HPV testing: Where are we now?

Objectives: 1) To assess if HPV (human papillomavirus)-DNA testing using the presently available technology offers any advantage over the utilization of the traditional Papsmear as a screening tool for women at risk for cervical precancers. 2) To assess if the HPV-DNA test is a valuable intermediate triage method for patients with Pap-smears demonstrating ASCUS (Abnormal Squamous Cells of Undetermined Significance) or LG-SIL (Low-Grade Squamous Intraepithelial Lesions) in order to better select those patients who would maximally benefit from colposcopy, thus, using clinical resources in an efficient way. Material and Methods: Review of the peer reviewed literature between 1992 and June 2000 regarding: 1) new and innovative approaches for cervical cancer screening and prevention; 2) advances in management protocols of ASCUS and LG-SIL with the introduction of HPV-DNA test. Results: HPV-DNA testing in association with the Pap (Papanicolau) smear performed either conventionally or, preferably, with the new liquid based cytology is a valuable adjunct with high sensitivity and acceptable specificity rates in defining those patients most likely to demonstrate HG-SIL (High-Grade Squamous Intraepithelial Lesions) at the time of colposcopy. Conclusion: At present available evidence indicates that the best reason for performing HPV-DNA testing is the triage of selected patients with ASCUS and in specific settings with LG-SIL. Ongoing clinical studies may demonstrate additional advantages for this technology when used in a screening application.