title: HrHPV-testing in a university hospital gynecology outpatient clinic: recommendations for clinical practice.
abstract: OBJECTIVE
  To study the effect of hrHPV-testing on the detection of CIN2/3+ in women referred to a gynecology outpatient clinic, and to assess a useful risk profile in relation to the referral reason to identify who should be tested for cervical pathology.
  
  
  METHODS
  This study was designed as an observational cohort study. In the first six months of 2007, we categorized the referral reason of 1149 consecutive women who visited our gynecology outpatient clinic and assessed the risk for CIN2/3+ as found by cytology or co-testing with a hrHPV-test and cytology.
  
  
  RESULTS
  Three different categories of referral reasons were identified; women with presumed cervix pathology, women with presumed endometrial pathology and women with other referral indications. The cumulative 18-month CIN2+ and CIN3+ risks were highest in the group with presumed cervical disease (adjusted risks 11.1% and 5.4% respectively) and lowest in the miscellaneous group with no suspicion of cervical and/or endometrial pathology (adjusted risks 4.1% and 1.8% respectively). HrHPV-testing detected significantly more CIN2/3+ lesions than cytology (relative detection rate: 1.42 (95%CI 1.05-1.92) and 1.38 (95%CI 0.95-2.05) respectively).
  
  
  CONCLUSIONS
  The high (>2%) cumulative 18-month CIN2/3+ risk in patients with presumed cervical and/or endometrial pathology warrants routine cervical testing. In these women a hrHPV-test should be added to cytology because this identifies a significant number of additional women with a substantial risk of CIN2/3+ lesions who would not be identified with cytology alone. Women referred for other reasons should not have cervical testing beforehand, because of their low risk of CIN2/3+.
authors: VU University Medical Center, Department of Pathology, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. ja.louwers@vumc.nl
authors: J A
authors: JA
authors: Louwers
authors: J
authors: J
authors: Berkhof
authors: A
authors: A
authors: Zaal
authors: M
authors: M
authors: Kocken
authors: L
authors: L
authors: Rozendaal
authors: D A M
authors: DA
authors: Heideman
authors: W M
authors: WM
authors: van Baal
authors: P J F
authors: PJ
authors: Snijders
authors: R H M
authors: RH
authors: Verheijen
authors: C J L M
authors: CJ
authors: Meijer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006176:Gynecology / Q000379:methods / Q000592:standards; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000473:pathology / Q000821:virology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology*