HPV Testing in Cervical Screening

Virtual Issues
30 April 2019
30 April 2019

Human papillomavirus (HPV) testing now is now becoming an established or considered component of cervical screening programmes in many countries. This virtual issue brings together some of the articles published in Cytopathology in the last few years which report on the performance of various HPV tests and the outcome in terms of high grade cervical intraepithelial neoplasia (CIN) of HPV positivity, particularly in women with low grade cytological abnormalities.

H. Cubie and K. Cuschieri’s review sets the scene by providing a background to HPV tests, explaining the different technologies and how these can be optimally utilised in cervical disease management. The commentary by H. Llewellyn responds to N. Dudding and J. Crossley's editorial in Cytopathology (volume 24, issue 5), addressing the relationship between sensitivity and specificity of cytology and HPV tests as disease prevalence falls and emphasising the importance of follow-up of women with positive HPV tests.

S. J. Lee et al investigate the prognostic significance HPV viral load in women with ASC-US cytology. M. McKenna et al show that, in young women with borderline cytology or mild dyskaryosis, the relative risk of high grade CIN is greater in women infected with HPV16/18 compared to non-HPV16/18 high-risk genotypes. HPV 16 genotype, p16/Ki-67 staining and koilocytic morphology were all found by D. Vrdoljak-Mozetič et al to be useful in predicting those progressing to high grade CIN, and the prospective study from Ireland featured here suggests that the addition of p16/Ki-67 to HPV DNA testing may help in determining which women with recurrent borderline or low grade cytological abnormalities should attend colposcopy.

The third paper selected from Cytopathology Volume 27, Issue 4, compares the sensitivity and specificity for CIN2 or worse of the Hybrid Capture 2 and cobas assays in SurePath samples. The two final papers included in this virtual issue are from the Cytopathology Special Issue: Revised Terminology in Cervical Cytology and Histology (Volume 26, Issue 6). One compares the performance of four HPV tests to determine whether they could be approved for triage in the NHS cervical screening programme, the other explores the effect and implications of changing HPV platforms for test of cure.

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Table of Contents

Free Access

Understanding HPV tests and their appropriate applications

H. A. Cubie,  K. Cuschieri, 
Free Access

Measures of test performance for high-risk HPV tests and triage cytology and the importance of follow-up of women with positive test results

H. Llewellyn, 
Free Access

Semi-quantitative HPV viral load in patients with ASC-US cytology: viral load correlates strongly with the presence of CIN but only weakly with its severity

S. J. Lee,  W. Y. Kim,  S.-H. Shim,  S.-H. Cho,  I. K. Oh,  T. S. Hwang,  S.-N. Kim,  S.-B. Kang, 
Free Access

HPV16 and HPV18 genotyping triage in young women with borderline cytology or mild dyskaryosis: effect of age on genotype-specific risk of high-grade CIN

M. McKenna,  M. McMenamin,  A. McDowell, 

This study shows the relative risk of high grade CIN is greater in women infected with HPV16/18 compared to the non-HPV16/18 high-risk genotypes. The authors suggest that HPV genotyping could be used to improve the specificity of HPV DNA triage and tailor management of younger women with mild cytological abnormalities.

Free Access

HPV16 genotype, p16/Ki-67 dual staining and koilocytic morphology as potential predictors of the clinical outcome for cervical low-grade squamous intraepithelial lesions

D. Vrdoljak-Mozetič,  M. Krašević,  D. Verša Ostojić,  S. Štemberger-Papić,  R. Rubeša-Mihaljević,  M. Bubonja-Šonje, 
Free Access

Triage of LSIL/ASC-US with p16/Ki-67 dual staining and human papillomavirus testing: a 2-year prospective study

C. White,  S. Bakhiet,  M. Bates,  H. Keegan,  L. Pilkington,  C. Ruttle,  L. Sharp,  S. O' Toole,  M. Fitzpatrick,  G. Flannelly,  J. J. O' Leary,  C. M. Martin, 

This small national prospective study suggests that the addition of p16 / Ki-67 to HPV DNA could be used to stratify women with recurrent borderline or low grade cytological abnormalities to determine who should attend colposcopy.

Open Access

Hybrid Capture 2 and cobas human papillomavirus assays perform similarly on SurePath samples from women with abnormalities

D. Fornari,  M. Rebolj,  B. Bjerregård,  M. Lidang,  I. Christensen,  E. Høgdall,  J. Bonde, 

This study, from two Danish laboratories, compares the sensitivity and specificity for CIN2 or worse for these two assays in SurePath samples from 566 women 30 years or older with atypical squamous cells of undetermined significance and 411 women after treatment of cervical intraepithelial neoplasia. Their findings suggest that the two assays could substitute one another for these defined indications without significant changes to the clinical outcomes.

Free Access

Comparison of the performance of HPV tests in women with abnormal cytology: results of a study within the NHS cervical screening programme

S. M. Moss,  A. Bailey,  H. Cubie,  K. Denton,  A. Sargent,  P. Muir,  I. B. Vipond,  R. Winder,  H. Kitchener, 
Free Access

High-risk HPV platforms and test of cure: should specific HPV platforms more suited to screening in a ‘test of cure’ scenario be recommended?

A. Innamaa,  N. Dudding,  K. Ellis,  J. Crossley,  J. H. Smith,  J. A. Tidy,  J. E. Palmer,