Cytology and hrHPV for cervical cancer screening assessment

Background A new nationwide screening strategy was implemented in Germany in January 2020. No data are available for women referred to certified dysplasia units for secondary clarification after primary diagnosis by a local physician. We therefore investigated combined testing with Papanicolaou (Pap) smears and high-risk human papillomavirus (hrHPV) and compared the data with the histological findings.

Methods Between January 2015 and October 2020, all referred women who underwent colposcopy of the cervix in our certified dysplasia unit were included. Cytology findings were classified using the Munich III nomenclature, and hrHPV co-testing was performed using the Hybrid Capture 2 (HC2) test (2015–2018), and the Abbott RealTime high-risk HPV (Since 2018).

Results A total of 3588 colposcopies were performed in 3118 women, along with Pap smear and hrHPV co-testing, followed by histology. Women with Pap II-p and a positive hrHPV co-test had a 22.4% risk for cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesion (HSIL), and women with Pap III-p and a positive hrHPV co-test had a 60.7% risk. The risk of CIN 3/HSIL was 83.8% in women with Pap IVa-p (HSIL) and a positive hrHPV co-test. A positive hrHPV co-test increased the likelihood for HSIL+ (OR 5.942; 95% CI, 4.617 to 7.649; P < 0.001).

Conclusions The accuracy of Pap smears is comparable with the screening results. A positive hrHPV test increases the likelihood for HSIL+ fivefold. Carrying out this co-test is an essential part of the diagnostic routine in a dysplasia unit. Colposcopy is necessary to diagnose HSIL+ correctly.

Zweitpublikation Die Arbeit wurde bei der Zeitschrift Archives of Gynecology and Obstetrics zur Veröffentlichung eingereicht.

Publikationsverlauf

Artikel online veröffentlicht:
11. Oktober 2022