Early colposcopy in non-16/18 high-risk human papillomavirus positivity with normal cytology.

Abstract / Summary

Very few clinical studies have been done to evaluate the potential clinical benefit of utilizing early colposcopy in women with normal Pap smear cytology but positive for high-risk human papillomavirus types other than human papillomavirus 16 or human papillomavirus 18 in a screening population for cervical cancer. The aim of this study was to compare two follow-up strategies and assess the need for colposcopy at the initial visit, based on cytology, human papillomavirus testing, and colposcopic findings at 1 year, among study participants. In total, 122 women who had negative Pap smears and were positive for high-risk types of human papillomavirus (not human papillomavirus 16/18) were randomly allocated to two groups via simple computer-generated randomization. Notably, one group had a colposcopic examination when they were first diagnosed (61), and the other group had standard Pap/human papillomavirus follow-up without a colposcopic examination (61). All women in both groups had repeat Pap and human papillomavirus testing and a colposcopic examination after 1 year. Rates of loop electrosurgical excision procedure application were similar between groups (11.5 and 8.2%; p=0.343). So early colposcopy has enabled the treatment of high-grade squamous intraepithelial lesion lesions without increasing the number of loop electrosurgical excision procedures. In women who had negative cytology yet positive high-risk human papillomavirus types other than human papillomavirus 16/18, there was no statistically significant difference in either high-risk human papillomavirus persistence, abnormal cytology rates, or loop electrosurgical excision procedure requirements at a 1-year follow-up after having their colposcopy performed early vs. delayed assessments. This suggests that these patients can be appropriately managed with risk-based follow-up care.

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