Introduction This study aimed to evaluate the significance of HPV testing as a screening test for cervical cancer.

Methods Between April 2010 and September 2021, women initially diagnosed with ASCUS or LSIL and having HPV infection were included. They underwent cytology and HPV testing every 6 months until disease progression. Cytology results were categorized as ASCUS/LSIL positive or HSIL positive. HPV infection patterns were divided into high-risk 1 (16, 18, 31, 33, 45, 52, 58), high-risk 2 (35, 39, 51, 56, 59, 66, 68), low-risk 3, and regression 4 (HPV regression within 6 months). Sensitivity for cytology and HPV testing at 1, 2, and 3-year intervals was evaluated, along with Cox analysis for disease progression.

Results Total 1,273 participants were included, and 98 women (7.7%) experienced disease progression. The best AUC for cytology was 0.85 with a sensitivity of 0.735 over 3 years in the HSIL positive group. For HPV testing, the best AUC was 0.778 and sensitivity was 0.765 over 3 years in the high-risk 1 group. Disease progression significantly differed among the HPV groups, with a hazard of 11.4 (p=0.001) in the high-risk 1 group. HPV regression showed no disease progression. Among participants under 30, no statistically significant progression was observed as HPV infection pattern.

Conclusion/Implications In women diagnosis for ASCUS/LSIL, HPV test showed slightly higher sensitivity compared to cytology. Considering survival analysis, it is recommended to add HPV test of high-risk 1 for women over 30 years.