HPV TESTING IN CLINICAL PRACTICE.

Potential roles for HPV testing in cervical screening.The most important clinical value of HPV testing in thelower genital tract is to distinguish women at very low riskof malignancy from those at some risk.In cervical screening, the principal roles that HPV testingmay play are(i) in primary screening,(ii) in following up the treatment of cervical abnormalities,(iii) triage of mild abnormalities.Study findingsThe ASCUC-LSIL triage study (ALTS) investigated the sensitivityof HPV testing using HC II combined with repeat cytologyin detecting CIN3+ lesions (Table 1) [11].Further results from the ALTS study, in which 897 cases oflow-grade squamous intraepithelial lesion (LSIL) and 1193cases of HPV DNA-positive ASCUS were followed for 2 years,suggested that LSIL lesions and HPV-positive ASCUS areclinically equivalent [12]. Initial colposcopic detection of obviouslyprevalent CIN2+ reduces risk. However, for the remainingwomen who have CIN ≤ 1 on colposcopy and directedbiopsy, the risk for subsequent CIN grade 2 or 3 isapproximately 12% over 2 years.The HPV in addition to routine testing (HART) studylooked at the management of women who tested positivefor high-risk types of HPV, but had negative or borderlinescreening abnormalities [13]. HPV testing was more sensitivethan borderline-or-worse cytology (97.1% versus 76.6%,P = .002), but less specific (93.3% versus 95.8%, P < .0001)for detecting CIN2+. Surveillance at 12 months was as effectivefor monitoring progression as immediate colposcopy.From study results to clinical practiceA meta-analysis to assess the accuracy of HPV DNA testingas an alternative to repeat cytology in women who had equivocalresults on a previous Pap smear suggests thatHC II assayhas higher sensitivity and similar specificity than the repeatPap smear (ASCUS as threshold) for CIN2+ among womenin this patient group [14].HPV testing has a high negative predictive value and althoughthe positive predictive value is lower, it offers considerablebenefits in triaging patients. It can also assist decisionmaking on behalf of women with mild cytological abnormalities. [ABSTRACT FROM AUTHOR]