Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Gynecologic Cytopathology Acta Cytologica DOI: 10.1159/000335145 Implementing Human Papillomavirus Testing in a Public Health Hospital: Challenges and Opportunities Mariana Carmezim Beldi a Maricy Tacla a Helio Caiaffa-Filho c Alexandre Ab’saber b Sheila Siqueira b Edmund Chada Baracat a Venancio Avancini Ferreira Alves b, d Adhemar Longatto-Filho d, e Departments of a Obstetrics and Gynecology and b Pathology, Clinics Hospital, c Molecular Biology Branch, Central Laboratory Division, Clinics Hospital, School of Medicine, and d Laboratory of Medical Investigation 14, Department of Pathology, Medical School, University of São Paulo, São Paulo, Brazil; e Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, and PT Government Associate Laboratory, Braga, Portugal the HC2 assay versus cytology (84.5 vs. 69.7%; p ! 0.0001) but a lower specificity (49.90 vs. 88.78%; p ! 0.0001). Conclusion: The combination of both methods seems to be useful in im- proving detection of cervical lesions. Copyright © 2012 S. Karger AG, Basel Background Cervical cancer is the second most common cancer in women worldwide [1], although its incidence has fallen by 50% or more in developed countries since the intro- duction of Pap smear screening. However, a single cervi- cal cytology test is insensitive for the detection of pre- cancer and cancer of the cervix [2]. Human papilloma- virus (HPV) infection is very common in young women after the onset of sexual activity and, when it persists, the viral oncoproteins can disrupt cell-cycle controls, result- ing in cervical intraepitheal neoplasia (CIN). In their mildest appearance, CIN1, these lesions are generally no more than manifestations of HPV infection, but at their most severe, CIN3, the risk of progression to invasive Key Words Cytology  Pap test  Human papillomavirus testing  Primary screening Abstract Objectives: Robust evidence now supports human papillo- mavirus (HPV) testing as a more effective option to screen- ing and as more sensitive than cytology in detecting high- grade cervical intraepithelial neoplasia . Our goal was to an- alyze the performance of the Hybrid Capture II (HC2) assay for high-risk HPV (hrHPV) in women undergoing gynecolog- ical examination at a public health hospital as part of the evaluation of HPV screening as an alternative or comple- ment to cytology. Study Design: This analysis is a subset of a cross-sectional study carried out at a large public hospital serving a predominantly low-resource population. A total of 705 women were enrolled; the sensitivity and specificity of each test were estimated and compared. Results: The analy- sis identified 272 hrHPV-positive women (mean age 36.3 years) and 433 hrHPV-negative women (mean age 41.2 years). HPV testing showed a significantly increased sensitivity of Received: July 27, 2011 Accepted: November 14, 2011 Published online: $$$ Correspondence to: Dr. Adhemar Longatto-Filho Laboratory of Medical Investigation (LIM) 14 Faculty of Medicine, University of São Paulo 1246-903 São Paulo (Brazil) Tel. +55 11 3061 7413, E-Mail longatto16  @  hotmail.com © 2012 S. Karger AG, Basel 0001–5547/12/0000–0000/$38.00/0 Accessible online at: www.karger.com/acy ACY335145.indd 1 ACY335145.indd 1 10.01.2012 08:35:49 10.01.2012 08:35:49