Abstract
BackgroundTesting for high-risk human papillomavirus DNA (HPV test) has gained increasing acceptance as an alternative method to cytology in cervical cancer screening. Compared to cytology, HPV test has a higher sensitivity for the detection of histologic high-grade squamous intraepithelial lesion or worse (HSIL+), but this could lead to a large colposcopy burden. Genotyping for HPV16/18 has been recommended in triaging HPV-positive women. This study was aimed to evaluate the screening performance of HPV testing and the role of genotyping triage in Northern Thailand.MethodsA population-based cervical screening program was performed in Chiang Mai (Northern Thailand) using cytology (conventional Pap test) and HPV test (Hybrid Capture 2). Women who had abnormal cytology or were HPV-positive were referred for colposcopy. Cervical samples from these women were genotyped using the Linear Array assay.ResultsOf 5,456 women, 2.0% had abnormal Pap test results and 6.5% tested positive with Hybrid Capture 2. Of 5,433 women eligible for analysis, 355 with any positive test had histologic confirmation and 57 of these had histologic HSIL+. The sensitivity for histologic HSIL+ detection was 64.9% for Pap test and 100% for Hybrid Capture 2, but the ratio of colposcopy per detection of each HSIL+ was more than two-fold higher with Hybrid Capture 2 than Pap test (5.9 versus 2.8). Genotyping results were available in 316 samples. HPV52, HPV16, and HPV58 were the three most common genotypes among women with histologic HSIL+. Performance of genotyping triage using HPV16/18/52/58 was superior to that of HPV16/18, with a higher sensitivity (85.7% versus 28.6%) and negative predictive value (94.2% versus 83.9%).ConclusionsIn Northern Thailand, HPV testing with genotyping triage shows better screening performance than cervical cytology alone. In this region, the addition of genotyping for HPV52/58 to HPV16/18 is deemed necessary in triaging women with positive HPV test.
Highlights
Testing for high-risk HPV DNA (HPV test) has gained increasing acceptance as an alternative method to cervical cytology in primary cervical cancer screening [1]
In Northern Thailand, HPV testing with genotyping triage shows better screening performance than cervical cytology alone
Based on the guidance for primary HPV screening, HPV-positive women with genotypes HPV16/18 should be referred for immediate colposcopy, whereas those with other high-risk HPV genotypes should be triaged by cytology [1]
Summary
Testing for high-risk HPV DNA (HPV test) has gained increasing acceptance as an alternative method to cervical cytology in primary cervical cancer screening [1]. It has been demonstrated HPV test has a higher sensitivity in the detection of cervical precancerous lesions than cytology, and women with negative HPV testing have a lower cumulative incidence of cervical cancer and precancerous lesions compared to those with negative cytology [1,2,3,4]. Testing for high-risk human papillomavirus DNA (HPV test) has gained increasing acceptance as an alternative method to cytology in cervical cancer screening.
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