Prevalence of high-grade dysplasia in cytology-negative, HPV-positive cervical cancer screening

Abstract

This study has two aims: determine the prevalence of CIN3\u2009+\u2009in patients with discordant cotesting, defined as negative cytology and positive human papillomavirus (HPV) testing, and identify factors (including HPV strain) associated with CIN3\u2009+\u2009, defined as cervical intraepithelial neoplasia (CIN) 3 or cancer within this population. We conducted a retrospective chart review of women age 30–65 with intact cervices who had discordant cotesting results between January 1, 2013 and September 1, 2018, at an academic medical center. We used the t test for continuous variables and the Chi-square test for categorical variables to compare women with and without CIN3\u2009+\u2009. To identify factors associated with CIN3\u2009+\u2009, we performed univariate and multivariate logistic regression. The primary outcome was the prevalence of CIN3\u2009+\u2009based on pathologic diagnosis following biopsy or excisional procedure. Among 375 patients with discordant co-testing, the mean age was 43.8 years, 58.4% were parous, and 84.8% were white. Overall, 43/375 (12.0%) had CIN3\u2009+\u2009and 7/375 (1.9%) had AIS. On logistic regression, only parity\u2009≥\u20091 (p\u2009=\u20090.04, adjusted OR\u2009=\u20092.23, CI\u2009=\u20091.06–4.68) was significantly associated with CIN3\u2009+\u2009. HPV-18 was less likely to be associated with CIN3\u2009+\u2009(p\u2009=\u20090.02, adjusted OR 0.08, CI 0.01–0.65) but was present in 43% of AIS cases. HPV16 and other HR-HPV strains were highly associated with CIN3\u2009+\u2009. Women with discordant cotesting are at significant risk for CIN3\u2009+\u2009. We recommend that biopsy be performed at the time of indicated colposcopy for all patients with discordant cotesting to assess for high-grade dysplasia.