Introduction/Background During the last decades many countries have established national screening programs that include co-testing (HPV DNA and cytology). The addition of HPV testing to cytology resulted in an increased detection of CIN3+. HPV-mRNA is a promising alternative for cervical screening and more specific tool in recognizing an active infection. Our aim was to compare the use of both tests (HR-mRNA and HPV DNA) combined with liquid based cytology in a primary HPV cervical screening program.

Methodology In our prospective study we included women aged 25–65 (mean age=45 years old) that attended the gynecological department of the Naval hospital of Athens over the period 2019–2022. They underwent liquid-based cytology (LBC) and 14 type mRNA-HPV (APTIMA) along with 49 type HPV DNA (CLART, Genomica).

Results So far, 300 women have been tested. 30/300 (10%) have been found mRNA(+) and 82/300 (27,3%) HPV-DNA (+). Among patients with low grade findings in cytology (ASCUS, LGSIL) 79% were HPV-DNA (+) and 26% mRNA(+). Among patients with normal cytology 42% were HPV-DNA (+) and 12% mRNA(+). 10% of them developed CIN 2+ lesions in the next 2 years. Interestingly, there were 55/300 (18%) women that had minor intraepithelial lesions and were mRNA (-). Two HSIL patients being negative for HPV-DNA were mRNA positive and CIN 2+ was confirmed in biopsies.

Conclusion Combination of both HPV tests with cytology undoubtedly increased sensitivity. mRNA had better specificity, over HPV DNA, in identifying cases with normal cytology that are at risk of developing CIN 3+ lesions. Furthermore, it can also be used as a triage of women with ASCUS and LGSIL cytology, that represent HPV transient infections, are often HPV DNA positive and cause a lot of anxiety among women. The main advantage of mRNA, over HPV DNA, is the identification of women with a true risk of developing cervical cancer.

Disclosures No conflict of interest