Accuracy of High-Risk HPV DNA Genotyping, Cytology, and VIA as Triage Strategies for HPV-Positive Women in Cervical Cancer Screening
Abstract:
Introduction: Human papillomavirus (HPV) testing is increasingly adopted as the primary tool for cervical cancer screening. However, given the transient nature of many HPV infections, effective triage strategies are needed to iden tify women at true risk of precancerous lesions and to reduce overtreatment.
Objective: This study aimed to determine the proportion of abnormal triage results and evaluate the accuracy of HPV genotyping, cytology, and visual inspection with acetic acid (VIA) among HPV-positive women to predict the presence of CIN.
Methods: A hospital based diagnostic accuracy study was conducted at Yangon Central Women’s Hospital among women aged 25–50 who tested positive for HPV. Participants underwent HPV genotyping, cytology sampling, and VIA. Colposcopy directed biopsy was used as the diagnostic reference standard.
Results: Among 169 HPV-positive participants, 34.3% had CIN1+ and 16% had CIN2+ lesions. For CIN2+ detec tion, cytology (ASCUS threshold) showed 40.7% sensitivity, 57.0% specificity, and 54.4% accuracy. VIA achieved 92.6% sensitivity, 59.9% specificity, and 65.1% accuracy. HPV 16/18 genotyping demonstrated 74.1% sensitivity, 40.1% specificity, and 45.6% accuracy. VIA also showed higher overall predictive accuracy for both CIN1+ and CIN2+ lesions compared to cytology.
Conclusion: VIA demonstrated superior sensitivity and predictive accuracy over cytology and HPV genotyping in detecting precancerous lesions among HPV-positive women. As a low-cost and accessible approach, VIA represents an effective triage strategy for low- and middle-income settings, supporting early detection while limiting unneces sary intervention
