HPV testing in the screening and follow-up of patients with cervical high-grade squamous intraepithelial lesions

Objectives. - To evaluate the value of high-risk HPV (HR HPV) testing in screening and post-treatment follow-up of high-grade squamous intraepithelial cervical lesions (HSIL). Methods. - A systematic review of the literature from 2000 to 2019 was conducted including the following keywords: "human papilloma virus", "HPV testing", "cervical squamous intraepithelial lesion", "cervical cancer". Result. - Numerous recent randomized studies and meta-analyzes have concordant results in favor of HR HPV superiority over cervical smear in the screening and post-treatment monitoring of HSIL. In screening, the sensitivity of the HR HPV tests is 63% to 98% whereas that of the cervical smear is only 38% to 65% for the detection of HSIL+ (HSIL and invasive cancers). A negative HR HPV test is associated with less than 5% risk of LIEHG + at 6 years. In addition, after removal of a LIEHG, HR HPV tests have a sensitivity > 90% and specificity > 80% to predict treatment failure. After surgicale exision, a negative HR HPV test is associated with a risk of failure < 2% (negative predictive value of 98%), and 12-25% if it is positive. Conclusions. - HR HPV tests are effective, allowing early detection of LIEHG+ identification of low-risk women in case of negative test, and a prediction of the risk of failure after treatment. (C) 2019 Elsevier Masson SAS. All rights reserved.