Cytopathology & Histopathology

Biography

Biography: Grazyna A. Stanczuk

Abstract

Background: The objective of this study is to examine clinical performance of HPV 16/18 genotyping, reflex liquid-based cytology (LBC) and CINtec plus immunocytochemistry for triage of high-risk HPV positive (hrHPV+) women for detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in a Scottish population. Methods: LBC samples of 536 hrHPV+ women identified in the papillomavirus Dumfries and Galloway (PAVDAG) study were processed for CINtec plus immunocytochemistry. All women with positive CINtec plus tests were invited to colposcopy if they had not been otherwise investigated through the PAVDAG protocol. Results: Triage of hrHPV+ women with CINtec plus was more sensitive for CIN2+ than LBC. However, the sensitivity of CINtec plus for CIN2+ was relatively low (84.2%) in HPV16/18+ women. One in three (32%) women with CIN2+, who tested LBC negative were also CINtec plus negative. Relative sensitivity and specificity of LBC vs. CINtec plus in cervical and vaginal hrHPV+ women with other than HPV16/18 types (hrHPV other+) was 0.95 (0.73-1.23), 1.12 (1.09-1.12) and 1.00 (0.78-1.28), 1.07 (0.95-1.20) respectively. Conclusions: CINtec plus has better sensitivity for CIN2+ in non type-specific hrHPV+ women compared to LBC. However this difference is much smaller when HPV16/18+ women are referred for colposcopy directly and only hrHPV other+ women are triaged. These results are similar irrespective of the sampling method used (clinician-collected cervical or self-collected vaginal samples) for hrHPV detection. The optimal hrHPV based cervical screening should include HPV16/18 typing to allow direct referral to colposcopy for all HPV16/18+ women. Further triage of other than HPV16/18 hrHPV+ women should include LBC follow-by CINtec plus testing of LBC- women.