Retrospective Analysis of Human Papillomavirus Genotyping and Cytology (Pap Smears) in Cervical Cancer Screening: An Institutional Experience in the State of Oregon, USA

TL;DR

This study compares HPV testing and Pap smears for cervical cancer screening in Oregon, finding HPV testing has similar sensitivity but lower specificity for detecting high-grade lesions.

Contribution

The study provides population-level data on HPV and cytology concordance in detecting cervical intraepithelial neoplasia in a U.S. institutional setting.

Findings

HPV testing showed similar sensitivity (88.8%) but lower specificity (27.1%) compared to cytology for CIN2/CIN3 detection.

90.6% of CIN3 cases were HPV-positive, with 82.9% having abnormal cytology.

35 cases had multiple HPV type co-infections among HPV-positive patients.

Abstract

Background/Objectives: The 2020 American Cancer Society guidelines endorse human papillomavirus (HPV) testing as the preferred method for cervical cancer screening. This study aims to evaluate the concordance of HPV and cytology findings for cervical intraepithelial neoplasia (CIN) at a population level. Methods: A retrospective cohort review of cervical cytology, HPV testing, and biopsies for all patients at a single Oregon-based medical center was performed over 21 months. The performance of HPV and cytology in detecting high-grade CIN lesions was compared. Results: A total of 22,488 tests were evaluated, showing 7.5% abnormal cytology and 7.4% positive HPV. Among 574 patients who underwent co-testing and a subsequent biopsy, 345 had abnormal cytology, with 212 having abnormal biopsy results. HPV was positive in 455 cases, with 266 having abnormal biopsy results. Among 455 HPV-positive cases, there were 283, 104 and 33 cases of non-16/18, 16, and 18 types, respectively. Additionally, 35 cases had co-infection with multiple HPV types. Among the cases diagnosed as CIN3 on biopsy, 90.6% had positive HPV testing (N = 96), and 82.9% had abnormal cytology (N = 94). HPV testing demonstrated a slightly higher sensitivity (88.8% vs. 78.3%, p = 0.128) and lower specificity (27.1% vs. 48.9%, p < 0.01) compared to cytology for CIN2 and CIN3 diagnosis. Conclusions: HPV testing showed a similar sensitivity but lower specificity compared to cytology for detecting high-grade lesions.

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