A randomized trial of basing treatment on human papillomavirus and/or cytology results in low-grade cervical lesion triage

• Published in: American journal of obstetrics and gynecology Vol. 199; no. 1; pp. 24.e1 - 24.e7
• Main Authors: Bjerre, Pontus, MD, Silfverdal, Lena, MD, Dillner, Lena, MD, PhD, Hagmar, Björn, MD, PhD, Edvardsson, Henrik, MD, Dillner, Joakim, MD, PhD, Andersson-Ellström, Agneta, MD, PhD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 2008; Elsevier
• Subjects: Adult; Algorithms; atypical squamous cells of undetermined significance; Biological and medical sciences; cervical; cervical intraepithelial neoplasia; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - surgery; Cervical Intraepithelial Neoplasia - virology; Cervical Intraepithelial Neoplasia/pathology/surgery/virology; Cervix Uteri - pathology; Cervix Uteri - surgery; Cervix Uteri - virology; Cervix Uteri/pathology/surgery/virology; Clinical Medicine; Colposcopy; Electrosurgery - methods; Female; Gynecology. Andrology. Obstetrics; Humans; Infectious diseases; intraepithelial neoplasia; Klinisk medicin; loop electrosurgical excision; loop electrosurgical excision procedure; MEDICAL AND HEALTH SCIENCES; Medical sciences; MEDICIN OCH HÄLSOVETENSKAP; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Obstetrics, Gynecology and Reproductive Medicine; Papanicolaou Test; Papillomaviridae - isolation & purification; procedure; randomized trial; Reproduktionsmedicin och gynekologi; Treatment Outcome; Triage; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Uterine Cervical Neoplasms - virology; Uterine Cervical Neoplasms/pathology/surgery/virology; Vaginal Smears; Viral diseases; colposcopy; atypical squamous cells of undetermined significance; randomized trial; cervical intraepithelial neoplasia; loop electrosurgical excision procedure; Gynecology; Cytology; Papovaviridae; Uterine cervix; Obstetrics; Infection; Papillomavirus; Virus; Human papillomavirus; Randomization; Treatment; Viral disease; Clinical trial; Lesion; Low grade
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2007.11.053

Objective This study was undertaken to compare management algorithms that base treatment with loop electrosurgical excision procedure on human papillomavirus and/or repeat Papanicolaou test smear results. Study Design A randomized trial that referred 674 women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions cytology results, detected in organized screening to treatment either (1) if they were positive in a repeat Papanicolaou test smear and/or a human papillomavirus test or (2) if they were positive in the repeat Papanicolaou test smear test only. Women who tested positive were treated, regardless of colposcopic findings. Results There were 208 of 337 (62%) women who were treated in the human papillomavirus /Papanicolaou test smear group (187/337 because of HPV positivity) and 138 of 337 (41%) in the Papanicolaou test smear only group. Histopathologically diagnosed cervical intraepithelial neoplasia grade 2 or worse was found among 112 of 337 (33.2%) women in the human papillomavirus/Papanicolaou test smear group compared with 85 of 337 (25.2%) women in the Papanicolaou test smear only group (P < .05). Twenty-one women with cervical intraepithelial neoplasia 2+ had normal colposcopy. Conclusion For adequate cervical intraepithelial neoplasia 2+ sensitivity, the decision to use loop electrosurgical excision procedure needs to be based on human papillomavirus testing results and should not exclude women with normal colposcopy.