Reflex HPV testing identifies most women with high-grade cervical lesions

The use of reflex HPV testing in routine clinical practice is helpful in identifying most women with high-grade cervical lesions, according to a report published in the June 25th issue of Cancer Cytopathology, but testing all women may not be the best screening strategy.

Based on sensitivity/specificity findings, such testing appears to be most beneficial for women older than 30 years with a Pap smear showing atypical squamous cells of undetermined significance (ASCUS).In the current study, reflex HPV testing was performed on 2114 women who showed ASCUS or low-grade squamous intraepithelial lesions (LSIL) on liquid-based Pap testing. The study focused on 630 of these women who underwent subsequent biopsy and had results available for comparison, senior author Dr. Raheela Ashfaq and colleagues, from the University of Texas Southwestern Medical Center at Dallas, note.Unlike conventional Pap smears, the liquid-based test, produced by Massachusetts-based Cytyc Corp. under the name ThinPrep, allows the cervical sample to be “reflexly” tested later for HPV DNA, obviating the need for a repeat clinic visit and smear.Eighty-one percent of women younger than 30 years had high-risk HPV types on reflex testing, compared with 50% of older women (p < 0.0001), the investigators note. The prevalence of such types in women with LSIL was 78%, while the prevalence in women with ASCUS was 47%.High-grade lesions, as verified on biopsy, were also more common in younger patients, the authors state. The prevalence of such lesions in younger and older patients were 24% and 17%, respectively.More than 90% of high-grade lesions tested positive for HPV DNA and, in nearly all cases, the HPV type detected was high-risk, the researchers note. In younger women, reflex testing yielded a sensitivity and specificity of 92% and 22%, respectively. In older women, the sensitivity was slightly worse-84%--but the specificity was greatly improved-59%. "The current study is, to our knowledge, the first time reflex HPV testing has been performed as part of a standard clinical practice in a high-risk population," the investigators note. "Our study confirms that reflex HPV testing...is a sensitive and cost-effective alternative to colposcopy even in a high-risk population."(Source: Cancer Cytopathology 2003;99:149-155: Reuters Health: June 26, 2003: Oncolink)