Obstetrics & Gynecology · 2 h ago
Cytology and HPV testing compared in vaccinated women entering cervical screening
A prospective observational study in Scotland assessed cytology and high-risk human papillomavirus (hrHPV) testing in women eligible for HPV vaccination. In the study’s selective colposcopy referral pathway, hrHPV testing had a high negative predictive value but a low positive predictive value for CIN2+; the authors support cytology triage and call for further evaluation in highly vaccinated populations.
- Study included 10,000 samples from HPV-vaccine-eligible women.
- hrHPV testing NPV for CIN2+ was 98.9% in the referral framework.
- Its PPV was 14.3%; high-grade cytology PPV was 71.7%.
- Authors call for further screening-strategy evaluation in vaccinated populations.
Researchers analysed 10,000 residual screening samples from women born between 1991 and 1995 who were eligible for HPV immunisation and screened in three Scottish Health Boards from 2011 to 2015. Samples were tested for hrHPV using Hybrid Capture 2. Women meeting specified cytology and hrHPV criteria, plus a subset with hrHPV-positive, negative cytology, were invited for colposcopy. Outcomes were obtained for 1,352 attendees, and repeat testing was examined in 1,007 women.
A total of 184 CIN2+ cases were identified among colposcopy attendees. Within the selective referral framework, hrHPV testing had a positive predictive value (PPV) of 14.3% (95% CI 12.5–16.4) and a negative predictive value (NPV) of 98.9% (95% CI 94.0–99.9). High-grade cytology had a PPV of 71.7% (95% CI 59.2–81.5) and an NPV of 89.2% (95% CI 87.4–90.8). Among women with repeat testing, hrHPV persistence declined with longer intervals between tests.
The findings suggest that cytology triage may remain relevant in vaccinated populations, where lower disease prevalence can reduce the PPV of hrHPV testing. However, estimates reflect a historical Scottish programme and selective colposcopy referrals, not population-level screening accuracy; further evaluation of screening strategies is needed.
In practice
For women eligible for HPV vaccination who enter cervical screening, this Scottish study found that hrHPV testing had a high NPV but a low PPV for CIN2+ within the study’s selective colposcopy referral pathway. The findings support continued evaluation of cytology triage alongside hrHPV testing, but do not establish which screening strategy should be adopted: the cohort was screened under a historical programme, and the reported predictive values are not population-level accuracy measures. Further research in highly vaccinated populations is needed.
AI-generated clinical interpretation · Not editor-reviewed
Is this summary clinically accurate?
Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.
Sign in to rate this summary →Source
BJOG: An International Journal of Obstetrics & Gynaecology: Cytology and hrHPV Testing in HPV ‐Vaccinated Women Entering Cervical Screening: A Prospective Observational Study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.