High-Risk Human Papillomavirus Testing of Women with Cytological Low-Grade Squamous Intraepithelial Lesions

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Abstract
Testing for carcinogenic human papillomavirus (HPV) types has been suggested to evaluate patients with atypical squamous cells of unknown significance. We wanted to know whether this test was clinically useful in patients with low-grade squamous intraepithelial lesions (SIL) detected by Papanicoloau (Pap) smear. We tested 159 women with low-grade SIL Pap smears for high-risk HPV types, using the Hybrid Capture HPV DNA Assay (Digene Corp., Silver Springs, MD) during evaluation by colposcopy and cervical biopsies. We constructed a receiver-operating characteristic curve and calculated sensitivity, specificity, and predictive values for the presence of high-risk virus and cervical intraepithelial neoplasia (CIN). The receiver-operating characteristic curve suggested that 3.0 relative light units was the best cutoff for a positive test, rather than the manufacturer-recommended 1.0 relative light units. The sensitivity for detecting CIN was 0.858 [95% confidence interval (Cl); 0.792-0.925] and specificity was 0.623 (95% Cl, 0.492-0.753). The pretest probability of CIN was 0.667 in this group of patients, and the positive predictive value was 0.820. The Hybrid Capture HPV DNA Assay is of limited use in predicting those low-grade SIL Pap smears will have histologically confirmed CIN.

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