Cytology and high risk HPV HPV testing in cervical cancer screening program: Outcome of 3‐year follow‐up in an academic institute

摘要

Background Combination of cervical cytology and high‐risk human papillomavirus (HR‐HPV) testing, co‐testing, has been increasingly used in screening cervical cancers. The present study summarized the outcome of co‐testing by reviewing 3‐year clinical and pathological follow‐up information. Methods Patients were retrospectively identified via computerized search and were grouped based on the cytologic diagnosis and HR‐HPV status as negative for intraepithelial lesion or malignancy (NILM)/HPV–, NILM/HPV+, atypical squamous cells of undetermined significance (ASC‐US)/HPV–, ASC‐US/HPV+, low grade squamous intraepithelial lesion (LSIL)/HPV–, LSIL/HPV+, atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion (ASC‐H)/HPV–, ASC‐H/HPV+, high grade squamous intraepithelial lesion (HSIL)/HPV–, and HSIL/HPV+. The patients' pertinent past medical history and follow‐up information were analyzed. Results During 3‐year follow‐up period, histologically proven HSIL was found in 5 of 1565 (0.3%) patients with NILM/HPV–, 7 of 141 (5.0%) with NILM/HPV+, 2 of 502 (0.4%) with ASC‐US/HPV–, 30 of 274 (10.9%) with ASC‐US/HPV+, 1 of 81 (1.2%) with LSIL/HPV–, 28 of 159 (17.6%) with LSIL/HPV+, 3 of 18 (16.7%) with ASC‐H/HPV–, 34 of 69 (49.3%) with ASC‐H/HPV+, 7 of 7 (100%) with HSIL/HPV–, and 35 of 56 (62.5%) HSIL/HPV+. In reviewing 12 HSIL cases that were originally diagnosed as NILM, 7 remained as NILM, and the other 5 were reclassified as 1 HSIL, 1 ASC‐H, and 3 ASC‐US, respectively. In 18 HSIL cases with negative HR‐HPV, 12 patients had a prior history of positive HR‐HPV testing and/or positive p16 IHC stain in the follow‐up cervical biopsy. Conclusion HR‐HPV testing plays an important role in cervical cancer screening by identifying HSIL in patients with ASC‐US, LSIL, and NILM. Co‐testing is an optimal method to identifying the patients with higher risk for developing cervical abnormalities.