Triage by HPV-DNA testing: is it useful in women with persistent minor smear abnormalities?



Background.  This study was carried out to evaluate the efficacy of HPV-DNA (Human Papilloma Virus) testing as a triage strategy for persistent borderline and mild cytological abnormalities.

Methods.  A prospective cross-sectional study involving 321 women registered between January and December 2001 with two smears showing borderline or mild dyskaryosis, taken 6 months apart. This study was undertaken in a colposcopy unit in a large district general hospital in central London.

Results.  Three hundred and twenty-one women referred with persistent borderline and mild dyskaryosis were recruited in this study. HPV-DNA testing was positive in 194 women (60.4%). Histology of colposcopically directed biopsy showed CIN2/3 in 57 women (18%). Fifty-one of these 57 women were detected by HPV-DNA testing (sensitivity for high-grade disease 89.5%). Specificity for high-grade disease was 45.8%. Negative predictive value was 95.3%. Women with a positive HPV-DNA result had a 7.2 times higher risk of having a high-grade cervical cancer precursor lesion.

Conclusion.  Negative predictive value of HPV-DNA testing for high-grade cervical lesion is very high. Hence, it can be used as a triage strategy for persistent borderline changes and mild dyskaryosis.