title: Effectiveness of two strategies to follow-up ASC-US and LSIL screening results in The Netherlands using repeat cytology with or without additional hrHPV testing: a retrospective cohort study.
abstract: OBJECTIVE
  The purpose of the study was to assess the effectiveness of repeat cytology with and without additional high-risk human papilloma virus (hrHPV) testing after atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASC-US/LSIL) screening results.
  
  
  METHODS
  In the Netherlands, ASC-US/LSIL is triaged by repeat cytology at 6 months or repeat cytology at 6 months with additional hrHPV testing. ASC-US/LSIL results from 13,734 screenees in 2008 were extracted from "Dutch Pathology Registry" including cytology, histology, and/or HPV follow-up results. Proportions of compliance, repeat cytology, referral, and detected cervical intraepithelial neoplasia (CIN) were assessed.
  
  
  RESULTS
  With additional hrHPV testing, 46.8 % was send back to regular screening at 6 months, 28.6 % needed second repeat cytology, and 24.6 % was referred for colposcopy. Without additional hrHPV testing, this was 0.0, 76.1, and 23.9 %, respectively. With additional hrHPV testing, significantly higher proportions of persisting ASC-US/LSIL; compliance with repeat/referral advices; and histological detection of CIN0 (no CIN or cancer), CIN1, and CIN2 were found but equal proportions CIN3+.
  
  
  CONCLUSIONS
  Additional hrHPV testing shortens follow-up without altering CIN3+ detection. Detection of CIN0, CIN1, and CIN2 was higher, presumably by hrHPV-driven biased cytology and detection bias. Restricting additional hrHPV testing to older women, reading cytology without knowledge of hrHPV status, and addition of more specific triage tests could further improve the effectiveness of additional hrHPV testing.
authors.affiliation: Department of Pathology, 824, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands, bert.siebers@radboudumc.nl.
authors.forename: Albert G
authors.initials: AG
authors.lastname: Siebers
authors.forename: Marc
authors.initials: M
authors.lastname: Arbyn
authors.forename: Willem J G
authors.initials: WJ
authors.lastname: Melchers
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: van Kemenade
authors.forename: Judith E M
authors.initials: JE
authors.lastname: Vedder
authors.forename: Hans
authors.initials: H
authors.lastname: van der Linden
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Ruud L M
authors.initials: RL
authors.lastname: Bekkers
authors.forename: Johan
authors.initials: J
authors.lastname: Bulten
mesh_terms: D000328:Adult; D065309:Atypical Squamous Cells of the Cervix / Q000473:pathology; D015331:Cohort Studies; D003127:Colposcopy; D003581:Cytodiagnosis; D003663:Decision Trees; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology