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.
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.
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%).
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+.