CS 03-03THE DETECTION OF CIN2+ AFTER AN ABNORMAL PAP-SMEAR AND hrHPV POSITIVITY USING REPEAT CYTOLOGY, hrHPV GENOTYPING AND COLPOSCOPIC IMPRESSION

14. Colposcopy and management
A. Leeman 1, A. Kasius 1, M. Del Pino 2, A. Rodriguez 2, B. Ter Harmsel 3, M. Van De Sandt 1, A. Torne 2, J. Ordi 4, F. Van Kemenade 5, D. Jenkins 1, W. Quint 1.
1DDL Diagnostic Laboratory, Visseringlaan 25, 2288 ER Rijswijk (Netherlands), 2Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic Clínic—Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona (Spain), 3Roosevelt Clinic, Rooseveltstraat 67, 2321 BL, Leiden (Netherlands), 4Department of Pathology, Hospital Clínic, Barcelona (Spain), 5Erasmus Medical Center, Department of Pathology, PO Box 2040, 3000 CA Rotterdam (Netherlands)

Background / Objectives

In HPV screening, most women testing positive in cytology and hrHPV will be offered colposcopy. Colposcopy has a variable sensitivity, influenced by the expertise of the colposcopist and the number of biopsies taken. Information collected prior to or during colposcopy may increase effectiveness of CIN2+ detection i.e. decision making about treatment and follow-up.

Objective: To compose risk profiles of CIN2+ based on results of intake cytology, hrHPV genotyping and colposcopic impression for treatment decision support.


Methods

From a population of women referred to colposcopy after an abnormal PAP-smear, 682 hrHPV positive women were selected retrospectively. At the clinic, women had a physician-taken intake smear and a colposcopy with up to 4 biopsies. Physician-taken smears were tested with the clinically validated GP5+/6+-EIA-Luminex system and cytological analysis was performed. Colposcopy findings were described following the criteria of the IFCPC. Biopsies were reviewed by a local pathologist. Combinations of findings identifying a high risk of CIN2+ and a low risk of CIN2+ were examined.


Results

Among the 682 women, there were 94 (13.8%) women with an ASC-US referral smear, 240 with LSIL (35.2%) and 348 (51.0%) with ≥HSIL. In 359 (52.6%) women a CIN2+ lesion was detected in the biopsy. CIN2+ was detected in 34.0% of the women in the ASC-US group, in 30.4% in the LSIL group and in 73.0% in the ≥HSIL group.

Intake cytology, hrHPV genotype and colposcopic impression as individual factors all significantly increased the risk of CIN2+ after ≥HSIL cytology at referral (intake cytology  ≥HSIL 85.0%, HPV16/18 82.4%, colposcopic impression ≥CIN2 84.5%). When combining the factors, a combination of ≥HSIL intake cytology and ≥CIN2 colposcopic impression resulted in significant increase of risk of CIN2+ among the women with ≥HSIL referral cytology (93.2%). For women with ASC-US and LSIL referral cytology with ≥HSIL intake cytology and ≥CIN2 colposcopic impression, the risk of CIN2+ was 71.4% and 92.6%, respectively. This combination also resulted in a significant decrease of risk of CIN2+ for women with LSIL referral cytology followed by ≤LSIL intake cytology and ≤CIN2 colposcopic impression (13.0%).


Conclusion

The combination that yielded the highest increase in risk was intake cytology combined with colposcopic impression. Women with ≥HSIL referral cytology, ≥HSIL intake cytology and ≥CIN2 colposcopic impression had a risk of CIN2+ of 93.2%. Women with persistent low-grade cytology and matching colposcopic impression were at a low, but not negligible risk. A combination of other risk factors, such as methylation status, might increase and/or decrease the risk of CIN2+.


References