HPV triage of patients with ASCUS cervical pap smears
Reliable, affordable human papilloma virus (HPV) testing makes this an excellent screening tool for triage management of ASCUS Pap smears and detection of cervical dysplasia. Major randomized trials show that reflex HPV testing with hybrid capture is at least as effective and cheaper than repeat cytology for evaluation of an ASCUS Pap. It avoids about 50% of colposcopies that would normally be performed if immediate colposcopy were done for all ASCUS Paps, while retaining excellent negative predictive value. High-risk HPV testing is the desirable strategy for women over 30, as long as there is reasonable follow-up.
Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL
Warner K. Huh, M.D., University of Alabama at Birmingham, Division of Gynecologic Oncology, OHB Rm 538, 619 19th Street South, Birmingham, AL 35249-7333, 205-934-4986
Key points
•The main limitation in cervical cancer screening is that it isn't done
•Immediate colposcopy for women with ASCUS Pap smears has been considered the gold standard; however, this has been questioned
•In women younger than 30, HPV is more prevalent but the infections are more likely to be transient; patients older than 30 are more likely to be truly positive, with HPV infection that correlates with dysplasia
ABSTRACT
