Exploration of treatment strategies for normal cytology smears with reactive cellular changes.
OBJECTIVE
To evaluate the use of high-risk humanpapillomavirus (HR-HPV) DNA testing in women who have normal cytology result with reactive cellular changes to identify high risk patients of developing precancerous cervical lesions and cervical cancer.


METHODS
Outpatient patients with normal liquid-based cytology (LCT) results showing reactive cellular changes (case group, n=1085) and normal LCT without reactive cellular changes (control group, n=1085) were recruited from cervical clinics at the International Peace Maternity & Child Health Hospital from January 2012 to December 2013. The HPV status and cervical biopsy pathology results were analyzed.


RESULTS
The HR-HPV positive rate of the case group (598/1085) was higher than that of the control group (163/1085) (P<0.001). HR-HPV prevalence among CIN1, CIN2, CIN3 and cervical cancer was 73%, 87%, 100%, and 100% respectively (P<0.05). In patients with positive HR-HPV results, more CIN2+ were found significantly in case group (37/598) than those in control group (3/163), P=0.027. The sensitivity of diagnosis of CIN2+ lesions by HR-HPV testing was 92.5%, the specificity was 36%, the positive predicted value was 8.6%, and the negative predictive value was 98.6%. The incidence of CIN2+ lesions was not different among different age groups (P>0.05).


CONCLUSIONS
Reactive cellular changes in normal cervical smears should be further investigated. HR-HPV testing could be used as an effective triage in cases of reactive cellular changes. Colposcopy is recommended for those cases showing reactive cellular changes combined with HR-HPV positivity to reduce the risk of failure to diagnose cervical cancer and precancerous lesions.
Department of Gynecology, The International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai 200030, China; Department of Gynecology, Shanghai Xuhui Maternity & Infant Health Hospital, Shanghai 200030, China.
Jin
J
Yang
Department of Gynecology, The International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai 200030, China. Electronic address: dr.wudan@163.com.
Dan
D
Wu
Department of Gynecology, The International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai 200030, China.
Zhunan
Z
Li
Department of Gynecology, The International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai 200030, China.
Jiahao
J
Wu
Department of Gynecology, The International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai 200030, China.
Li
L
Ding
Department of Gynecology, The International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai 200030, China.
Ying
Y
Xu
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology
Cervical cancer; HR-HPV; Liquid-based cervical cytology; Pathology; Reactive cellular changes