Screening for Cervical Intraepithelial Lesions with TCT and HPV DNA: A Triage Strategy

To explore the value of the ThinPrep cytology test (TCT) combined with human papillomavirus (HPV) DNA detection in the screening and triage of cervical lesions.

A total of 1671 patients with cervical inflammation or lesions who underwent colposcopy and biopsy between April 2020 and December 2022 were analyzed. The data included TCT, HPV DNA, and pathological findings.

The incidence of high-grade squamous intraepithelial lesions (HSILs) or above significantly increased with TCT severity: 25.9% in the negative for intraepithelial lesion or malignancy (NILM) group, 39.4% in the atypical squamous cells of undetermined significance (ASCUS) and low-grade SIL (LSIL) groups, and 76.5% in the HSIL+ group (P<0.001 for all pairwise comparisons). The incidence also varied significantly by HPV status: 58.2% in the HPV 16 or 18 group, 28.6% in the other high-risk groups, and 17.6% in the low-risk and negative groups (P<0.001 for all pairwise comparisons). Multivariate analysis revealed independent risk factors for HSIL+: younger age (OR=0.972), HSIL and above cytology (OR=10.154), ASCUS and LSIL cytology (OR=2.250), HPV 16/18 infection (OR=8.061), and other high-risk HPV infections (OR=2.578). Patients with concurrent HPV 16/18 infection and HSIL or above cytology presented a substantially elevated risk (OR=41.517). Among the cohort, 35 cases of cervical squamous cell carcinoma were identified.

TCT combined with HPV DNA testing provides an effective strategy for risk stratification in cervical screening. Our findings support that patients with HPV16 or 18 should be referred directly for colposcopy, and patients with other high-risk HPV types and TCT results of ASCUS and above are also recommended for colposcopy referrals. These referral suggestions warrant further validation in larger, multicenter studies.