title: HPV DNA testing improves CIN2+ risk stratification and detection of CIN2+ in delayed triage of ASCUS and LSIL. A population-based follow-up study from Western Norway.
abstract: In Norway, Pap smears with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are triaged after 6 months. The aim of the study was to evaluate effects of implementing human papillomavirus (HPV) test (2005) in delayed triage of ASCUS and LSIL in a cohort of women from Western Norway. After a survey of 119,469 cervical Pap smears during 2005-2007, a total of 1055 women with an index ASCUS or LSIL were included in the study and followed up for 3-6 years with respect to progression into cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Overall sensitivity for detection of CIN2+ with HPV testing and cytology was 96% and 72%, respectively. The sensitivity for detection of CIN2+ was not affected by age, but the specificity of the HPV test increased with age. Thus, for the age groups <34 years, 34-50 years, and >50 years, the specificity of a positive HPV test to detect CIN2+ was 47%, 71%, and 82%, respectively. Positive predictive values for CIN2+ in women with positive cytology, positive HPV test, negative cytology, negative HPV test, or negative HPV and cytology tests were 52%, 41%, 8%, 1.5%, and 0.4%, respectively. HPV testing resulted in a net 22% increased detection of CIN2+. Fifty-six percent of CIN2+ was detected at an earlier time point with HPV testing in triage. Implementation of HPV testing in delayed triage of ASCUS and LSIL improved the stratification of CIN2+ risk and increased CIN2+ detection and at an earlier time point than with triage by cytology alone.
authors.affiliation: Department of Pathology, Haukeland University Hospital, N-2021, Bergen, Norway.
authors.forename: Elisabeth B
authors.initials: EB
authors.lastname: Budal
authors.forename: Hans K
authors.initials: HK
authors.lastname: Haugland
authors.forename: Robert
authors.initials: R
authors.lastname: Skar
authors.forename: Bjørn O
authors.initials: BO
authors.lastname: Maehle
authors.forename: Tone
authors.initials: T
authors.lastname: Bjørge
authors.forename: Olav K
authors.initials: OK
authors.lastname: Vintermyr
mesh_terms: D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009664:Norway; D027383:Papillomaviridae / Q000235:genetics* / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000235:genetics / Q000473:pathology / Q000821:virology*; D011247:Pregnancy; D014218:Triage; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral
keywords: ASCUS; HPV; LSIL; cervical cancer; delayed triage