Triage of women with atypical squamous cells of undetermined significance (ASC-US): results of an Italian multicentric study.
OBJECTIVE
To compare the performance of immediate colposcopy, repeat Pap test and HPV test as triage options for women diagnosed as having atypical squamous cells of undetermined significance (ASC-US) while attending organised screening for cervical carcinoma in five centres of the Veneto region.


METHODS
Women consecutively diagnosed as having ASC-US were included in a prospective study, and underwent colposcopy and collection of cervico-vaginal cells for conventional Pap test and HPV test (Hybrid Capture 2, High-risk probe set, Digene). Repetition of all three tests was scheduled for 12 months later. DNA was subsequently extracted from residual cells of positive samples, and analysed by polymerase chain reaction with several primers for typing of HPV sequences. Sensitivity, specificity and positive predictive value (PPV) of the different triage options for histology-confirmed cervical intraepithelial neoplasia, grade 2 or worse (CIN2+) were calculated among all women and by age (under and above 35 years).


RESULTS
Seven hundred forty-nine women 25-64 years old (median age 42 years) were enrolled in the study. Pap smears at enrolment were read as ASC-US or more severe in 211 (29.4%) cases, colposcopy disclosed an atypical transformation zone in 254 (34.2%) women, and HPV test was positive in 181 (24.2%). High-grade cervical lesions developed in 29/749 (3.9%) women. HPV typing was possible in 163 (90%) of the samples, and carcinogenic types were present in 123.


CONCLUSIONS
HPV test showed the best performance; overall, it had the highest sensitivity (92.3%), specificity (78.6%) and PPV (14.9%).
Del Mistro
Annarosa
A
Immunologia Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto (IOV) IRCCS, Padova, Italy. annarosa.delmistro@ioveneto.it
Frayle-Salamanca
Helena
H
Trevisan
Rossana
R
Matteucci
Mario
M
Pinarello
Antonella
A
Zambenedetti
Pamela
P
Buoso
Rita
R
Fantin
Gian Piero
GP
Zorzi
Manuel
M
Minucci
Daria
D
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology* / Q000821:virology; D003127:Colposcopy; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000473:pathology; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology
D004279:DNA, Viral