Accuracy of Human Papillomavirus (HPV) Test for Triage of Women with Atypical Squamous Cells of Undetermined Significance (ASCUS)

In recent years, human papillomavirus (HPV) test has been approved in triage of women with Atypical Squamous Cells of Undetermined Significance (ASCUS). However, due to the low prevalence of cervical cancer, high costs and limited access to test, the effectiveness of this test in our country is ambiguous.

In a diagnostic accuracy study, 245 women who were diagnosed as ASCUS in cervical cytology based on Bethesda 2001 criteria, were then assessed with colposcopy. Cervical biopsy was taken when needed. They were classified according to the results to high risk [Cervical Intraepithelial Neoplasia (CIN) > 2] or normal. Cobas® HPV Test was conducted for participants. Considering the colposcopy-biopsy as the golden standard, the performance of the HPV test was determined for detecting precancerous lesions.

24 patients had CIN1, 10 patients CIN of 2, and 4 patients had CIN ≥ 3. The sensitivity and specificity of the HPV test was 80% and 77%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) was 12.9% and 98.9%, respectively.

Considering the low prevalence of high-risk lesions in this series of women with ASCUS cytology, and the high NPV of the HPV test, it seems that its application can be helpful in the initial triage of patients with this pathology. In other words, the negative result of this test provides sufficient assurance that there are no precancerous or cancerous lesions.