Is cervical cytology testing as a part of co‐test unnecessary for HPV 16/18‐infected women? A retrospective cohort study of 1647 women

Abstract

BackgroundWe aimed to present the biopsy results of women with HPV 16/18 infection and investigate whether cytology is necessary as a part of routine cervical cancer screening in women with HPV 16/18.MethodsThis is a retrospective cohort study conducted on 1647 patients between the ages of 30 and 65 years with HPV 16/18 undergoing colposcopy‐guided biopsy at a tertiary gynecological cancer center between January‐2016 and January‐2019. We compared the preinvasive lesion rates and the invasive cervical cancer rates of women with HPV 16/18 between the negative and the abnormal cytology group.ResultsOf the 1647 women, 1105 (67.1%) had negative cytology and 542 (32.9%) had abnormal cytology. Among women with initial negative cytology, cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 205 (18.6%) women. The rate of CIN 2+ lesion in women with abnormal cytology was 28%. There was a significant difference between negative and abnormal cytology group in terms of CIN 2+ lesion rates (P < .001). Among women with initial negative cytology, invasive cervical cancer was detected in 6 (0.5%) women. The rate of invasive cervical cancer in women with abnormal cytology was 8 (1.5%). There was no significant difference between negative and abnormal cytology group in terms of invasive cervical cancer rates (P = .082).ConclusionsThe rate of cervical cancer among HPV 16/18‐infected women with negative cytology is similar to women with abnormal cytology. Based on the results of this study, Pap testing could be unnecessary in HPV 16/18‐infected women to diagnose invasive cervical cancer who will undergo colposcopy biopsy.

Prevalence of higher-grade dysplasia in persistently high-risk human papillomavirus positive, cytology negative women after introduction of the new cervical cancer screening in Germany

“…Even though we did not detect any cases of invasive cervical carcinoma, other groups found invasive cervical carcinoma in up to 0.5% of the women [43,44,46]. Interestingly, Giray et al observed that the rate of invasive cancer did not differ significantly between women with normal and abnormal cytology in HPV 16/18 positive women (0.5% vs. 1.5%, p = 0.082) and concluded that Pap testing could be unnecessary in HPV 16/18 positive women who will undergo colposcopy-guided biopsy to diagnose invasive cervical cancer [44].…”

“…While we observed only very few CIN 1 cases (three in total, all of them other hrHPV positive), prevalence of CIN 1 is reported as high as 21.6% in HPV 16/18 positive women [ 44 ] and 23.9% for other hrHPV positive, cytology negative women [ 43 ]. The comparably low number of CIN 1 cases in our study might at least be partially explained by referral for colposcopy only in case of a persistently positive HPV test after 12 months.…”

“…In our study, prevalence of CIN 3 was 14% for HPV 16/18 positive women who underwent biopsy and 9% for other hrHPV positive. Reviewing literature, CIN 3 prevalence for the former subgroup ranges from 9.1 to 11.8% [ 44 , 46 , 51 ] and from 2.7 to 14.6% for the latter [ 43 , 46 , 51 ]. However, comparability of the studies among each other and with ours is very limited due to various reasons such as differences in study design (retrospective or prospective), timing of colposcopy (immediate or only in case of repeatedly positive HPV testing at 12 months), threshold for obtaining histological specimens (omission of biopsy in case of normal colposcopic finding or taking a biopsy and/or ECC regardless of colposcopic finding), considered set of patients (all hrHPV positive patients or only those from whom a biopsy was obtained), median age of the study population, method applied for HPV testing and regional prevalence of particular hrHPV types.…”

Colposcopic Biopsy Findings in ASCUS or Normal Cervical Cytology Patients with High-Risk HPV Positivity

“…Comparison with existing research can offer valuable insights into HPV genotypes' epidemiology and their associated factors. However, direct comparisons can sometimes pose challenges due to the varying population characteristics, HPV testing methodologies, and statistical analysis methods employed across different studies [13,14]. Large-scale, multicenter studies would serve to substantiate our ndings and establish stronger associations.…”

Pap Smear Image Analysis Based on Nucleus Segmentation and Deep Learning – A Recent Review

“…The Pap test refers to the cancer prevention method that involves a specific and laborintensive analysis of cytological arrangements to trace possibly cancerous cells from the external and internal cervix surface [16]. While looking for abnormal cells, a cytopathologist must examine various microscopic regions [17].…”