Accuracy of High-Risk HPV Testing Compared with Cotesting and Factors Related to Hrhpv Persistence in Postmenopausal Women

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Gynecologic Oncology

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Cervical cytology in postmenopausal women is challenging due to physiologic, atrophic changes occurring in the hypoestrogenic state. Misinterpretation of an atrophic smear as atypical squamous cells of uncertain significance (ASCUS) is one of the most common errors. We hypothesize that hrHPV may be more accurate with fewer false positive results than cotesting for prediction of CIN2+ in postmenopausal women. This study also aims to evaluate for factors related to hrHPV persistence and CIN2+ in this cohort.


Retrospective case-control study of 924 postmenopausal women and 543 premenopausal women with index cervical Pap smears, hrHPV testing, and documented five-year clinical outcomes. Index Pap diagnoses prompting colposcopy (ASCUS or greater versus NIL) and hrHPV testing results were compared with gold standard five-year outcomes. Proportions of demographic factors were compared by the use of two-sided χ2 tests or two-sided Fisher's exact tests between postmenopausal women who demonstrated hrHPV clearance versus persistence and between women who developed CIN2+ versus those who did not.


The prevalence of hrHPV in premenopausal and postmenopausal women was 41.6% and 11.5%, respectively. The specificity of hrHPV testing (89.6% [87.4–91.5]) was significantly greater than that of cotesting (67.4% [64.2–70.4]) (p < .05). A greater proportion of women with persistent hrHPV developed CIN2+ compared with women who cleared hrHPV (p = .012). There was no demographic factor with a significantly greater proportion among women with persistent hrHPV compared with those who cleared hrHPV. Demographic data for hrHPV clearers compared with persisters and women who developed CIN2+ compared with those who did not are shown inTable 1.


Our data suggest that hrHPV testing may be more accurate than cotesting in postmenopausal women and that cytology does not add clinical value in this population. CIN2+ was more common among women with persistent hrHPV than those who cleared hrHPV, but no risk factors for persistence were identified in this study. Prior history of abnormal Pap and smoking history may be useful in predicting clinically significant cervical dysplasia among postmenopausal women.


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