Human papillomavirus deoxyribonucleic acid testing in screening of high grade cervical intraepithelial neoplasia

Objective: To rest the role of human papillomavirus DNA Hybride Capture II in the screening of cervical intraepithelial neoplasia in a large group of 1,158 women refered with abnormal cytology and colposcopy or both from 102 outpatient clinics in the Czech Republic. Methods: The study group consists of 1,158 women. Their cervical scrabs were sent to the KLINLAB/Clinical Laboratories Prague during a period of two years 1997-1998, because of the abnormal results obtained in the primary screening, Patients diagnosed with abnormal colposcopy and cytology, ASCUS, AGNUS, LSIL, HSIL were eligible for this study. Only fully completed records of women human papillomavirus test, cytology, colposcopy) biopsy were accepted for assessment. Results: The median age among the 1,158 women was 34.7 years range 16-73, 245/21% of the patients had high grade cervical intraepithelial neoplasia or microinvasive cancer. Human papillomavirus testing detected 171 cases 70% of high grade disease. The sensitivity of cytology of women with minor cytological abnormality, ASCUS, LSIL, for major cervical disease of cervical intraepithelial neoplasia 2/3 or microinvasive cancer was only 35%. The overall sensitivity of human papillomavirus DNA testing was 66%, A combined cytology and human papillomavirus DNA test gave an increased sensitivity for major cervical disease of 83%. Conclusion: Our results suggests that cytology alone is not sufficient in common clinical practice for the screening of neoplastic non invasion lesions of the cervix, One hundred and fifty three, 66.5% of the cervical intraepithelial neoplasia 2/3 and 8 cases of microinvasive cancer showed negative, borderline or mild cytological changes. The combined use of cytology with human papillomavirus testing increased the sensitivity with a reduction in specificity. We suggest the human papillomavirus resting could helpfully amplifying but not replace cytology in screening of cervical intraepithelial neoplasia.