HPV test results discussed at the MDT meeting

HPV test results are not ‘black and white’ and depend on which test has been carried out and what cut-off level was used (Cubie & Cuschieri 2013).

Although high-risk HPV positivity may support an equivocal cytology result (e.g. ASC-H or HSIL vs. immature metaplasia) it cannot prove its nature in the absence of other evidence (e.g. colposcopic findings or punch biopsy).

The low PPV of high-risk HPV-positivity must be taken into account (e.g. Moss et al. 2013: 4-12% for CIN3+ and 12-23% for CIN2+). 

High-risk HPV is not uniformly found in high-grade CIN or cancer.  Its sensitivity for CIN2+ and CIN3+ is usually higher than cytology but its sensitivity is in the range of 85-95%. 

 

HPV status of cases at MDT meetings

  • When reviewing cases at MDT meetings members of the team should take account of the significance of the low PPV and <100% sensitivity of high-risk HPV
  • Confirmed diagnoses of HSIL or AIS/CGIN/adeno-carcinoma should not be downgraded by HPV negativity

 

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