Abstract
The objective of this study was to determine the prevalence of significant lesions defined as high grade squamous intraepithelial lesions (HSIL), adenocarcinoma in situ (AIS) and invasive carcinoma in women who had HPV-positive and cytology negative co-testing screening results. This retrospective study was conducted in Chiang Mai University Hospital between May, 2013 and August, 2014. Hybrid capture 2 (HC2) was used for HPV testing and conventional Pap smears for cytologic screening. A repeat liquid-based cytology (LBC) was performed in women with such co-testing results followed by colposcopy. Random biopsy was performed in cases of normal colposcopic findings. Further investigations were carried out according to the biopsy or the repeat LBC results. During the study period, 273 women met the criteria and participated in the study. The mean age of these women was 46.4 years with 30% of them reporting more than one partner. The median interval time to colposcopy was 165 days. About 40% showed an abnormality in the repeat cytology. Significant cervical lesions were found in 20 (7.3%) women, including 2 invasive cancers. Of interest was that only 2 of 20 significant lesions were diagnosed by colposcopic examination while the remainder were initially detected by cervical biopsy and abnormal repeat cytology. In conclusion, the prevalence of significant cervical lesions in HPV positive and cytology negative women in Northern Thailand was 7.3%. Further diagnostic work up with repeat cytology follow by colposcopy is recommended. Random biopsy should be performed even when the colposcopic findings are normal.
Highlights
Cervical cancer is currently recognized as the most preventable cancer via primary prevention with HPV vaccination and secondary prevention with regular screening utilizing various methods
The aim of cervical cancer screening is early detection and prompt treatment of the precancerous lesions including cervical intraepithelial neoplasia (CIN) grade 2, CIN 3 commonly known as high- grade squamous intraepithelial lesions (HSIL) and adenocarcinoma in situ (AIS)
According to the 2012 American Cancer Society, American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology (ASCCP) screening guidelines, the preferred screening method for women aged 30-65 years was a combination of HPV testing and cervical cytology known as co-testing
Summary
Cervical cancer is currently recognized as the most preventable cancer via primary prevention with HPV vaccination and secondary prevention with regular screening utilizing various methods. According to the 2012 American Cancer Society, American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology (ASCCP) screening guidelines, the preferred screening method for women aged 30-65 years was a combination of HPV testing and cervical cytology known as co-testing. Women with HPV-negative and cytology-negative co-testing can be re-screened every five years, while women with HPV-positive and cytology-negative results are at risk for having underlying HSIL and developing such lesions in the future (Saslow et al, 2012). The recommended guidelines for managing HPV-positive but cytology-negative women is to either repeat co-testing at one year or perform HPV 16/18 genotyping. If the co-test results at one year is a positive HPV test or the cytology has atypical squamous cells of undetermined significance (ASC-US) or worse, colposcopy is recommended. Previous studies in the Western countries where the incidence of cervical cancer was low, have reported that the risk of having underlying HSIL in women with HPVpositive and cytology-negative results was approximately
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