title: Evaluation of the clinical performance of high-risk human papillomavirus testing for primary screening: a retrospective review of the Southern California Permanente Medical Group experience.
abstract: OBJECTIVE
  We investigated the potential impact of using the high-risk human papillomavirus (HPV) test as a primary screening tool for the detection of cervical cancer and its precursor lesions.
  
  
  METHODS
  From October 2005 to March 2006, conventional cervical cytological samples and Hybrid Capture II HPV tests were cocollected from all patients. Human papillomavirus tests were processed in all women aged 30 years and older and women younger than 30 years with a cytological finding of atypical squamous cells of undetermined significance. Patients with biopsy-proven cervical intraepithelial neoplasia (CIN) served as the study population.
  
  
  RESULTS
  We identified 263 women with CIN of whom 194 (73.8%) (95% confidence interval [CI] = 68.2%-78.8%) had HPV results. Human papillomavirus tests were negative in 4 (6.1%) of 66 CIN 3 cases (95% CI = 2.1%-14.5%), in 8 (16%) of 50 CIN 2 cases (95% CI = 7.3%-28.2%), and in 22 (22.8%) of 78 CIN 1 cases (95% CI = 18.6%-38.9%) distributed across all referral cytology categories. Negative HPV test rates were most significant for CIN 1 cases anteceded by a cytological finding of atypical squamous cells of undetermined significance (p =.0016). The mean age of women with HPV-negative CIN was 10 years older than that for women with HPV-positive CIN.
  
  
  CONCLUSIONS
  Human papillomavirus testing may miss more CIN than previously reported, especially in older women. Prospective trials of HPV testing as a primary screen for cervical cancer should incorporate additional tests to minimize missed lesions.
authors.affiliation: Kaiser Permanente, Anaheim, CA, USA.
authors.forename: Neal M
authors.initials: NM
authors.lastname: Lonky
authors.forename: Ali
authors.initials: A
authors.lastname: Mahdavi
authors.forename: Girma
authors.initials: G
authors.lastname: Wolde-Tsadik
authors.forename: Kathy
authors.initials: K
authors.lastname: Bajamundi
authors.forename: Juan C
authors.initials: JC
authors.lastname: Felix
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D002584:Cervix Uteri / Q000166:cytology / Q000821:virology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D055815:Young Adult