Testing for HPV types 16 and 18 in women with minor cervical lesions may be useful as a second triage after high-risk HPV testing to determine which patients should go on to colposcopy.

The results of a systematic review and meta-analysis are published in Annals of Internal Medicine.

Women with minor cervical abnormalities, including atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL), have a modestly increased risk for cervical cancer.

Testing for high-risk HPV can be used to triage these women, but most will test positive and referring them all to colposcopy carries a considerable burden and cost.

Because HPV types 16 and 18 cause about 70 percent of cervical cancer cases, genotyping for these types of HPV could allow for more precise patient management.

Researchers reviewed 24 moderate- to good-quality published studies involving almost 14,000 women with minor cervical lesions to evaluate the accuracy of genotyping for HPV types 16 and 18 and to determine its utility as a second triage step after high-risk HPV testing.

The data suggests that genotyping for HPV 16 and 18 was more efficient compared with high-risk HPV testing, but at the expense of a loss in sensitivity.

Since women testing positive for HPV 16 and 18 are at high risk for cervical cancer, they should be referred to colposcopy.

The authors suggest that women carrying other high-risk HPV types are at borderline risk and may be referred to colposcopy or retesting, depending on local decision thresholds.

Source: American College of Physicians