Expanded cytological referral criteria for colposcopy in cervical screening: Comparison with human papillomavirus testing

Objective. The goal of this study was to investigate whether expanded cytol ogic referral criteria for colposcopy or the addition of human papillomavir us (HPV) testing on cervical screening could improve the rates of detection of cervical intraepithelial neoplasia (CIN). Methods. HPV testing by semiquantitative polymerase chain reaction/ELISA wa s performed in 1000 women who were self-referred for routine Pap smear. The y underwent colposcopy following an abnormal smear result or a positive HPV test. As abnormal smear results were considered reports of low- or high-gr ade squamous intraepithelial lesion, atypical squamous cells of undetermine d significance, and even HPV-associated reactive cellular changes (mild koi locytosis, mild dyskeratocytosis, hyperchromatic nuclei, bimultinucleation, and cleared cytoplasm). Loop excision of the transformation zone was perfo rmed in women with cytology and colposcopy indicative of CIN, as well as in women with normal cytology but positive HPV test and colposcopic impressio n of CIN. Results. The Pap test was abnormal in 89% of the cases of CIN 1 (34/38) and 96% of CIN 2/3 (27/28) diagnosed in our population. HPV testing picked up four additional cases of CIN 1 (11%) and one case of CIN 2/3 (4%). Overall the HPV test detected 95% of the cases of CIN 1 (36138) and 89% of the case s of CIN 2/3 (25/28). Conclusion. HPV testing does not appear to add significantly to cytology in terms of positive predictive value or detection rate, if extended cytologi c indications for colposcopy are used. (C) 2001 Academic Press.