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Prediction of Cervical Intraepithelial Neoplasia Grade 2–3 Using Risk Assessment and Human Papillomavirus Testing in Women With Atypia on Papanicolaou Smears

From the Departments of Public Health, Obstetrics, and Gynecology, and Family Medicine, Denver Health and Hospital Authority; and Departments of Preventive Medicine and Biometrics, Family Medicine, Medicine, and Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado.

Address reprint requests to: Judith C. Shlay, MD Denver Public Health 605 Bannock St. Denver, CO 80204-4507 E-mail: jshlay{at}dhha.org

Objective: To determine whether human papillomavirus (HPV) DNA testing and risk assessment can predict cervical intraepithelial neoplasia (CIN) 2–3 on biopsies in women with atypia on Papanicolaou smears.

Methods: One hundred ninety-five consenting women were referred for colposcopy because of atypia on Papanicolaou smears between September 1997 and April 1999. Before colposcopy, women completed risk assessments and had cervical swabs collected for HPV testing using the Hybrid Capture-II assay (Digene Corporation, Silver Spring, MD). Associations of demographic and clinical variables were assessed by ² analysis, and logistic regression was used to assess factors associated with CIN 2–3. The cost-effectiveness of routine colposcopy versus reflex HPV testing by either conventional or liquid-based Papanicolaou smear media was compared.

Results: Cervical intraepithelial neoplasia was diagnosed in 70 of 195 women (35.9%), 55 (28.2%) with CIN 1 and 15 (7.7%) with CIN 2–3. High-risk HPV types were detected in 31.3% of all subjects, 36.4% of those with CIN 1, and 93.3% of those with CIN 2–3. By logistic regression, CIN 2–3 was associated only with detection of high-risk HPV (odds ratio 110.08, 95% confidence interval 8.35, 999.00). The sensitivity of high-risk HPV for detecting CIN 2–3 was 93.3%, specificity 73.9%, positive predictive value 23.0%, and negative predictive value 99.3%. The cost of reflex HPV testing using conventional smear or liquid-based media was less than routine colposcopy ($4809 and $4308, respectively, versus $4875 per case detected).

Conclusions: Triage based on HPV testing would result in referral of approximately 31% of patients to colposcopy and appears to be a sensitive and cost-effective alternative to colposcopy.

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