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

Abstract

Purpose According to the recently implemented organized cervical cancer screening program in Germany, women older than 35 years with negative cytology but persistent high-risk human papilloma virus (hrHPV) infection > 12 months should be referred to colposcopy for further evaluation. This study aimed to present and dissect colposcopic and histopathological findings with particular focus on associated hrHPV genotypes. Methods This study is a retrospective analysis of clinical data from 89 hrHPV positive patients with normal cytology who underwent colposcopic examination at a certified dysplasia outpatient clinic in Germany in 2021. Results While 38 (43%) women had a normal colposcopic finding, 45 (51%) had minor and 6 (7%) major changes. Thirty-one (35%) of the women were HPV 16 and/or HPV 18 positive and 58 (65%) women were positive for other hrHPV only. Among patients who underwent colposcopy with biopsies (in case of an abnormal finding or type 3 transformation zone, n = 68), eight (12%) had cervical intraepithelial neoplasia (CIN) 3 and six (9%) had CIN 2. The proportion of women diagnosed with CIN 3 varied among different hrHPV genotypes (HPV 16: 11%, HPV 18: 33%, HPV 31: 27%, HPV 33: 33%, HPV 52: 33%). Conclusion Persistently hrHPV positive women with negative cytology are at increased risk of being diagnosed with CIN 3. As CIN 3 prevalence seems to differ with regard to hrHPV strain, immediate HPV genotyping for risk stratification and subsequent early referral for colposcopy might constitute a feasible strategy.

Registry Study of the Working Group on Cervical Pathology and Colposcopy (AGCPC) on the Diagnostic Algorithm for the New Cervical Cancer Screening – Initial Data

“…Thus, we demonstrated that colposcopic major change findings were assigned three times more frequently in patients with group II-a (NILM) than in patients with group I (NILM). The rate of major changes in patients with group I (NILM) correlates with the data from Berger et al (2023) 2020 . However, in this small case study, no subgroup analysis was performed between groups I (NILM) and II-a (NILM), but all patients with normal cytological findings were evaluated together.…”

“…In the group of participants presenting with cytology group II-p (535), colposcopically minor changes were most frequent (54.8 %, 291), followed by physiological changes with 26.6 % (141). Major changes were detected in 13.6 % (72) and nonspecific abnormal findings in 3.8 % (20). Other findings were found in 1.3 % of cases (7).…”

“…So konnten wir nachweisen, dass bei Patientinnen mit der Gruppe II-a (NILM) kolposkopisch Major-Change-Befunde 3-mal häufiger vergeben wurden, als bei Patientinnen mit der Gruppe I (NILM). Die Rate der Major Changes bei Patientinnen mit einer Gruppe I (NILM) korreliert mit den Daten von Berger et al (2023) [20]. In dieser kleinen Fallstudie wurde allerdings zwischen den Gruppen I (NILM) und II-a (NILM) keine Subgruppenanalyse durchgeführt, sondern es wurden alle Patientinnen mit einem zytologischen Normalbefund gemeinsam ausgewertet.…”

“…Januar 2020 eine organisierte Krebsfrüherkennungs-Richtlinie (oKFE-RL). Dies bedeutet, dass Frauen ab einem Alter von 20 Seit 1. Januar 2020 stellt der vom G-BA festgelegte Abklärungsalgorithmus die Grundlage für die Abklärung suspekter zytologischer und virologischer Befunde dar.…”

Correlation between high‐risk HPV infection and p16/Ki‐67 abnormalities in Pap samples in a South Eastern Europe cohort

“…However, a recent retrospective analysis showed that in 60% of cases with a positive hrHPV result, but negative Pap, had positive colposcopic findings (either minor or major). 21 This provides strong evidence that most patients would benefit from cotesting with a Pap smear and HPV Conversely, we identified hrHPV positive cases that were not associated with any detectable abnormalities, but no conclusions can be made with regard to the infection due to the absence of follow-up visits. The positive expression for p16/Ki-67 has proven to be extremely important in triaging patients diagnosed with ASC-US/LSIL, or non-HPV16/18 hrHPV types.…”