EPIDEMIOLOGY AND DIAGNOSTIC PROCEDURES OF CERVICAL INTRAEPITHELIAL NEOPLASIA - IS THE CURRENT CONCEPT OF SCREENING AND DIAGNOSTIC TRIAGE STRATEGY STILL VALID

Infection with human papillomavirus (HPV) is the major factor in the g enesis of cervical intraepithelial (CIN) and invasive neoplasia. Howev er, screening is still based upon cytology and further diagnostic inve stigation relies on colposcopy with punch biopsy. In this review, rece nt studies are evaluated with regard to consequences for optimal scree ning and management strategies of CIN. In summary, exfoliative cytolog y is still widely considered as the method of choice for population sc reening. Primary HPV DNA screening proves equivalent or superior to cy tology only in populations with a low prevalence of HPV infections. Pr eliminary data from serological HPV tests are less promising. Cytologi cal diagnosis of HPV infection may be verified by HPV testing. Recogni zing high oncogenic risk viruses in CIN 1 may help to reduce the contr ol period from 24 to 12 months and may lead to immediate therapy for C IN 2 lesions. However, further prospective studies evaluating the cost -effectiveness of HPV DNA tests in German-speaking countries are neces sary.