Comparison of Hybrid capture 2 testing at different thresholds with cytology as primary cervical screening test.
BACKGROUND
We evaluated the performance of primary high-risk human papillomavirus (hrHPV) testing by hybrid capture 2 (HC2) with different thresholds for positivity, in comparison with conventional cytology.


METHODS
We used data of 25,871 women (aged 30-60 years) from the intervention group of the VUSA-Screen study (VU University Medical Center and Saltro laboratory population-based cervical screening study), who were screened by cytology and hrHPV. Primary outcome measure was the number of cervical intraepithelial neoplasia grade 3 or higher (CIN3+), detected within 3 years. We compared baseline cytology testing with three possible hrHPV screening strategies at different relative light unit/cutoff (RLU/CO) thresholds.


RESULTS
Compared with baseline cytology testing, hrHPV DNA testing as a sole primary screening instrument did not yield a superior sensitivity, as well as lower colposcopy referral rate and lower false positivity rate at any RLU/CO threshold. The hrHPV screening at 1 RLU/CO threshold with cytology triage at baseline and at 12 months revealed the highest sensitivity for CIN3+ (relative sensitivity of 1.32), although still displaying a lower colposcopy referral rate than cytology testing (relative colposcopy rate of 0.94). Higher thresholds (>1 RLU/CO) yielded lower colposcopy rates, but resulted in substantial loss in sensitivity.


CONCLUSIONS
The hrHPV testing at the commonly used threshold of 1 RLU/CO with cytology triage at baseline and at 12 months showed a much higher sensitivity with a lower colposcopy referral rate compared with cytology testing.
Rijkaart
D C
DC
Department of Pathology, VU University Medical Center, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands.
Coupe
V M H
VM
van Kemenade
F J
FJ
Heideman
D A M
DA
Hesselink
A T
AT
Verweij
W
W
Rozendaal
L
L
Verheijen
R H
RH
Snijders
P J
PJ
Berkhof
J
J
Meijer
C J L M
CJ
D000328:Adult; D003127:Colposcopy; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D009693:Nucleic Acid Hybridization; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D014218:Triage; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000382:microbiology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000382:microbiology
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