High-risk HPV may indicate cytologically false negative smears. An analysis of "normal" smears preceding CIN2/3
- Nathalie C. Fransen Daalmeijer (n.fransendaalmeijer{at}vumc.nl)
Abstract
Aims:Cervical screening, currently performed by cervical cytology, depends for its success on the timely detection of malignant lesions. The presence of high-risk human papillomavirus (hrHPV) is associated with an increased risk of subsequent high-grade cervical intra-epithelial neoplasia (CIN2/3) and cervical cancer. In this study we determined to which extent hrHPV is present in cervical smears with a high a priori chance of being false negative, ie, in normal smears preceding CIN2/3.
Methods: Archival specimens of 187 women with CIN2/3 and preceding normal conventional smears were identified retrospectively. Of these specimens, 144 (77%) had adequate cytologic samples for further HPV DNA testing.
Results: Of 144 CIN2/3 lesions, preceding normal smears showed hrHPV positivity in 80% of cases. Of the hrHPV positive smears 69% were upgraded cytologically at rescreening compared to 24% of hrHPV negative smears (p<0.001). Upgrading of smears was not associated with specific hrHPV types (p=0.217). In over 90% of cases, type-concordance in both smear and CIN2/3 lesion was demonstrated.
Conclusions: HrHPV is present in a high proportion of normal archival smears preceding CIN2/3 and false negative cytology was highly associated with the presence of hrHPV. This supports the current notion that hrHPV testing can be used as a primary cervical screening tool. If so, hrHPV positive cervical smears should be carefully examined for cytological abnormalities to reduce false negative cervical cytology.
