title: High risk HPV testing in the triage of repeat ASC-US and LSIL.
abstract: BACKGROUND
  The purpose of this study was to evaluate the real-life performance of high-risk (HR) HPV testing in the triage of repeat atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesions (LSIL).
  
  
  METHODS
  In 2004-2012, 127 women with repeat ASC-US and 118 women with LSIL were triaged with HPV testing using either a Hybrid Capture 2(®) or Abbott RealTime(®) HR-HPV test. The patient charts were retrospectively reviewed for performance of the tests.
  
  
  RESULTS
  In the repeat ASC-US group, 40.9% of the women were positive for HR-HPV. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 8.7%. The sensitivity of the HR-HPV testing for detection of CIN2+ was 90.9% (95% Cl 58.7-98.5%), with a specificity of 63.8% (95%CI 54.4-72.5%). In women ≥30 years old, the specificity was 70.4%, whereas in younger women it was only 27.8%. The negative predictive value to predict CIN3 was 100% (95% CI 95.2-100.0%). Of the women with LSIL, 68.6% were positive for HR-HPV and the prevalence of CIN2+ was 14.4%. The sensitivity of HR-HPV testing for detection of CIN2+ was 94.1% (95% CI 71.2-99.0%), and the specificity 35.6% (95% CI 26.4-45.8%), respectively. The negative predictive value to predict CIN3 was 100% (95% CI 90.4-100.0%).
  
  
  CONCLUSIONS
  HR-HPV testing seems to be beneficial in the triage of repeat ASC-US in women ≥30 years old, but a high prevalence of HR-HPV infection combined with poor specificity limit the use of HPV testing in the case of LSIL.
authors.affiliation: Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
authors.forename: Olga
authors.initials: O
authors.lastname: Veijalainen
authors.affiliation: Science Center, Pirkanmaa Hospital District, Tampere, Finland.
authors.forename: Sanna
authors.initials: S
authors.lastname: Tuomisaari
authors.affiliation: Science Center, Pirkanmaa Hospital District, Tampere, Finland.|School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Luukkaala
authors.affiliation: Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.|School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Mäenpää
mesh_terms: D000293:Adolescent; D000328:Adult; D065309:Atypical Squamous Cells of the Cervix; D005260:Female; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000473:pathology / Q000821:virology*; D014218:Triage; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology
keywords: ASC-US; CIN; HP triage; LSIL; cervical cancer; cytology; human papillomavirus; squamous intraepithelial lesions