Clinical significance of genotyping for human papillomavirus (HPV) 16 18/45 combined with cytology in cervical exfoliated cells in HPV oncogenic mRNA-positive women

Abstract

ObjectivesThis study aimed to assess human papilloma virus (HPV) 16 18/45 typing test results combined with cytology for cervical exfoliated cells from women who screened positive in an HPV E6/E7 mRNA assay (Aptima HPV, AHPV). MethodsIn total, 3257 AHPV-positive women aged 25–65 years were underwent AHPV 16 18/45 Genotype assay (AHPV-GT) testing with cytology. Women were referred for colposcopy and further biopsy if indicated. Different triaging strategies were compared. ResultsOverall, 624 women (19.2%) tested AHPV-GT positive. When identifying CIN2+, compared with cytology, AHPV-GT achieved a similar AUC (0.72 vs. 0.69, P = 0.158) but a higher specificity (85.1% vs. 79.3%, P < 0.001) and positive predictive value (PPV) (29.6% vs. 23.2%, P < 0.001). When identifying CIN2+, compared with cytology, the cotesting strategy (cytology combined with AHPV-GT) increased the AUC from 0.69 to 0.76 (P < 0.001), with a higher sensitivity (84.6% vs. 59.5%, P < 0.001), higher NPV (97.6% vs. 94.9%, P < 0.001) and similar PPV (21.6% vs. 23.2%, P = 0.054). When identifying CIN2+, the results of combination strategy (AHPV-GT genotyping plus reflex cytology in women positive for the 11 other hrHPV genotypes) were consistent with those of the cotesting strategy. Similar results were achieved when identifying CIN3 + . ConclusionsThe AHPV-GT test may be a promising triage approach with high specificity in women receiving AHPV-positive primary screening tests. Although a combination strategy and cotesting strategy detected the same CIN2+ and CIN3+ cases, the former required significantly fewer screening tests.