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Integrated HPV Testing, TCT, and Colposcopic VIA/VILI Improves Detection Rate for HSIL and Cervical Cancer: A
Hong Xie1,2, Jian Huang2,3, Mei Ye4
1Department of Gynecology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, 518020, People's Republic of China.
Purpose:
To evaluate the diagnostic performance of the current three-step cervical cancer screening strategy in Chinese women and explore the optimized value of integrating human papillomavirus (HPV) testing, ThinPrep cytology test (TCT), and colposcopic visual inspection with acetic acid/Lugol's iodine (VIA/VILI) for improving cervical disease detection.
Patients And Methods:
A retrospective study was conducted on 11,405 outpatients of Shenzhen People's Hospital (2018-2023). Inclusion criteria were a history of sexual activity plus at least one of the following: high-risk HPV (HR-HPV) positivity, abnormal TCT results, or highly suspicious symptoms. Exclusions included prior hysterectomy, cervical cancer (CC) treatment history, pregnancy, or incomplete medical records. The diagnostic performance of HR-HPV testing, TCT, and colposcopic VIA/VILI results was evaluated using pathologically confirmed high-grade squamous intraepithelial lesion (HSIL) and CC as the reference standard. The calculated metrics comprised sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC).
Results:
Among the cohort, the positive rates were 71.56% for HR-HPV, 32.57% for abnormal cytology, and 9.34% for colposcopic VIA/VILI. For detecting HSIL/CC, the NPVs of HPV testing, TCT, and colposcopic VIA/VILI were 0.976, 0.955, and 0.965, respectively. Combined use of the three modalities achieved an NPV of 0.999 for HSIL/CC. Integrating colposcopic VIA/VILI into primary screening also reduced both false-positive and false-negative results compared with single-modality strategies.
Conclusion:
In this large real-world retrospective cohort, combining HPV testing, TCT, and colposcopic VIA/VILI improves the diagnostic accuracy of high-grade cervical disease (HSIL and CC), with practical feasibility for clinical application. However, this integrated approach needs prospective multi-center validation before widespread promotion in cervical cancer screening among community populations.
