Cytology and HPV testing in detection of cervical high grade squamous intraepithelial lesions

The first organized national cytology screening program for detecting cervical lesions in Croatia was initiated at the end of 2012. This screening program is currently under review. The working proposal is to screen women aged 20–29 by cytology alone, those aged 30–34 by cytology and hrHPV cotesting, and woman 35–64 years old by high risk Human papillomavirus (hrHPV testing) without cytology cotesting. The objective is to contribute to the selection of cervical screening options among various possibilities in our population. Methods: We conducted a retrospective analysis of preceding cervicovaginal cytology and hrHPV test results in biopsy proven HSIL between January 1, 2016 and December 31, 2016. This included 143 HSIL cases from patients aged 18–85. Results: In detecting HSIL Pap test has been abnormal in 99% (142/143), and hrHPV test in 80% (115/143). The cytology, analyzed within one year prior to the HSIL biopsy, has reported ASC-H/HSIL in 87% (125/143) cases, whereas 12% (17/143) and 0.7% (1/143) have reported ASC-US/LSIL and negative respectively. The hrHPV negative test has been found in 13% (5/39) of the 20–29 age group, 21% (7/33) of the 30–34 age group, and 22% (15/68) of the 35–65 age group. Conclusions: Our data suggest that approximately 22% of analyzed woman in the 35–64 age group may be misdiagnosed for HSIL, when using HPV testing as the only cervical screening method. The widespread replacement of cytology by hrHPV testing should be subject to further investigation and given careful consideration