Triage of women with ASCUS and LSIL on pap smear reports: Management by repeat pap smear, HPV DNA testing, or colposcopy?

Daron G. Ferris, Thomas C. Wright, Mark S. Litaker, Ralph M. Richart, Attila T. Lorincz, Xiao Wei Sun, Lynn Borgatta, Henry Buck, Larry Kramer, Richard Rubin

Research output: Contribution to journalArticlepeer-review

94 Scopus citations


BACKGROUND. The purpose of this study was to determine the efficacy of a repeat Papanicolaou (Pap) smear and the Hybrid Capture tube-based (HCT) HPV DNA test for detecting cervical intraepithelial neoplasia (CIN) grade 2 or 3 in women with recent atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) Pap smear reports. METHODS. Women with a recent Pap smear report of ASCUS (n=169) or LSIL (n=110) had a repeat Pap smear, sampling of the cervix for HCT HPV DNA assay and a colposcopy examination. Data were evaluated using three different triage thresholds for colposcopy examination: a repeat Pap smear of persistent ASCUS or more severe dysplasia, a finding of persistent LSIL or more severe dysplasia, and a carcinogenic HPV test result. RESULTS. The sensitivity, specificity, and positive and negative predictive values for detecting CiN 2/3 were 70%, 45%, 7%, end 96% for a repeat Pap smear using an ASCUS-positive threshold and 20%, 86%, 8%, and 94% for a repeat Pap smear using an LSIL-positive threshold, respectively, when women with an initial ASCUS Pap smear were considered. HPV testing for carcinogenic viruses alone or in combination with a repeat Pap smear (using ASCUS as a positive threshold) yielded results of 50%, 67%, 9%, and 96%, respectively, and 70%, 37%, 7%, and 95%, respectively, for detecting CIN 2/3. In women with an initial LSIL Pap smear, respective values for detecting CIN 2/3 by a repeat Pap smear with an ASCUS threshold were 92%, 26%, 14%, and 96%, and for an LSIL threshold 23%, 64%, 8%, and 86%, respectively. Hybrid Capture HPV testing alone or in combination with a repeat Pap smear yielded 69%, 43%, 14%, end 91%, respectively, and 100%, 21%, 14%, and 100%, respectively. CONCLUSIONS. A Pap smear triage threshold restricted to LSIL or more severe dysplasia for women with prior ASCUS or LSIL Pap smear results was clearly ineffective for detecting high-grade cervical precancerous lesions. In contrast, when the repeat Pap smear triage threshold was expanded to include persistent ASCUS as abnormal, 83% of the women with CIN 2/3 were detected. Detection of carcinogenic HPV DNA using the HCT test was almost as sensitive for detecting CIN 2/3 as a solitary repeat Pap smear using an ASCUS or more severe positive threshold. Combining the HPV test with a repeat Pap smear did not significantly improve the sensitivity of cytology for detecting high- grade CIN. This study suggests that women with ASCUS and particularly LSIL Pap smears should be referred for a colposcopy examination until better triage methods become available.

Original languageEnglish (US)
Pages (from-to)125-134
Number of pages10
JournalJournal of Family Practice
Issue number2
StatePublished - Feb 1998


  • Cervical dysplasia
  • Cervical intraepithelial neoplasia
  • Colposcopy
  • DNA probes
  • HPV
  • Papanicolaou
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Family Practice


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