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Type-Specific Human Papillomavirus Testing for the Follow-up of Women with a Typical Squamous Cells of Undetermined Significance (ASCUS) Pap Smears

Geraldine Gonfrier, Jerome Delotte, Andr? Bongain, Sebastien Vitale, Anne Chevalier and Valerie Giordanengo

Background: The aim of our study was to assess the prevalence of Human papillomavirus (HPV) genotypes amongst women diagnosed with Atypical Squamous Cells of Undetermined Significance (ASC-US) Pap smears in southern France and to determine whether the systematic application of HPV genotyping in this patient population could improve the ability to identify women with a higher or lower risk of progression to cervical cancer or CIN2 or 3. The ultimate goal is to limit the number of colposcopy performed unnecessarily in women with ASC-US cytology.

Methods: We performed a retrospective study of HPV genotype distribution in 313 ASC-US Pap smears from women who attended at the University Hospital of Nice between 2008 and 2012. We analysed by logistic regression the progression of cervical lesions correlating with the genotypes identified.

Results: We observed a high prevalence of HPV 16 (12%), 31 (7%), 51 (7%), 53 (7%), 56 (7%), 52 (5%), 66 (5%), 68 (5%), and 58 (4%) among HR HPV identified in ASC-US smears. Infection with one of the HPV genotypes 16, 18, 31, 33, 45, 52, 58, or 68 was associated with a 3.4-fold higher risk (95% CI [1.20-9.94]) of discovering a CIN2 or 3 lesion at biopsy. Furthermore HPV16 mono- and poly-infections increased this risk by 7.1-fold (95% CI [2.1-24.52]). No correlation between age and severity of lesion was observed in our study.

Conclusion: The results from this preliminary study suggests an increased risk to develop CIN2 or 3 in women with ASC-US cytology associated with 8 HR HPV genotypes (16, 18, 31, 33, 45, 52, 58, 68). This observation suggests the systematic use of HPV genotyping to improve the management of patients with ASC-US and must be completed by a large international prospective study.