The management of ASCUS cervical cytologic abnormalities and HPV testing: A cautionary note

A recently published study of the management of low-grade cytologic smears compared immediate colposcopy to human papillomavirus (HPV) triage and entr y cytology smears (conservative management) as three triage techniques for managing atypical squamous cells of undetermined significance (ASCUS) smear s (Atypical Squamous Cells of Undetermined Significance/Low-grade Squamous Intraepithelial Lesion Triage Study [ALTS]). The study reported a high sens itivity (96.3%) for HPV testing using hybrid capture 2 to detect cervical i ntraepithelial neoplasia (CIN) III. The authors concluded that HPV testing is a viable option for managing ASCUS smears. We have reviewed the publishe d data from the ALTS trial and have found a large excess of colposcopies an d biopsies in the HPV arm in comparison with. the conservative management ( cytology) arm. In addition, the ALTS trial quality control and pathology re view results raise doubts about the diagnostic validity of the study to est ablish standards of clinical practice. Furthermore, until the 2-year follow -up analysis of the conservative management arm is completed to detect CIN III, a valid comparison between HPV triage and conservative management is n ot possible. We conclude that, based on published data, HPV testing for rou tine clinical management of low-grade cytologic abnormalities (ASCUS smears ) is not warranted, and that HPV testing is currently an investigational to ol. (Obstet Gynecol 2001;98:849-51. (C) 2001 by the American College of Obs tetricians and Gynecologists.).