title: A prospective study of human papillomavirus (HPV) testing to resolve uncertainty in colposcopy.
abstract: OBJECTIVE
  UK colposcopy services are seeing increased workloads, a large proportion of which are follow-up appointments. The English Cervical Screening Programme HPV Special Interest Group identified five subcategories of colposcopy clinic patients who often require prolonged follow-up regimes for low-grade abnormalities. Human papillomavirus (HPV) testing has a high negative predictive value, meaning that HPV-negative women are at very low risk of underlying disease. Our objectives were to quantify the number of HPV-negative women in each study subcategory and to evaluate the number who could potentially be discharged from colposcopy on the basis of their results.
  
  
  METHODS
  Four colposcopy clinics prospectively identified women according to five categories over 12 months. All women underwent cytological testing and high-risk HPV (hrHPV) testing using the Hybrid Capture 2 test. Management outcomes and decisions based on a knowledge of the HPV status were recorded.
  
  
  RESULTS
  Data available on 755 women showed that 422/755 (55.9%) and 260/755 (34.4%) had persistent cervical intraepithelial neoplasia grade 1 (CIN1) (Category 1) or a minor abnormality following treatment (Category 2), respectively. In Categories 1 and 2, 51.7% and 60.2%, respectively, were hrHPV negative. The rates with biopsies of CIN2 or worse (CIN2+) across the two categories were 3/355 (0.8%) and 21/291 (7.0%) for hrHPV-negative and hrHPV-positive women, respectively.
  
  
  CONCLUSIONS
  The incorporation of hrHPV testing within organized cervical screening programmes has been widely accepted. hrHPV testing for the clinical scenarios outlined in this study detects women who are hrHPV negative and therefore at low risk of underlying disease, potentially reducing anxiety and inconvenience for women and costs to colposcopy services.
authors.affiliation: Department of Gynaecology, Chelsea and Westminster Hospital, Fulham Road, London, UK School of Cancer and Enabling Sciences, University of Manchester, Manchester, UK Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, UK Department of Gynaecology, Birmingham City Hospital, Birmingham, UK Department of Gynaecology, Great Western Hospital, Swindon, UK NHS Cancer Screening Programmes, Sheffield, UK Department of Gynaecology, Royal Free Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Bowring
authors.forename: R
authors.initials: R
authors.lastname: Albrow
authors.forename: A
authors.initials: A
authors.lastname: Fisher
authors.forename: G
authors.initials: G
authors.lastname: Downey
authors.forename: J
authors.initials: J
authors.lastname: Cullimore
authors.forename: J
authors.initials: J
authors.lastname: Patnick
authors.forename: P G
authors.initials: PG
authors.lastname: Walker
authors.forename: H C
authors.initials: HC
authors.lastname: Kitchener
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification* / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D011247:Pregnancy; D011446:Prospective Studies; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology