From the Guidelines
Patients with positive high-risk HPV testing should undergo colposcopy, particularly if they have abnormal cytology findings or persistent HPV infection. The management of HPV positivity with colposcopy involves a systematic approach based on risk stratification, as outlined in the 2021 guidelines for the management of abnormal cervical cancer screening tests and cancer precursors 1. During colposcopy, the cervix is examined using a colposcope after applying acetic acid and Lugol's iodine to identify abnormal areas. Biopsies should be taken from any suspicious lesions, with endocervical curettage considered for patients with unsatisfactory colposcopy or concerning findings at the endocervical canal.
Key considerations in the management of HPV positivity with colposcopy include:
- The type of HPV infection, with HPV 16 and 18 being considered high-risk types that warrant colposcopy even if cytology results are normal 1
- The presence of abnormal cytology findings, such as ASC-US or LSIL, which may require colposcopy and biopsy 1
- The patient's history of previous abnormal test results, which may influence the decision to perform colposcopy or expedited treatment 1
- The patient's pregnancy status and immune status, which may require special considerations and more frequent monitoring 1
Management following colposcopy depends on biopsy results:
- CIN 1 (mild dysplasia) typically requires observation with repeat co-testing in 12 months
- CIN 2/3 (moderate to severe dysplasia) generally requires treatment with excisional procedures like LEEP (Loop Electrosurgical Excision Procedure) or conization
- For persistent HPV positivity without visible lesions, surveillance with repeat co-testing in 12 months is recommended, as outlined in the 2007 consensus guidelines for the management of women with abnormal cervical cancer screening tests 1.
It is essential to note that the 2021 guidelines provide more specific recommendations for the management of HPV positivity with colposcopy, including the use of HPV genotyping and the consideration of expedited treatment for patients with high-risk HPV types and abnormal cytology findings 1.
From the Research
Guidelines for Colposcopy with HPV Positivity
The management of Human Papillomavirus (HPV) positivity with colposcopy involves several guidelines based on the type of HPV and the results of cytological findings.
- For patients with high-risk HPV subtypes, including HPV 16-18, colposcopic examination is recommended, even if cytologic findings are normal 2.
- The current guidelines suggest annual co-test follow-up in non-16/18 high-risk HPV positive patients without abnormal cytologic findings 2.
- However, some studies suggest that all women testing positive for HPV, regardless of Pap smear result, should be referred to colposcopy 3.
- Colposcopy-oriented biopsy is recommended for women who consecutively test positive for high-risk HPV without significant changes on reflex cytology or dysplasia on cervical colposcopy-oriented biopsy 3.
HPV Typing and Colposcopy
HPV typing can be helpful in cervical cancer screening and prevention, especially in patients with colposcopy-positive findings 4.
- HPV 16 was detected in 18% of colposcopy-positive patients, while HPV (excepting type 16) was detected in 12% of colposcopy-positive patients 4.
- Colposcopy and HPV typing can be used to triage patients with atypical squamous cells of undetermined significance (ASC-US) cytological findings, reducing the number of unnecessary cervical biopsies 5.
Triage of Patients with LSIL Cytology
For patients with low-grade squamous intraepithelial lesion (LSIL) cytology referred to colposcopy, CINtec PLUS cytology and cobas HPV tests can be used for triaging 6.