Is human papillomavirus testing of value in clinical practice?

The objective of this review was to evaluate the current status of human pa pillomavirus testing in predicting the presence of high-grade or invasive d isease in the cervix in women with Papanicolaou smears reported as atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion. This is a review of many of the studies already pub lished evaluating the utility of human papillomavirus testing as part of th e triage for patients whose Papanicolaou smears were reported as ASCUS or l ow-grade squamous intraepithelial lesion. Two triage approaches for follow- up of such patients are presented, and recommendations are made as to which is most cost-effective and safe. Data related to human papillomavirus test ing were obtained with both currently available commercial kits for detecti on of high-risk human papillomavirus and the polymerase chain reaction. The re was variation in results reported, possibly related to populations studi ed. The approach to management by cytologic screening and colposcopy, when indicated, appeared over the long term to be equal to human papillomavirus testing. In our opinion current human papillomavirus testing is of little c linical use to the practitioner. Its use should be limited to appropriately designed and implemented research studies.