Role of HPV Testing in Secondary and Primary Screening of Cervical Neoplasia

To evaluate the performance of HPV testing in identifying cervical neoplasia.

Minor cytologic atypia of the uterine cervix, particularly atypical squamous cells of undetermined significance (ASCUS) represent a vast group, at least three times more frequent than cytologic high-grade squamous intraepithelial lesions (HGSIL). Even though, individually, ASCUS smears correspond to a normal cervix in nearly 80% of cases, their marked prevalence in the screened population suggests that this category of smear is one of the main sources of histologically confirmed high-grade SIL.The recent recommendations by the National Agency of Accreditation and Evaluation (ANAES) for managing ASCUS smears indicate that it is possible to advise a follow-up smear at regular intervals or immediate colposcopy. The follow-up smear option has limitations related to its incomplete sensitivity (25-40% of existing high-grade SIL can go unrecognized). Colposcopy has optimal sensitivity in recognizing high-grade lesions, but falls short due to lack of specificity.The Hybrid Capture (HC II) (Digene, Silver Spring, MD) test is an objective and reproducible test that makes it possible to detect nononcogenic and oncogenic types of human papillomavirus (HPV) and the DNA viral load, thereby increasing the probability that significant cervical lesions will not go unrecognized.

The Hybrid Capture test is simple to perform and positive results for high-risk HPV strongly correlate with the presence of high-grade CIN (sensitivity of approximately 98%). The test's nearly 100% negative predictive value makes it possibly to fully reassure patients who have had an ASCUS smear, freeing them from regular cytologic follow-up, colposcopy, and biopsy. A Hybrid Capture II test that is positive for oncogenic HPV significantly increases the probability of recognizing significant, precancerous cervical lesions. When the reference smear has been done in a liquid suspension, the Hybrid Capture test can be done on the residual cells in the suspension, thereby avoiding an additional visit.

Recent French and international evaluations and publications should encourage the ANAES task force to propose the HPV test as a possible option for managing smears with minor atypia.▪.