Extended HPV typing as an efficient alternative within HPV-based screening programs

Extended high-risk human papilloma virus (hrHPV) typing emerges as a potential alternative for detecting cervical intraepithelial neoplasia 3 (CIN3), without additional triage tests. We evaluate the extended hrHPV typing as an alternative to improve CIN3 detection within an HPV-based screening program. Between January 2017 and August 2018, 5856 women aged 25-65 years were screened as part of a public cervical cancer screening program of the Tlalpan Sanitary Jurisdiction in Mexico City. HPV testing was performed by BD Onclarity™, which individually detects hrHPV types 16, 18, 31, 45, 51, and 52, and pools of types 33/58, 56/59/66, and 35/39/68. Specific hrHPV types within these pools were further identified using the Atila AmpFire platform. All HPV-positive women (n = 691) were referred to colposcopy evaluation for diagnostic confirmation. Of these, 561 women completed both colposcopy and histological confirmation, representing our analytical sample. HPV-16 alone had a sensitivity of 43.0% and specificity of 85.4% for CIN3 detection. Sequentially adding HPV-18/33/31/39 increased sensitivity to 100% for CIN3 detection, although with lower specificity (54.5%). The proportion of HPV-16/18/33/31/39 positive women was 47.0%, with a CIN3 PPV 5.3%. Extended genotyping with HPV-16/18/33/31/39 achieved 100% sensitivity for CIN3 detection, but a moderate specificity. This strategy aligns with the international recommendation for colposcopy referral in women with a PPV of CIN3 larger than 4.0%.