Follow-up with histopathology and HPV testing on LSIL cytology in China's largest academic woman's hospital

Cervical cancer remains a major health problem in China. To provide baseline data for establishing the appropriate screening strategy, the authors investigated the histopathologic follow-up and human papillomavirus (HPV) testing results of low-grade squamous intraepithelial lesion (LSIL) cytology in the Chinese Largest Women Hospital.

Women with LSIL cytology, human papillomavirus (HPV) testing, and immediate histopathologic follow-up between 2011 and 2016 were analyzed.

The frequency of LSIL among 1,095,022 Papanicolaou (Pap) tests was 1.4%, and was significantly higher in cases using liquid-based cytology (LBC; 1.5%-1.6%) compared with conventional Pap smears (CPS; 0.5%). The CPS method had performance for predicting cervical intraepithelial neoplasia (CIN) that was comparable to that of LBC (75% vs 69.1% and 71.9%). Among 8079 LSIL cases with an immediate histopathologic diagnosis, CIN-2/3 or higher (CIN-2/3+) was found in 11.9% of cases and carcinoma in 0.3% of cases. A total of 158 patients (15.7%) with HPV-positive LSIL had a diagnosis of CIN-2/3 compared with 18 patients (5.5%) with HPV-negative LSIL. In postmenopausal women with LSIL cytology, the detection rate for CIN-2/3 in HPV-negative patients was significant lower than that in HPV-positive patients. Furthermore, HPV type 16 (HPV-16) was the most common genotype noted in patients with CIN-2+ lesions, whereas HPV-18 was the most common in patients with CIN-1.

Although its reporting rate is lower than that of LBC, CPS is useful due to its low cost and comparable predictive value. HPV testing is helpful for stratifying postmenopausal women with LSIL into lower and higher risk groups. HPV-16 is the most commonly identified genotype in CIN-2+ lesions diagnosed in Chinese women with LSIL cytology, whereas HPV-18 is the most commonly identified genotype in patients with CIN-1 lesions.