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Human papillomavirus testing improves the accuracy of colposcopy in detection of cervical intraepithelial neoplasia
  1. J. Monsonego*,
  2. J. Pintos,
  3. C. Semaille*,
  4. M. Beumont*,
  5. R. Dachez*,
  6. L. Zerat,
  7. A. Bianchi* and
  8. E. Franco
  1. *Institut Alfred Fournier, Paris, France
  2. McGill University, Montreal, Canada
  3. Laboratoire Lavergne-Victor Hugo, Paris, France
  1. Address correspondence and reprint requests to: Dr Joseph Monsonego, MD, Institut Fournier, 174 rue de Courcelles, 75017 Paris, France. Email: jm{at}eurogin.com

Abstract

To assess the performance of human papillomavirus (HPV) testing and colposcopy in detection of cervical pathology. A series of 389 women referred for colposcopy due to an abnormal Pap smear had cervical swabs analyzed for oncogenic (high-risk [HR]) HPV types using Hybrid Capture II (HC2) assay. Loop electrical excision procedure cone biopsy (88%) or colposcopic biopsy (11%) was used as the gold standard. Of the atypical squamous cells of undetermined significance (ASCUS) smears, 48% were positive for HR HPV, as compared to 76.3% of low-grade squamous intraepithelial lesions (LSIL) smears. HR HPV was detected in 66.7% and 90% of patients with cervical intraepithelial neoplasia (CIN) 1 and CIN2 (or higher), respectively. The sensitivity of the Pap smear using an ASCUS threshold in detecting high-grade CIN was 94.5% (95% confidence intervals (CI): 91–97%) and that of colposcopy 98.5% (95% CI: 95–99%). The respective specificities were 30% (95% CI: 17–28%) and 35.6% (CI: 29–42%). HC2 test had comparable sensitivity, 90% (95% CI: 85–93%), but higher specificity, 54.3% (95% CI: 47–61%). Combining HC2 test with Pap increased specificity, 66.7% and 41.3% for ASCUS and LSIL cutoff, respectively. The minor-abnormality threshold together with HC2 increased specificity of colposcopy with no changes in sensitivity. High viral load (>100 relative light unit/positive control) was associated with significant disease. HPV DNA testing improves the accuracy of colposcopy in the detection of high-grade CIN in women with ASCUS or LSIL smears.

  • ASCUS
  • cervical intraepithelial neoplasia
  • colposcopy
  • human papillomavirus
  • LSIL
  • test performance

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