Using tests for HPV types 16 and 18 as a second triage after high-risk HPV tests in women with minor abnormal cytology may help determine whether colposcopy is necessary, according to findings published in Annals of Internal Medicine.
“Women with minor cytologic abnormalities, including atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL), have only a modestly increased risk for cervical cancer,” Marc Arbyn, MD, MSc, from the Scientific Institute of Public Health in Brussels, and colleagues wrote. “The widespread practice of referring all women with [high-risk] HPV infection and ASC-US or LSIL to colposcopy carries a considerable burden and cost. Because HPV types 16 and 18 cause about 70% of cervical cancer cases, genotyping for these types has been proposed as an additional tool to allow more fine-tuned management.”
Arbyn and colleagues performed a systematic review and meta-analysis to determine the effectiveness of genotyping for HPV 16/18 and its usefulness for women with minor cervical lesions as a second triage test after hrHPV. From Jan. 1, 1999 to Feb. 1, 2016, they searched four databases and found 24 moderate- to good-quality studies of women with ASC-US (n = 8,587) and with LSIL (n = 5,284) who were triage-tested for high-risk HPV and HPV 16/18.
They found that for women with either ASC-US or LSIL, the pooled sensitivity of HPV 16/18 genotyping for cervical intraepithelial neoplasia grade 3 (CIN3+) was approximately 70%. For women with ASC-US and LSIL, the pooled sensitivity of grade < 2 CIN was 83% (95% CI, 80-86) and 76% (95% CI, 74-79), respectively. In addition, HPV 16/18-positive women with ASC-US and LSIL had a 17% and 19% average risk for CIN3+, respectively. The average risk for CIN3+ in high-risk HPV-positive, but HPV 16/18-negative women with either ACS-US or LSIL was 5%.
“Triage of women with minor cytologic abnormalities with partial genotyping for HPV 16/18 increases efficiency compared with [high-risk] HPV testing, but at the expense of a loss in sensitivity,” Arbyn and colleagues concluded. “Women testing positive for HPV 16 and 18 are at high risk and should be referred for colposcopy. Women carrying other high-risk HPV types cannot be released to routine screening. Whether the risk is sufficiently low in these women to avoid referral to colposcopy or to propose repeated testing depends on local decision thresholds.” – by Alaina Tedesco
Disclosure: The authors report funding by 7th Framework Programme of the European Commission.