Cytology and High-Risk Human Papillomavirus Test for Cervical Cancer Screening Assessment
Frederik A. Stuebs,
Martin C. Koch,
Anna K. Dietl,
Werner Adler,
Carol Geppert,
Arndt Hartmann,
Antje Knöll,
Matthias W. Beckmann,
Grit Mehlhorn,
Carla E. Schulmeyer,
Paul Gass
Affiliations
Frederik A. Stuebs
Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
Martin C. Koch
Department of Gynecology and Obstetrics, Hospital ANregiomed Ansbach, Escherichstraße 1, 91522 Ansbach, Germany
Anna K. Dietl
Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
Werner Adler
Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 6, 91054 Erlangen, Germany
Carol Geppert
Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
Arndt Hartmann
Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
Antje Knöll
Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schlossgarten 4, 91054 Erlangen, Germany
Matthias W. Beckmann
Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
Grit Mehlhorn
Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
Carla E. Schulmeyer
Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
Paul Gass
Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
Background: A new nationwide screening strategy was implemented in Germany in January 2020. No data are available for women referred to certified dysplasia units for secondary clarification after primary diagnosis by a local physician. We therefore investigated combined testing with Papanicolaou smears and high-risk human papillomavirus (hrHPV) and compared the data with the final histological findings. Methods: Between January 2015 and October 2020, all referred women who underwent colposcopy of the uterine cervix in our certified dysplasia unit were included. Cytology findings were classified using the Munich III nomenclature. Results: A total of 3588 colposcopies were performed in 3118 women, along with Pap smear and hrHPV co-testing, followed by histology. Women with Pap II-p (ASC-US) and a positive hrHPV co-test had a 22.4% risk for cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesion (HSIL). The risk of CIN 3/HSIL was 83.8% in women with Pap IVa-p (HSIL) and a positive hrHPV co-test. A positive hrHPV co-test increased the risk for HSIL+ (OR 5.942; 95% CI, 4.617 to 7.649; p < 0.001) as compared to a negative hrHPV co-test. Conclusions: The accuracy of Pap smears is comparable with the screening results. A positive hrHPV test increases the risk for HSIL+ fivefold. Colposcopy is necessary to diagnose HSIL+ correctly.
