HPV testing added no benefit to liquid-based cytology for CIN detection

The detection of cervical intraepithelial neoplasia did not increase when HPV testing was combined with liquid-based cytology screening, according to the results of the U.K. ARTISTIC trial.

Liquid-based cytology is a liquid form of the Pap smear that has replaced conventional Pap cytology in the United Kingdom and a number of other developed countries, according to researchers.

The researchers enrolled 24,510 women aged 20 to 64 to compare liquid-based cytology plus HPV testing with liquid-based testing alone.

All women were assigned to combined HPV testing and liquid-based cytology screening; however, the results were both revealed and acted upon (n=18,386) in some women and concealed (n=6,124) in others. Follow-up screening occurred at year three when the primary outcome — the detection rate of cervical intraepithelial neoplasia greater than grade 3 — was assessed.

At the first screening, the primary outcome occurred in 1.27% of the revealed group and 1.31% of the concealed group. At year three, the rate of cervical intraepithelial neoplasia greater than grade 3 decreased to 0.25% in the revealed group and 0.47% in the concealed group.

When both screenings were combined, the overall rate for cervical intraepithelial neoplasia greater than grade 3 was 1.51% in the revealed group and 1.77% in the concealed group.

Follow-up of the ARTISTIC trial will continue until six years postenrollment in order to determine if “HPV testing could extend screening intervals because of the longer duration of protection conferred by a negative HPV result than by a negative liquid-based cytology finding,” according to researchers.

Kitchener HC. Lancet Oncol. 2009;doi:10.1016/S1470-2045(09)70156-1.