Rev Bras Ginecol Obstet. 2026 Sep 23;48:e-rbgo62. doi: 10.61622/rbgo/2026rbgo62. eCollection 2026.
ABSTRACT
OBJECTIVE: To evaluate the performance of HPV testing and liquid-based cytology (LBC) in detecting HSIL+ (CIN2, CIN3, AIS, or cancer) after negative colposcopy in women screened with ASC-H, HSIL or AGC cytology.
METHODS: We conducted a multicenter clinical trial (NCT05120167) involving 600 women referred for colposcopy due to ASC-H or worse cytology between October-2021 and October-2022. After excluding positive colposcopy cases, 257 women with negative colposcopy underwent HPV DNA testing and LBC. Histopathological diagnosis after excision of the transformation zone or 18-month negative follow-up served as the reference standard. Sensitivity, specificity, predictive values (PV), and accuracy were calculated for each test individually and combination.
RESULTS: A total of 227 women completed the study. HSIL+ was diagnosed in 15.4% (35/227), including two superficially invasive carcinomas. HPV testing alone demonstrated the highest sensitivity (94.3%) and negative PV (98.6%), but lower specificity (73.4%) and positive PV (39.3%). When restricted to HPV16 and/or 18, specificity increased to 94.8% and PPV to 57%. LBC showed balanced performance, with sensitivity of 80%, specificity of 84.9%, and PPV of 49.1%. Combining HPV and LBC using an «OR» rule yielded the highest sensitivity (97.1%) and NPV (99.2%), whereas the «AND» rule provided the highest specificity (91.7%), PPV (62.8%), and overall accuracy (89.4%).
CONCLUSION: A substantial proportion of HSIL+ lesions persist despite negative colposcopy. HPV testing effectively rules out disease, and combining with LBC enhances diagnostic safety and accuracy. This dual-test approach offers a practical strategy to guide management and reduce diagnostic failures in women with ASC-H or worse cytology.
PMID:42924372 | PMC:PMC13690385 | DOI:10.61622/rbgo/2026rbgo62
