Have We Resolved How To Triage Equivocal Cervical Cytology?

Extract

Virtually all cases of cervical cancer are caused by one of the 15 or more oncogenic types of human papillomavirus (HPV) infection. With the development and refinement of assays to detect HPV DNA, the question becomes how best to integrate HPV testing into cervical cancer screening, which for more than half a century has relied almost exclusively on the Papanicolaou cervical cytology test. One approach has been to consider HPV testing as a second triage test for the relatively large number of women with borderline, equivocal cytology findings of atypical squamous cells of undetermined significance (ASCUS).

ASCUS encompasses both reactive changes that mimic, but are unrelated to, HPV and HPV-associated cell abnormalities that fall below the morphologic threshold for a definitive diagnosis. Expert pathologists cannot reliably distinguish between the two conditions (1–3). Given this heterogeneity in interpretation, it is not surprising that women with cytology results of ASCUS have variable clinical outcomes; most do not have clinically significant disease, but some have precancerous lesions or even cancer found on further evaluation. The role of triage is to identify which women with ASCUS are at risk and require colposcopy and which women can be spared the anxiety and costs associated with intensified follow-up.