Impact of knowledge of HPV positivity on cervical cytology performance in Latin America

Scientists from the International Agency for Research on Cancer (IARC) and partner institutions have completed the first large-scale evaluation in Latin America of the impact of knowledge of human papillomavirus (HPV) positivity on the performance of cervical cytology. Initially, professionals interpreted cytology samples without knowledge of the HPV infection status. Later, the samples from women who had screened positive for HPV were reinterpreted under similar conditions by professionals who were informed that the sample they were evaluating came from a woman who had screened positive for HPV. This research is part of the ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano) study and was published in the Journal of the National Cancer Institute.

The researchers found that professionals who were aware of the HPV infection had an approximately 10% higher capacity in detecting cervical intraepithelial neoplasia of grade 3 or higher (CIN3+) than when there was no awareness of the HPV infection. The sensitivity for CIN3+ of cytology was 47.2% without knowledge of HPV positivity, compared with 58.9% with knowledge of HPV positivity.

Although the sensitivity was found to be improved, knowledge of HPV positivity led to more false-positive results, resulting in a decrease in specificity. The specificity for CIN3+ of cytology was 89.4% without knowledge of HPV positivity, compared with 78.9% with knowledge of HPV positivity.

The analysis included data from seven ESTAMPA study centres across Latin America, including more than 4000 women who had screened positive for HPV, among whom 743 cases of CIN2+ were detected. Performance estimates in both sensitivity and specificity varied by study centre.

The variability among study centres emphasizes the need for training and quality control, and to continue exploring alternative triage methods for HPV-based cervical cancer screening programmes that are more objective and potentially more efficient than cytology. These findings are particularly crucial for countries that are transitioning to HPV-based screening programmes.

Ramírez AT, Mesher D, Baena A, Salgado Y, Kasamatsu E, Cristaldo C, et al.; on behalf of the ESTAMPA Study Group
Impact of knowledge of human papillomavirus positivity on cervical cytology performance in Latin America
J Natl Cancer Inst. Published online 12 November 2024;
https://doi.org/10.1093/jnci/djae283

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