PCR based high risk HPV testing is superior to neural network based screening for predicting incident CINIII in women with normal cytology and borderline changes

Background/Aims-To improve the accuracy of conventional cytology in cervica l cancer screening, high risk human papillomavirus (HPV) testing and neural network based screening have been developed. This study assessed the power of both techniques to detect women at risk of developing incident CIN III; that is, CIN III detected during the follow up of women with normal cytolo gy and borderline nuclear changes. Methods-A cohort of 2250 women, 34-54 years of age, who attended population based cervical cancer screening from 1988 to 1991 and had normal smears or borderline nuclear changes was followed. All smears were tested for high r isk HPV and the smears were rescreened using neural network based screening . The value of neural network based screening for predicting incident CIN I II during a mean follow up period of 6.4 years was compared with that of hi gh risk HPV testing. In addition, morphological markers presumed to be rela ted to HPV were correlated with HPV status. Results-Thirteen (0.6%) women had incident CIN III. Both high risk HPV posi tivity and abnormal cytology were associated with an increased risk for inc ident CIN III (odds ratio, 240 and 22, respectively) and high risk HPV posi tivity was associated with abnormal cytology. The sensitivity of high risk HPV testing for predicting incident CIN III was much higher than that of ne ural network based screening (92% and 46%, respectively). None of the morph ological markers assessed, including koilocytosis, was correlated with high risk HPV status. Conclusion-High risk HPV testing is superior to neural network based screen ing in identifying women at risk of developing CIN III. For women with norm al cytology and borderline changes and a negative high risk HPV test, the s creening interval can be considerably prolonged.