Relevance of human papillomavirus screening in management of cervical intraepithelial neoplasia

• Published in: American journal of obstetrics and gynecology Vol. 176; no. 1; pp. 87 - 92
• Main Authors: Kaufman, Raymond H., Adam, Ervin, Icenogle, Joseph, Lawson, Herschel, Lee, Nancy, Reeves, K.O., Irwin, John, Simon, Terry, Press, Milan, Uhler, Robert, Entman, Carol, Reeves, William C.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-01-1997; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; cervical intraepithelial neoplasia; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - virology; DNA Probes, HPV; Female; Human papillomavirus; Human viral diseases; Humans; Infectious diseases; Medical sciences; Middle Aged; Papanicolaou Test; Papillomaviridae - genetics; Papillomaviridae - isolation & purification; Predictive Value of Tests; screening; Sensitivity and Specificity; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - virology; Vaginal Smears; Viral diseases; Viral diseases of the genital and urinary system; Human papillomavirus; screening; cervical intraepithelial neoplasia; Human; Colposcopy; Premalignant lesion; Papovaviridae; Medical screening; Female genital diseases; Infection; Papillomavirus; Virus; Cervical dysplasia; Viral disease; Female; Papanicolaou smear test; Endoscopy; Uterine cervix diseases
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(97)80017-8

OBJECTIVE: To evaluate the utility of human papillomavirus detection in identifying women with abnormal Papanicolaou smears who can be safely followed up with cytologic study only, we conducted a study to determine the sensitivity, specificity, and negative and positive predictive values of a Food and Drug Administration–approved human papillomavirus test kit for detection of cervical intraepithelial neoplasia in colposcopically directed biopsy specimens. STUDY DESIGN: We enrolled women with abnormal Papanicolaou smears referred to a colposcopy clinic serving indigent patients. All 1128 women had a referral Papanicolaou smear, a clinic Papanicolaou smear, and a sample for human papillomavirus deoxyribonucleic acid test; 1075 underwent colposcopically directed biopsies and endocervical curettage. We used the HPV Profile kit for human papillomavirus testing. RESULTS: Of 486 women with low-grade squamous intraepithelial lesions on Papanicolaou smear, 35.4% had high-risk human papillomavirus deoxyribonucleic acid detected, and of 592 with high-grade lesions, 44.4% had high-risk human papillomavirus detected. Among 527 women with biopsy specimens showing cervical intraepithelial neoplasia and in 267 with cervical intraepithelial neoplasia grades 2 or 3, 38.7% and 56.2% had high-risk human papillomavirus deoxyribonucleic acid detected. However, the sensitivity of human papillomavirus deoxyribonucleic acid detection to identify biopsy-confirmed cervical intraepithelial neoplasia grades 2 or 3 was 55.7%, and the positive predictive value of the test was only 34.9%. CONCLUSION: Human papillomavirus appears to be causally associated with cervical cancer but human papillomavirus screening does not appear to be of value to identify women with abnormal Papanicolaou smears who can be safely followed up with cytologic study alone. (Am J Obstet Gynecol 1997;176:87-92.)