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The Triage of Women with ASCUS Cytology Using Human Papillomavirus DNA Testing

Objective. Our goal was to determine whether human papillomavirus (HPV) DNA testing is a valuable tool in triage of patients with cytology demonstrating atypical squamous cells of undetermined significance (ASCUS). Methods. Our study included a total of 355 women who were referred for evaluation of a Papanicolaou smear with ASCUS diagnosed during routine screening. At the first visit, all patients had colposcopic examinations and HPV DNA testing by Hybrid Capture assay. Patients were evaluated every 4 to 6 months. Follow‐up included repeat cytology and colposcopy at each visit; biopsy was performed if indicated. Followup continued for up to 2 years. Results. Sensitivity, specificity, and positive and negative predictive values of HPV DNA testing in detecting cervical intraepithelial neoplasia grade 2 (CIN2) or CIN3 were 85%, 77%, 12%, and 99%, respectively. The prevalence of oncogenic HPV types was higher in patients younger than age 35 (35% versus 25%) in whom ASCUS‐favor dysplasia/ASCUS‐not otherwise specified was diagnosed. The presence of oncogenic HPV types equated with a 12.4% risk of biopsy‐proven CIN2 and CIN3. The rate of CIN2 and CIN3 was 0.4% in those who tested negative (95% confidence interval, 0‐2.1%). Conclusions. HPV DNA testing appears to be a valuable tool for triage of women with ASCUS smears. Its high negative predictive value provides needed reassurance for follow‐up with only periodic cytology.