We conducted a retrospective, observational study in order to evaluate the role of high-risk human papillomavirus (hrHPV)-DNA test in patients with first diagnosis of low-grade squamous intraepithelial lesions (L-SILs).Patients were divided into group A, annual Papanicolaou test and hrHPV-DNA tests (167 patients) and group B, immediate colposcopy, followed by annual papanicolaou test and hrHPV-DNA tests (164 patients). We assessed sensitivity, specificity, negative predictive value (NPV), positive predictive value, positive–negative likelihood ratio of hrHPV-DNA test, and 5-year relative risk of cervical intraepithelial neoplasia grade 2 in hrHPV-DNA+. Colposcopy is still considered the best choice for women with L-SIL and hrHPV-DNA+ test. High sensitivity and NPV of hrHPV-DNA test permit to use it in the follow-up of L-SIL with a HPV-negative status, without necessity of referring to colposcopy.
CottonSCSharpLLittleJTrial of management of borderline and other low-grade abnormal smears (TOMBOLA): trial design. Contemp Clin Trials. 2006;27(5):449–471.
2.
WrightTC Jr MassadLSDuntonCJSpitzerMWilkinsonEJSolomonD.Consensus conference. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007;197(4):346–355.
3.
Corrêa FdeMRussomanoFBOliveiraCA. Colposcopic triage methods for detecting cervical intraepithelial neoplasia grade 3 after cytopathological diagnosis of low-grade squamous intraepithelial lesion: a systematic review on diagnostic tests. Sao Paulo Med J. 2012;130(1):44–52.
4.
TOMBOLA Group. Cytological surveillance compared with immediate referral for colposcopy in management of women with low grade cervical abnormalities: multicentre randomised controlled trial. BMJ. 2009;339:b2546.
5.
HellstenCSjöströmKLindqvistPG. A 2-year follow-up study of anxiety and depression in women referred for colposcopy after an abnormal cervical smear. BJOG. 2008;115(2):212–218.
6.
DoorbarJ. Molecular biology of human papillomavirus infection and cervical cancer. Clin Sci (Lond). 2006;110(5):525–541.
7.
CottonSSharpLLittleJThe role of human papillomavirus testing in the management of women with low-grade abnormalities: multicentre randomised controlled trial. BJOG. 2010;117(6):645–659.
8.
ASCUS-LSIL Triage Study (ALTS) Group. A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Am J Obstet Gynecol. 2003;188(6):1393–1400.
9.
CoxJTSchiffmanMSolomonD; ASCUS-LSIL Triage Study (ALTS)Group. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol.2003;188(6):1406–1412.
10.
CuzickJArbynMSankaranarayananROverview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries. Vaccine. 2008;26(suppl 10):K29–K41.
11.
ArbynMSasieniPMeijerCJClavelCKoliopoulosGDillnerJ. Chapter 9: Clinical applications of HPV testing: a summary of meta-analyses. Vaccine. 2006;24(suppl 3):S3/78–S89.
12.
RoncoGSegnanNGiorgi-RossiPHuman papillomavirus testing and liquid-based cytology: results at recruitment from the new technologies for cervical cancer randomized controlled trial. J Natl Cancer Inst. 2006;98(11):765–774.
13.
RoncoGGiorgi-RossiPCarozziFHuman papillomavirus testing and liquid-based cytology in primary screening of women younger than 35 years: results at recruitment for a randomised controlled trial. Lancet Oncol. 2006;7(7):547–555.
14.
RoncoGGiorgi-RossiPCarozziFEfficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial. Lancet Oncol. 2010;11(3):249–257.
15.
FrederiksenMLyngeEReboljM.What women want. Women’s preferences for the management of low-grade abnormal cervical screening tests: a systematic review. BJOG. 2012;119(1):7–19.
16.
RanaDNMarshallJDesaiMFive-year follow-up of women with borderline and mildly dyskaryotic cervical smears. Cytopathology. 2004;15(5):263–270.
17.
KyrgiouMKoliopoulosGMartin-HirschPManagement of minor cervical cytological abnormalities: a systematic review and a meta-analysis of the literature. Cancer Treat Rev. 2007;33(6):514–520.
18.
La Colposcopia in Italia. Società italiana di Colposcopia e Patologia Cervico Vaginale. Linee Guida Edizione 2006. “Gestione delle pazienti con Pap-test anormale”. Anno XXI. http://www.colposcopiaitaliana.it/pdf07/Linee-Guida-2006.pdf. Accessed December 1, 2006.
19.
La Colposcopia in Italia. Società italiana di Colposcopia e Patologia Cervico Vaginale. Linee Guida Edizione 2002. “Gestione delle pazienti con Pap-test anormale”. Anno XIX. http://www.colposcopiaitaliana.it/pdf07/Linee-Guida-2002.pdfAccessed December 1, 2002.
20.
CarozziFMDel MistroAConfortiniM. Reproducibility of HPV DNA Testing by Hybrid Capture 2 in a Screening Setting. Am J Clin Pathol. 2005;124(5):716–721.
21.
RaffleAEAldenBQuinnMBabbPJBrettMT. Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented. BMJ. 2003;326(7395):901–905.
22.
LuesleyDLeesonS.Colposcopy and Programme Management. Guidelines for the NHS Cervical Screening Programme. Sheffield, England: NHS Cervical Screening Programmes; 2004(NHSCSP Publication No. 20).
23.
CuzickJClavelCPetryKUOverview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119(5):1095–1101.
24.
NauclerPRydWTörnbergSHuman papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med. 2007;357(16):1589–1597.
25.
BulkmansNWBerkhofJRozendaalLHuman papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial. Lancet. 2007;370(9601):1764–1772.
26.
KitchenerHCAlmonteMThomsonCHPV testing in combination with liquid-based cytology in primary cervical screening (ARTISTIC): a randomised controlled trial. Lancet Oncol. 2009;10(7):672–682.
27.
Human papillomavirus testing for triage of women with cytologic evidence of low-grade squamous intraepithelial lesions: baseline data from a randomized trial. The Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS) Group. J Natl Cancer Inst. 2000;92(5):397–402.
28.
MossSGrayALegoodREffect of testing for human papillomavirus as a triage during screening for cervical cancer: observational before and after study. BMJ. 2006;332(7533):83–85.
29.
ArbynMMartin-HirschPBuntinxFVan RanstMParaskevaidisEDillnerJ. Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate. J Cell Mol Med. 2009;13(4):648–659.
30.
BentleyECottonSCCruickshankME. Refining the management of low-grade cervical abnormalities in the UK National Health Service and defining the potential for human papillomavirus testing: a commentary on emerging evidence. J Low Genit Tract Dis.2006;10(1):26–38.
31.
AnderssonSDillnerLElfgrenKMintsMPerssonMRylanderE. A comparison of the human papillomavirus test and Papanicolaou smear as a second screening method for women with minor cytological abnormalities. Acta Obstet Gynecol Scand. 2005;84(10):996–1000.
32.
MelnikowJNuovoJWillanARChanBKSHowellLP.Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol.1998;92(4 pt 2):727–735.
33.
MoscickiABShiboskiSHillsNKRegression of low grade squamous intra-epithelial lesions in young women. Lancet. 2004;364(9446):1678–1683.
34.
ConfortiniMCarozziF.Prevenzione del carcinoma della cervice uterina –dal test HPV al vaccino – le nuove strategie. 1st ed. Milano, Italy: Elsevier; 2012.
35.
ArbynMRoelensJSimoensC.Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions. Cochrane Database Syst Rev. 2013;3:CD008054.
