Image-guided ThinPrep Papanicolaou tests and cotesting with high-risk human papillomavirus in women aged 30 years and older in a low-risk private practice population

BACKGROUND: Screening for cervical cancer precursors has evolved considerably with the introduction of new technologies to improve the early detection of disease. The objective of this study was to analyze the accuracy and effectiveness of combined screening with cytology and high-risk human papillomavirus (HR-HPV) testing in a low-risk population of women aged >30 years. METHODS: Consecutive unselected samples from a group of 1871 women aged >30 years were screened with image-guided ThinPrep tests and HR-HPV tests during a 6-month period. Histologic follow-up was reviewed among women with positive HR-HPV tests. RESULTS: A total of 85 (4.5%) women had positive HR-HPV tests. In 48 HR-HPV-positive women with follow-up biopsies, 41 (85%) were found to have histologic abnormalities. Thirty-three (1.9%) women with cytologically normal Papanicolaou (Pap) tests harbored HR-HPV, and a cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 1 (16%) of 6 women with histologic follow-up. Conversely, 2 (28%) of 7 women with high-grade intraepithelial lesion on cytology tested negative for HR-HPV during the same period. A case of serous carcinoma with atypical glandular cells on cytology was also negative for HR-HPV, as expected. CONCLUSIONS: In this low-risk population of women aged ≥30 years, histology-confirmed CIN2+ lesions were identified in women with negative cytology and positive HR-HPV tests, as well as in those with positive cytology and negative HR-HPV tests. Because both cytology and HPV testing alone missed significant lesions, cotesting with Pap and HR-HPV in women aged ≥30 years appears to be a reasonable option in a low-risk population.