PCR based high risk HPV testing is superior to neural network based screening for predicting incident CIN III in women with normal cytology and borderline changes

L Rozendaal¹, J Westerga¹, J C van der Linden¹, J M M Walboomers^1,*, F J Voorhorst², E K J Risse¹, M E Boon³ and C J L M Meijer¹

¹ Department of Pathology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
² Department of Epidemiology and Biostatistics, Academic Hospital Vrije Universiteit
³ Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands

Correspondence to:
Professor Meijer email: cjlm.meijer{at}azvu.nl

^* Professor J M M Walboomers died recently

Background/Aims—To improve the accuracy of conventional cytology in cervical cancer screening, high risk human papillomavirus (HPV) testing and neural network based screening have been developed. This study assessed the power of both techniques to detect women at risk of developing incident CIN III; that is, CIN III detected during the follow up of women with normal cytology and borderline nuclear changes.

Methods—A cohort of 2250 women, 34–54 years of age, who attended population based cervical cancer screening from 1988 to 1991 and had normal smears or borderline nuclear changes was followed. All smears were tested for high risk HPV and the smears were rescreened using neural network based screening. The value of neural network based screening for predicting incident CIN III during a mean follow up period of 6.4 years was compared with that of high risk HPV testing. In addition, morphological markers presumed to be related to HPV were correlated with HPV status.

Results—Thirteen (0.6%) women had incident CIN III. Both high risk HPV positivity and abnormal cytology were associated with an increased risk for incident CIN III (odds ratio, 240 and 22, respectively) and high risk HPV positivity was associated with abnormal cytology. The sensitivity of high risk HPV testing for predicting incident CIN III was much higher than that of neural network based screening (92% and 46%, respectively). None of the morphological markers assessed, including koilocytosis, was correlated with high risk HPV status.

Conclusion—High risk HPV testing is superior to neural network based screening in identifying women at risk of developing CIN III. For women with normal cytology and borderline changes and a negative high risk HPV test, the screening interval can be considerably prolonged.

Key Words: neural network based screening • high risk human papillomavirus testing • CIN III

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