Actualisation de la conduite à tenir en cas de lésions à papillomavirus humains (HPV)

Abstract

Human papillomaviruses (HPV) are the principal cause of cervical carcinomas. It is now well accepted that HPV testing is particularly useful in the triage of ASCUS. HPV testing can also be used as a primary screening tool. In our experience using the Hybrid Capture II® assay in 10 569 women, the sensitivity of HPV testing for detecting a histologically proven HGSIL was 100 % and 97,5 %, higher than that of conventional cytology (72.7 %) and liquid-based (80,3 %). The low specificity of 87 % of HPV testing was slightly increased to 89,5 % if HPV testing was reserved to women > 30 years old. The quantitative approach provided by the HC-II assay for the assessment of the viral load could not be used for predicting a HGSIL. The negative predictive value of the HPV testing was close to 100 %. HR-HPV testing could be proposed in primary screening of HGSIL in association with cytology. It significantly improves the detection of HGSIL with conventional cytology. A positive HR-HPV test selects population of women at high risk for developing HGSIL. Considering the high specificity of liquid-based cytology in our series (94,8 %), cytology on the same sample could be only performed in this population. In another way, a negative HR-HPV test selects populations at low risk who could benefit a different algorithm of screening of 2 to 3 years.