HPV Tests Prior to High Grade Cervical Histology

Suzanne Hyne, Annabelle Farnsworth, Clare Biro, Jennifer M Roberts, Julia K Thurloe

Douglass Hanly Moir Pathology, Sydney

Objective

As of May 2017, the Australian cervical screening program is changing from 2-yearly cytology to 5-yearly high risk (HR) HPV testing. Whereas much is known about the performance of cytology, less is known about HPV testing in routine clinical practice. Our aim was to examine HPV test results which preceded high grade intraepithelial and invasive histologic abnormalities.

Methods

We identified 599 women in our records with biopsy-proven high grade cervical disease (squamous and glandular) in 2015 and had at least one HPV test concurrent with/or in the 5 years preceding the diagnosis. The positive results were classified by HR types where possible. Further classification was made according to age cohort in 2007 when the HPV vaccine was introduced in Australia.

Results

Overall, 17.0% had at least one negative HPV test. Of those with at least one positive result, 39.9% overall had HPV types 16/18±other, but only 9.7% of those in the youngest vaccinated cohort.

Conclusions

That 17% of women with high grade disease had negative HPV tests suggests that the test in routine practice may not be as sensitive as has been assumed. The comparative figure for cytology screening for the same year was 23%. Of the positive HPV tests, approximately 60% overall had only HR types other than 16/18.

These results were not based on using HPV test as a primary screening test. Such data will not be available until after 2022.