Cytology plus HPV test don't improve detection rate

Liquid-based cytology (LBC) plus human papillomavirus (HPV) testing in women led to a small decrease in the detection rate of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in a second screening round, compared to only LBC; but when the rounds were combined, using both methods didn’t detect more CIN3+ or CIN2+ than LBC alone, according to research published online June 18 in The Lancet Oncology.

Henry C. Kitchener, MD, of the University of Manchester in the United Kingdom, and colleagues analyzed data from 18,386 women who were randomly assigned to receive LBC and HPV testing in which the results were revealed and acted upon, and 6,124 women who received combined testing from which the HPV result was concealed. The main outcome was the rate of detection of CIN3+ in a second screening round conducted roughly 3 years later.

In the first round, the revealed and concealed groups had similar proportions with CIN3+ (1.27% and 1.31%, respectively), the researchers discovered. In the second round, both groups saw large drops in women with CIN3+ (0.25% and 0.47%, respectively). When the two rounds were combined, the authors note, co-testing did not identify a higher rate of women with CIN3+ or CIN2+ than LBC alone.

“Over two rounds this trial showed no evidence that LBC combined with HPV testing in primary cervical screening detected more CIN2 or CIN3+ than cytology alone. This summed effect over two rounds is relevant because screening relies on repeated rounds to achieve its sensitivity,” the authors conclude.

A co-author reported being an unpaid consultant for Hologic.

Kitchener HC, Almonte M, Thomson C, et al. HPV testing in combination with liquid-based cytology in primary cervical screening (ARTISTIC): a randomised controlled trial. Lancet Oncolog. 2009;10:672-682. doi: 10.1016/S1470-2045(09)70156-1.