RELEVANCE OF HUMAN PAPILLOMAVIRUS SCREENING IN MANAGEMENT OF CERVICALINTRAEPITHELIAL NEOPLASIA

OBJECTIVE: To evaluate the utility of human papillomavirus detection i n identifying women with abnormal Papanicolaou smears who can be safel y followed up with cytologic study only, we conducted a study to deter mine the sensitivity, specificity, and negative and positive predictiv e values of a Food and Drug Administration-approved human papillomavir us test kit for detection of cervical intraepithelial neoplasia in col poscopically directed biopsy specimens. STUDY DESIGN: We enrolled wome n with abnormal Papanicolaou smears referred to a colposcopy clinic se rving indigent patients. All 1128 women had a referral Papanicolaou sm ear, a clinic Papanicolaou smear, and a sample for human papillomaviru s deoxyribonucleic acid test; 1075 underwent colposcopically directed biopsies and endocervical curettage. We used the HPV Profile kit for h uman papillomavirus testing. RESULTS: Of 486 women with low-grade squa mous intraepithelial lesions on Papanicolaou smear, 35.4% had high-ris k human papillomavirus deoxyribonucleic acid detected, and of 592 with high-grade lesions, 44.4% had high-risk human papillomavirus detected . Among 527 women with biopsy specimens showing cervical intraepitheli al neoplasia and in 267 with cervical intraepithelial neoplasia grades 2 or 3, 38.7% and 56.2% had high-risk human papillomavirus deoxyribon ucleic acid detected. However, the sensitivity of human papillomavirus deoxyribonucleic acid detection to identify biopsy-confirmed cervical intraepithelial neoplasia grades 2 or 3 was 55.7%, and the positive p redictive value of the test was only 34.9%. CONCLUSION: Human papillom avirus appears to be causally associated with cervical cancer but huma n papillomavirus screening does not appear to be of value to identify women with abnormal Papanicolaou smears who can be safely followed up with cytologic study alone.