Luxembourg does not have an organised cervical screening programme and screening has historically been conducted in a single national cytology laboratory. In 2014, the liquid-based ThinPrep® Pap Test and Imaging System (TPTIS) by Hologic replaced conventional cytology for cervical screening at this national facility. At the same time, human papillomavirus (HPV testing) using the Aptima HPV test was introduced, mainly on samples showing atypical squamous cells of undetermined significance (ASC-US) or upon physician’s request. The aim of our study was to estimate the prevalence of abnormal cervical cytology, of high risk HPV (hrHPV) infection and their correlation among screened women in Luxembourg.
From July 2014 until December 2015, 163,321 cervical samples from 121,027 women (mean age 42.2 years) were investigated by the national cytology laboratory in Luxembourg. Slides were prepared according to manufacturer’s instruction using the TPTIS methodology (Hologic Inc., Bedford, MA). Only the first sample of each woman assessed during the study period was considered for computation of the prevalence of cytological abnormalities as well as the prevalence of HPV per cytological category and by age.
The prevalence of abnormal cervical cytology was as follows: ASC-US 1.6 %, low-grade squamous intraepithelial lesion (LSIL) 2.0%, and high-grade squamous intraepithelial lesion (HSIL) 0.4%. Prevalence of LSIL was highest in 20-24 year olds (4.3%), whereas the prevalence of ASC-US and HSIL was highest in 25 -29 year olds (2.6% and 0.8%, respectively). Based on 11,582 samples with concomitant cytology and HPV testing, hrHPV was detected in 9.6%, 45.3%, 70.4%, and 91.9% of women negative for intraepithelial lesions and malignancies (NILM), ASC-US, LSIL and HSIL, respectively. The prevalence of hrHPV was highest in 20-24 year olds (43.5%). Among 235 HSIL samples, 48.5%, 4.3%, and 39.2% were positive for HPV 16, HPV 18/45 or other hrHPV, respectively; among NILM samples, the prevalences for HPV 16, HPV 18/45 and other hrHPV were 1.4%, 0.5% and 7.7%, respectively.
Our study showed a strong correlation between cytology and hrHPV. The prevalence of hrHPV infections in patients with HSIL (91.9%) and LSIL (70.4%) was similar to that observed in Belgium [1]. Our study provides important information to evaluate the prevention of cervical cancer in Luxembourg, particular in view of switching to primary HPV testing and for monitoring the future impact of HPV vaccination.
1. Arbyn M, Haelens A, Desomer A, Verdoodt F, Thiry N, Francart J, Hanquet G, Robays J. Cervical cancer screening program and human papillomavirus (HPV) testing, part ii: update on HPV primary screening – Summary. Health Technology Assessment (HTA) Brussels: Belgian Health Care Knowledge Centre (KCE). 2015. KCE Reports
238Cs. D/2015/10.273/16.