Relevance of HPV Screening for Triaging Equivocal Cytology Findings in the Pap II-p, Pap III and Pap IIID Groups – Results of Two Long-Term Studies

Abstract

Introduction: The use of HPV screening for the triage of ASC-US (atypical squamous cells of undetermined significance) cytology results has been established as a sound standard by international trials whereas the data for other cytology findings are in part contradictory. There is a lack of long-term studies on the use of HPV triage in Germany. Materials and Methods: For the present study data from a primary HPV screening project involving women aged over 30 years, ongoing since 2006, and an epidemiological study on women aged between 20 and 27 years, ongoing since 2009, were used. Upon recruitment, all women underwent a smear test for cytology and screening for “high-risk” HPV using Hybrid Capture 2 (HC2). If both tests were positive or if there were persisting remarkable cytology findings or a positive HPV test, then clarification by colposcopy was performed. Results: Altogether, among 282 women with Pap II-p (ASC-US), Pap III (ASC-H) or Pap IIID (LSIL + CIN2) and negative HPV test there was no case of CIN3+. Among the women under 30 years of age, however, 69 % (ASC-US) to 85 % (LSIL + CIN2) of the remarkable findings were HPV positive, also among the older women with Pap IIID, the 71 % prevalence of HPV was too high for a triage and even without triage there was a 23 % risk for CIN3+. On the other hand, of the women over 30 years old with ASC-US (Pap II-p) findings, only 21 % were positive for HPV and the risk for CIN3+ in this group was high at 29 %. Also for ASC-H (Pap III) findings in the age group of over 30 years with an HPV prevalence of 56 % there was an efficient triage for CIN3+. Discussion: In summary, the HPV triage of ASC-US (Pap II-p) findings in women aged over 30 years was found to be efficient; in contrast, LSIL + CIN2 (Pap IIID) findings in this age group justified an immediate referral to colposcopy whereas cytology control appeared to be sufficient for younger women.

Zusammenfassung

Einleitung: Der Einsatz der HPV-Testung zur Triage von ASC-US-(atypical squamous cells of undetermined significance-)Zytologiebefunden ist ein durch internationale Studien gut belegter Standard, für andere zytologische Befunde gibt es teils widersprüchliche Daten. In Deutschland fehlen bisher Langzeitstudien zum Nutzen der HPV-Triage. Material und Methoden: Für die vorliegende Untersuchung wurden Daten eines seit 2006 laufenden primären HPV-Screening-Projekts bei Frauen über 30 Jahren und einer seit 2009 laufenden epidemiologischen Studie bei Frauen zwischen 20 und 27 Jahren genutzt. Bei allen Frauen wurden bei Rekrutierung Abstriche für Zytologie und Testung auf „high-risk“-HPV mittels Hybrid Capture 2 (HC2) entnommen. Fielen beide Tests positiv aus oder persistierten auffällige zytologische Befunde oder ein positiver HPV-Test, dann erfolgte eine Abklärung mittels Kolposkopie. Ergebnisse: Insgesamt ergab sich bei 282 Frauen mit Pap II-p, Pap III oder Pap IIID und negativem HPV Test kein Fall einer CIN3+. Bei Frauen unter 30 Jahren waren aber 69 % (Pap II-p) bis 85 % (Pap IIID) der auffälligen Befunde HPV-positiv, auch bei älteren Frauen mit Pap IIID ergab sich für eine Triage mit 71 % eine zu hohe HPV-Prävalenz und bereits ohne Triage ein 23 % Risiko für CIN3+. Bei Frauen über 30 Jahren mit Pap-II-p-Befunden waren dagegen nur 21 % HPV-positiv, und das Risiko für CIN3+ war in dieser Gruppe mit 29 % hoch. Auch für Pap-III-Befunde ergab sich in der Altersgruppe über 30 Jahre bei einer HPV-Prävalenz von 56 % für CIN3+ eine effiziente Triage. Diskussion: Zusammenfassend erwies sich die HPV-Triage von Pap-II-p-Befunden bei Frauen über 30 Jahren als effizient, dagegen erschien bei Pap-IIID-Befunden in dieser Altersgruppe die sofortige Überweisung zur Kolposkopie gerechtfertigt während bei jüngeren Frauen die zytologische Kontrolle als ausreichend erschien.

Key words

HPV - human papillomavirus - Pap II-p - Pap IIID - triage

Schlüsselwörter

HPV - human papillomavirus - Pap II-p - Pap IIID - Triage

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