[Contribution of high risk human papillomavirus testing to the management of premalignant and malignant lesions of the uterine cervix]

Abstract

Background and objective: High risk human papillomaviruses (HR-HPV) are consistently associated with premalignant and malignant lesions of the uterine cervix. Thus, the use of molecular techniques to detect HPV has been proposed to improve the results of conventional diagnostic strategies. In the present study, we evaluated the usefulness of the detection of HR-HPV in a cervical pathology unit.

Patients and method: 1005 women (mean age [SD], 38.4 [12.3]; range, 16-83) were referred for a cytology of atypical cells of unknown origin (ASCUS), squamous intraepithelial lesion (SIL) or carcinoma in the six months previous to the admission. All patients underwent a colposcopy, Pap test and/or histological study as well as HR-HPV detection using the Hybrid Capture II test.

Results: HR-HPV was detected in 96% high grade-SIL, 86% carcinomas of the uterine cervix and 86% low grade-SIL, but only in 25% women with no cervical lesions and 0% women with metastatic carcinomas to the cervix (p<0.001). The sensitivity of this test for high grade-SIL or higher was 90.2% and the negative predictive value was 96.5% (odds ratio=18.9; 95% confidence interval, 10.9-33.1). In patients with ASCUS, a negative result for HR-HPV nearly excluded the presence of a cervical lesion (negative predictive value, 98.52%).

Conclusions: HR-HPV detection using Hybrid Capture II is useful in the study of lesions of the uterine cervix. It displays a high sensitivity for the diagnosis of squamous intraepithelial lesions and invasive carcinomas and a high usefulness in the management of ASCUS cases.