title: Comparison of human papillomavirus testing strategies for triage of women referred with low-grade cytological abnormalities.
abstract: OBJECTIVE
  To compare triage strategies using different human papillomavirus (HPV) consensus and genotyping tests and a p16(INK4a) test.
  
  
  METHODS
  1228 women referred with a borderline or single mildly dyskaryotic smear. Samples were taken at colposcopy using PreservCyt. Tests included Hybrid Capture 2, Abbott RealTime PCR, BD HPV, Cobas 4800, PreTect HPV-Proofer, APTIMA and p16(INK4a). Results were based on the worst histology within 9 months.
  
  
  RESULTS
  97/1228 (7.9%) women had CIN3+ (203/1228 (17%) CIN2+). HPV testing alone using Hybrid Capture 2, Abbott RealTime PCR, BD HPV, Cobas 4800 or APTIMA had a sensitivity for CIN3+ ranging from 99.0% to 100.0% and specificity for <CIN2 from 23.3% to 34.7%. p16(INK4a) had a sensitivity of 86.8% and specificity of 50.7%. PreTect HPV-Proofer had a sensitivity of 85.1% and specificity of 73.2%. Testing for HPV type 16 only had sensitivities ranging from 66.0% to 75.5% and specificities from 81.3% to 87.6%. Dual testing with HPV type 16 combined with p16(INK4a) gave a high sensitivity for CIN3+ (78.7% to 98.0%) and specificity for <CIN2 of 58.6% to 81.5%.
  
  
  CONCLUSIONS
  Triage with sensitive HPV testing assays can substantially reduce the number of unnecessary referrals in women with low grade cytology with virtually no loss of sensitivity. Even greater gains can be made if p16 and type 16 are used, but some cases of CIN2 will be missed. In both cases short term surveillance will be needed.
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
authors: David
authors: D
authors: Mesher
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
authors: Anne
authors: A
authors: Szarewski
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
authors: Louise
authors: L
authors: Cadman
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
authors: Janet
authors: J
authors: Austin
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
authors: Lesley
authors: L
authors: Ashdown-Barr
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
authors: Linda
authors: L
authors: Ho
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
authors: George
authors: G
authors: Terry
authors: Cytopathology Department, Royal Free Hospital, London NW3, UK.
authors: Martin
authors: M
authors: Young
authors: Department of Pathology, University of Virginia Health System, Virginia 22908, USA.
authors: Mark
authors: M
authors: Stoler
authors: Laboratoire Pasteur-Cerba, 95066 Cergy Pontoise Cedex 9, France.
authors: Christine
authors: C
authors: Bergeron
authors: Cytopathology Department, St. Mary's Hospital, Praed Street, London W2 1PG, UK.
authors: Julie
authors: J
authors: McCarthy
authors: Cytopathology Department, St. Mary's Hospital, Praed Street, London W2 1PG, UK.
authors: Corrina
authors: C
authors: Wright
authors: The Doctors Laboratory, 60 Whitfield Street, London W1T 4EU, UK.
authors: Stuart
authors: S
authors: Liddle
authors: Department of Gynaecology, Hammersmith and Queen Charlotte's & Chelsea Hospitals, Du Cane Rd., London W12 0HS, UK.
authors: W P
authors: WP
authors: Soutter
authors: Department of Gynaecology, St. Mary's Hospital, Praed Street, London W2 1PG, UK.
authors: Deirdre
authors: D
authors: Lyons
authors: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK. Electronic address: j.cuzick@qmul.ac.uk.
authors: Jack
authors: J
authors: Cuzick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000032:analysis; D055088:Early Detection of Cancer; D005260:Female; D005838:Genotype; D052162:Human papillomavirus 16 / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012367:RNA, Viral / Q000032:analysis; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral