Combination testing best for ASCUS results

OB/GYN News, Nov 15, 2001 by Robert Finn

When a Pap smear result indicates atypical squamous cells of undetermined significance, physicians are left with the vexing question of whether to refer the patient to colposcopy since only 5%-10% of these women turn out to have high-grade cervical intraepithelial neoplasia.

A new report indicates that the best strategy may be one that combines a repeat Pap smear with testing for human papilloma virus (HPV) detected by hybrid capture testing. Only women showing squamous intraepithelial lesions and testing positive for high-risk HPV with a hybrid capture test would be referred for colposcopy, according to Dr. Carol Morin of the Centre Hospitalier Affilie Universitaire-Hopital du St-Sacrement in Quebec City and her colleagues.

The investigators reported on a case-control study of 360 women with a finding of atypical squamous cells of undetermined significance (ASCUS) who were referred for colposcopy. These women received a repeat Pap smear and directed biopsies or endocervical curettage of all lesions of the cervix. Cervical specimens were taken with a Dacron swab. Three different methods of HPV DNA analysis were performed: first-generation hybrid capture (HC-1), second-generation hybrid capture (HC-2), and qualitative polymerase chain reaction. Nineteen women were found to have cervical intraepithelial neoplasia II or III, and those women were compared with the rest (J. Reprod. Med. 46[9]:799-805, 2001).

The combination strategies proved significantly superior to various strategies involving repeat Pap smears alone, HPV alone, or hybrid capture alone.