title: Outcomes in HrHPV-positive women with low grade cervical smears and normal or low grade initial colposcopy results.
abstract: OBJECTIVE
  To determine outcomes in HrHPV-positive women with low grade cervical smears and normal or low grade initial colposcopy biopsy results in a cohort of women over a 2-year follow-up period.
  
  
  BACKGROUND
  The revised National Cervical Screening (NCS) programme guidelines in New Zealand were implemented in October 2009. The guidelines state that women 30 years and older should undergo reflex HPV testing. If this test confirms the presence of HrHPV, women are to be referred for a colposcopic assessment. The guidelines do not mention what the follow-up period should be of women with HrHPV and normal or low grade abnormalities at colposcopy/biopsy.
  
  
  METHODS
  In this study we followed up women 30 years and older referred to Wellington Hospital from 1/10/2009 to 1/10/2011 with a LGSIL or ASC-US smear and positive HrHPV test. Those with a normal or low grade biopsy result were followed over a 2-year period to determine outcomes.
  
  
  RESULTS
  Our study found that 4% of women with initial normal biopsy results and 15.2% with initial low grade results had progressed to high grade (CIN 2/3/invasion) over a 2-year follow-up period. During the same time period, 68% of women with an initial normal biopsy and 61% with a low grade biopsy had a normal colposcopy after 2 years. Twenty-eight percent of women with normal and 24% of those with initial with low grade biopsy continued to have LG abnormalities at 2 years of follow-up.
  
  
  CONCLUSIONS
  Women 30 years and older who are HrHPV-positive and have low grade abnormalities at colposcopic biopsy may be followed up with a 12-month cervical smear rather than repeat colposcopy as the risk of progression to a high grade abnormality is low.
authors.forename: Erica
authors.initials: E
authors.lastname: Winsley
authors.affiliation: Department of Obstetrics and Gynecology, University of Otago (Wellington), PO Box 7343, Wellington South 6242. New Zealand. dean.maharaj@otago.ac.nz.
authors.forename: Dushyant
authors.initials: D
authors.lastname: Maharaj
authors.forename: Peter
authors.initials: P
authors.lastname: Abels
authors.forename: Diane
authors.initials: D
authors.lastname: Kenwright
authors.forename: Fali
authors.initials: F
authors.lastname: Langdana
mesh_terms: D000328:Adult; D003127:Colposcopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009520:New Zealand; D030361:Papillomavirus Infections / Q000175:diagnosis*; D011379:Prognosis; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears