Comparison of ThinPrep cytology and high-risk human papillomavirus testing with different triage protocols for...

To evaluate and compare the diagnostic performance of four cervical cancer screening triage strategies based on the ThinPrep cytologic test (TCT) and high-risk human papillomavirus (HR-HPV) testing, using histologically-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) as the reference standard.

This retrospective analysis included 1,582 consecutive women who underwent concurrent TCT and HR-HPV testing, followed by colposcopy and histopathologic evaluation, between January 2020 and December 2024. Four screening triage strategies were compared: Strategy A (co-testing, either positive), Strategy B (co-testing, both positive), Strategy C (HPV primary with TCT triage), and Strategy D (TCT primary with HPV triage). Using histologically confirmed CIN2+ as the gold standard, we calculated sensitivity, specificity, positive and negative predictive values, colposcopy referral rate, and the area under the receiver operating characteristic curve (AUC).

Among 42 confirmed CIN2+ cases, Strategy A achieved the highest colposcopy referral rate (20.10%) and sensitivity (97.62%), but had lower specificity (85.18%). Strategy B had the highest specificity (97.40%) and the lowest referral rate (2.34%), but substantially lower sensitivity (59.52%). Strategy C demonstrated balanced performance, with a sensitivity of 88.10%, specificity of 91.36%, and a referral rate of 9.42%; its AUC (0.897) was similar to that of Strategy A (0.914, P = 0.163). HPV16/18 positivity was the strongest predictor of CIN2+ (OR = 12.39).

HPV primary screening with TCT triage offers a clinically effective cervical cancer screening strategy, achieving a favorable balance between diagnostic accuracy and colposcopy workload. HPV16/18 genotyping further enhances risk stratification.