient management strategy than a repeat cytologic test.

The hr-HPV based cervical cancer screening: results of a four-years experience in a single screening center of Italy

“…However, in NTCC study the most frequently represented category was ASCUS, but with a value below the limits set by the GISCi guidelines (< 5%) [5], while in the present study the authors observed that the most frequently diagnosed category was LSIL (2.3%). Moreover, through the hr-HPV test used as triage of ASCUS category, the present authors showed that 69.9% of women with diagnosis of ASCUS were infected with the hr-HPV, and this value was higher than NTCC study that included the ASCUS+ category (60.6%) [17]. These data confirm that the ASCUS triage using hr-HPV test can help the operators in the management of women aged 25-34 with diagnosis of ASCUS in order to avoid unnecessary colposcopies [18].…”

Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening

“…29 Human papilloma virus (HPV) DNA testing has also been shown to be a better approach than repeated Pap tests in resolving unsatisfactory results. 30 HPV DNA testing should be investigated as a potentially patient-centered and clinically effective method of primary cervical cancer screening for transgender men. Use of stand-alone HPV DNA testing for primary cervical cancer screening has been studied in non-transgender women, and has been found to have some advantages, including increased sensitivity with only slightly reduced specificity.…”

Primary human papillomavirus screening for cervical cancer in the United States—US Food and Drug Administration approval, clinical trials, and where we are today

“…Other studies have documented that HPV test results may be positive despite unsatisfactory cytology results and can provide clinically useful follow‐up information . However, those studies were conducted in conjunction with cytology testing, and the study by Rossi et al classified specimens that lacked a transformation zone component as unsatisfactory.…”