title: Testing of integrated human papillomavirus mRNA decreases colposcopy referrals: could a change in human papillomavirus detection methodology lead to more cost-effective patient care?
abstract: OBJECTIVE
  This study investigates potential colposcopy referral rates, as per the latest American Society for Colposcopy and Cervical Pathology recommendations, following the change in high-risk human papillomavirus (HR-HPV) detection methodology from Hybrid Capture 2 (HC2) to APTIMA at our institution.
  
  
  METHODS
  Rates of colposcopy referral were compared between two cohorts, each comprising all Pap samples with a diagnosis of atypical squamous cells of undetermined significance (ASCUS) tested for HR-HPV in our laboratory during a 12-month period. Cohorts I and II included Pap samples tested with HC2 (n = 1,856) and APTIMA (n = 1,651), respectively. The rates of quantity not sufficient (QNS) results were determined for all Pap samples during the same time periods.
  
  
  RESULTS
  The proportion of HR-HPV-positive Pap samples with an ASCUS diagnosis was significantly lower with APTIMA (42%) than with HC2 (53%; p < 0.0001). APTIMA also resulted in a significantly lower QNS rate among all Pap samples (0.42 vs. 4.3% with HC2; p < 0.0001).
  
  
  CONCLUSIONS
  The change in HR-HPV detection methodology from HC2 to APTIMA has led to a 21% reduction in colposcopy referrals and a 90% decrease in QNS rates at our institution. The new methodology has resulted in more cost-effective patient care and fewer insufficient samples requiring repeat HR-HPV testing.
authors: Department of Pathology and Laboratory Medicine, Fletcher Allen Health Care, Burlington, Vt., USA.
authors: Jennifer L
authors: JL
authors: Sauter
authors: Sharon L
authors: SL
authors: Mount
authors: Timothy L
authors: TL
authors: St John
authors: Christina M
authors: CM
authors: Wojewoda
authors: Ronald J
authors: RJ
authors: Bryant
authors: Gladwyn
authors: G
authors: Leiman
mesh_terms: D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000191:economics / Q000473:pathology / Q000821:virology*; D005791:Patient Care / Q000191:economics / Q000379:methods; D012333:RNA, Messenger / Q000235:genetics*; D014626:Vaginal Smears / Q000379:methods*
chemical_list: D012333:RNA, Messenger