Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women

High-risk human papillomaviruses (HR-HPV) are the necessary cause of cervic al carcinomas. To determine whether HPR-HPV DNA detection in primary routin e screening could represent a sensitive and reliable technique for the dete ction of high-grade squamous intraepithelial lesions (HGSIL), laboratory an alysis using 2 cytologic techniques (conventional and liquid-based), HPV te sting with Hybrid Capture II assay (HC-II), followed by colposcopic examina tion of women with abnormal cervical finding and/or persistent HR-HPV infec tion, was conducted in 7932 women who had routine cervical examination. The sensitivity of HPV testing for detecting a histologically proven HGSIL was 100%, higher than that of conventional (68.1%) and liquid-based (87.8%) cy tology. The low specificities of 85.6% and 87.3% of HPV testing slightly in creased to 88.4% and 90.1% if HPV testing was reserved for woman >30 years old. The quantitative approach provided by the HC-II assay for the assessme nt of the viral load was not reliable for predicting HGSIL in normal smears . HR-HPV testing could be proposed in primary screening in association with cytology. With conventional cytology it significantly improves the detecti on of HGSIL. With the use of the same cervical scrape for HPV testing and l iquid-based cytology, HR-HPV testing would allow to select positive samples treated in a second time for cytology which gives a good specificity. (C) 2001 Cancer Research Campaign.