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Multicenter Study
. 2011 Sep 27;105(7):983-8.
doi: 10.1038/bjc.2011.326. Epub 2011 Sep 6.

HPV testing as a triage for borderline or mild dyskaryosis on cervical cytology: results from the Sentinel Sites study

R S Kelly  1 , J Patnick, H C Kitchener, S M Moss; NHSCSP HPV Special Interest Group
Collaborators, Affiliations
Multicenter Study

HPV testing as a triage for borderline or mild dyskaryosis on cervical cytology: results from the Sentinel Sites study

R S Kelly et al. Br J Cancer. .

Abstract

Background: Earlier pilot studies of human papillomavirus (HPV) triage concluded that HPV triage was feasible and cost-effective. The aim of the present study was to study the impact of wider rollout of HPV triage for women with low-grade cytology on colposcopy referral and outcomes.

Methods: Human papillomavirus testing of liquid-based cytology (LBC) samples showing low-grade abnormalities was used to select women for colposcopy referral at six sites in England. Samples from 10,051 women aged 25-64 years with routine call or recall cytology reported as borderline or mild dyskaryosis were included.

Results: Human papillomavirus-positive rates were 53.7% in women with borderline cytology and 83.9% in those with mild dyskaryosis. The range between sites was 34.8-73.3% for borderline cytology, and 73.4-91.6% for mild dyskaryosis. In the single site using both LBC technologies there was no difference in rates between the two technologies. The positive predictive value of an HPV test was 16.3% for CIN2 or worse and 6.1% for CIN3 or worse, although there was considerable variation between sites.

Conclusion: Triaging women with borderline cytological abnormalities and mild dyskaryosis with HPV testing would allow approximately a third of these women to be returned immediately to routine recall, and for a substantial proportion to be referred for colposcopy without repeat cytology. Variation in HPV-positive rates results in differing colposcopy workload.

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Figures

Figure 1
Figure 1
Study protocol. 1If sample is inadequate for the HPV test, recall for 6-month repeat cytology/HPV test or refer to colposcopy, depending on local referral practice. 2Follow-up after 12-month cytology only, should follow normal NHSCSP protocols. 3Women ⩾50 years who have normal cytology at 3 years will then return to 5-yearly routine recall. NB Women who reach 65 years still require to complete the protocol, otherwise need to comply with the national guidelines.
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