Performance of high-risk human papillomavirus testing in the triage of abnormal cervical cytology among Chinese younger women in Shanghai, China.

OBJECTIVE

This study aimed to evaluate the role of high risk HPV DNA testing in identifying Chinese younger women with abnormal cytology at risk of harboring cervical intraepithelial neoplasia at grade 2 (CIN2) or worse so as to popularize an effective triage strategy for younger women.

METHODS

A total of 246 younger women aged 25 - 36 years old with abnormal cytology were recruited in our study. All were assessed by liquid-based cytology, high-risk HPV DNA test, and colposcopy with directed biopsy and endocervical curettage as necessary. Residual specimens from liquid-based cytology were subjected to real-time PCR testing to identify the presence of 10 high-risk HPV types that are prevalent in China.

RESULTS

Among the 246 abnormal cytology samples, 97 (39.4%) were found to be positive for high risk HPV. A clear association was observed between cytological findings and the proportion of patients with positive high risk HPV DNA: namely 29.8% HPV positivity in the ASCUS group; 43.5% in LSIL group; and 90.0% in HSIL group (p<0.01). Overall, high risk HPV test achieved a high specificity (79.8%) and PPV (86.5%) for an endpoint of CIN2+, and higher sensitivity (91.3%) and NPV (98.7%) for an endpoint of CIN3+. For younger women with ASCUS+ cytology, high risk HPV test achieved a higher NPV for CIN2+ and CIN3+ (96.0%, 99.0%). For LISL+ cytology, high risk HPV testing had a high sensitivity with LSIL (90.0%) and HSIL (100%), but there was also a corresponding decrease in specificity.

CONCLUSIONS

The results indicate that high risk HPV DNA testing is highly sensitive and moderately specific for CIN grade 2 or worse in women younger than 36 years. LBC primary testing followed by high risk HPV DNA triage improved sensitivity and the false-positive rate for cervical cancer screening and are suitable for developed regions in China.