Stepwise algorithm combining HPV high-risk DNA-based assays and RNA-based assay for high grade CIN in women with abnormal smears referred to colposcopy.
BACKGROUND
The detection of high-risk human papillomavirus (HPV) DNA provides higher sensitivity but lower specificity than cytology for the identification of high-grade cervical intraepithelial neoplasia (CIN).


OBJECTIVE
The aim of this study was to combine DNA- and RNA-based assays in order to improve the detection of advanced disease (CIN2+).


METHODS
107 ASCUS+ women were included in Marseilles (France) between March 2007 and June 2008. Up to five tests were carried out on a liquid PreservCyt sample: Hybrid Capture 2 (HCII) (Digene), Papillocheck (Greiner), Abbott RealTime HR HPV (RT HR HPV) (Abbott), Linear Array (Roche), and EasyQ HPV (Biomérieux).


RESULTS
36 (34%) women had CIN2+ histology; among them 6 (6%) had CIN3+ histology. For CIN2+ detection, all tests had comparable sensitivities except EasyQ HPV test: HCII 94%, Papillocheck and LA 92%, RT HR HPV 89%, and NucliSENS EasyQ HPV 75% (P not significant). On the other hand, EasyQ HPV had a higher specificity than the other assays (except RT HR HPV assay). Combining DNA-based and RNA-based assay would allow to reduce the need of colposcopies to be performed among patients HPV positive with DNA-based assay: 32% (7/22) colposcopies not needed in < 30 years old patients, and 29% (14/49) colposcopies not needed in ≥ 30 years patients.


CONCLUSIONS
All tests had comparable diagnostic values for CIN2+ detection, but DNA-based tests seemed to be more sensitive and RNA-based assay more specific. The combined use of DNA- and RNA-based assays considerably reduces the number of colposcopies to be performed, and provides better diagnostic accuracy for CIN2+ disease.
Hôpital Ambroise Paré, Marseille, France. philippe.halfon@alphabio.fr
Philippe
P
Halfon
Dominique
D
Benmoura
Aubert
A
Agostini
Hacène
H
Khiri
Guillaume
G
Pénaranda
Agnès
A
Martineau
Bernard
B
Blanc
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003127:Colposcopy / Q000706:statistics & numerical data; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005602:France; D005821:Genetic Techniques; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D012367:RNA, Viral / Q000032:analysis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
D004279:DNA, Viral; D012367:RNA, Viral