HPV testing is not useful for LSIL triage - But stay tuned

The first analysis from the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS) enrollment database was a correlative analysis of human papillomavirus prevalence in patients with low-grade squamous intraepithelial lesion (LSIL) cytology. Of 642 women with an LSIL diagnosis who had analyzable Hybrid Capture II results, 82.9% of the women (95% confidence interval (CI) = 79.7 to 85.7%) had a positive result for the high-risk probe mix used in this assay. This high frequency of high-risk HPV positivity was confirmed by independent polymerase chain reaction assays on a subset of 210 of these patients with a very high concordance. Because of this finding, the potential for this HPV assay to effectively triage a population of women with an LSIL diagnosis is obviously limited. This study supports a growing consensus that the earlier reports suggesting that low-grade dysplasias were highly associated with low-risk HPV viral types were incorrect. Most of the mucosotropic viral infections that occur in the uterine cervix are high-risk viral types. Furthermore, most of these "high-risk" viral infections produce only low-grade lesions which are transient and not productive of high-grade dysplasia. Thus, the term "high-risk" or "oncogenic" HPV is a relative misnomer.