Wathirada Karnchanabanyong

Comparative Performance of Visual Inspection with Acetic Acid and Colposcopy for Detection of Cervical Precancer in Women with High-Risk Human Papillomavirus Infection: A Cross-Sectional Study

Introduction The World Health Organization recommends 4 triage strategies for women with high-risk human papillomavirus infection (hrHPV). These include visual inspection with acetic acid (VIA), colposcopy, reflex cytology, and HPV16/18 partial genotyping. However, in many low-resource settings, access to colposcopy remains limited. This study aimed to compare the diagnostic accuracy of visual inspection vs colposcopy for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2 + ). Methods Women who tested positive for hrHPV and were referred for colposcopy, with cytology results available as part of routine clinical care, underwent visual inspection with 3% acetic acid immediately before colposcopy. Colposcopic impressions were recorded, and images were scored using a modified Reid colposcopic index and a modified Swede score without iodine staining. We compared diagnostic performance for CIN2 + across visual inspection, colposcopic impression, modified Reid index (score ≥4), and modified Swede score (score ≥5). Statistical analysis used IBM SPSS Statistics and the Cochran Q test, with significance set at P < .05. Results Among 450 women, the median age was 38.0 years. A single hrHPV type was detected in 70.4% of cases; types 16, 52, and 18 were most common. Histopathological confirmation of CIN2 + occurred in 97 women (21.6%). Diagnostic accuracy for predicting CIN2 + was 78.2% with VIA and 77.5% with colposcopic impression. Accuracy was 78.4% for the modified Reid index ≥4 and 78.2% for the modified Swede score ≥5. No significant differences were observed among the 4 methods ( P = .941). Conclusions VIA demonstrates diagnostic accuracy comparable to colposcopy-based assessments in hrHPV-positive women evaluated within a cytology-informed clinical pathway, supporting its potential role in resource-limited settings.

Significance of Genotype‐Specific High‐Risk Human Papillomavirus Testing in Cervical Cancer Screening: A Hospital‐Based Study

ABSTRACTThis study explored histopathological outcomes among women who tested positive for high‐risk human papillomavirus (hrHPV), examined the significance of extended HPV genotyping, and identified predictors of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). This retrospective review assessed medical records of women who screened positive for hrHPV between January 1, 2020, and December 31, 2023. Genotyping results, diagnostic procedures, and histopathological findings were collected. Data were analyzed using SPSS, with p <  0.05 considered statistically significant. Among 1981 women, the median age was 40 years (IQR 32.0‒49.0), and the median parity was 1 (IQR 0‒2). Overall, 1223 women (61.7%) had prior screening, 1215 women (61.3%) had previous cytology, and 107 women (5.4%) had prior hrHPV testing. Single‐genotype infection occurred in 1408 women (74.7%), with HPV52, HPV16, and HPV58 identified in 23.7%, 15.6%, and 15.4% of cases, respectively. CIN2+ was detected in 152 women (7.7%), including 130 with CIN2/CIN3/AIS and 22 with cancer. Detection of HPV16 significantly increased the risk of CIN2+ (odds ratio [OR] 4.534, 95% CI: 3.197‒6.430), as did multiparity (OR 1.497, 95% CI: 1.070‒2.094). The immediate risk of CIN2+ for HPV31, HPV39, HPV56, HPV66, and HPV68 was below 4%. Among hrHPV‐positive women, 7.7% had CIN2+. Extended hrHPV genotyping may refine risk stratification by highlighting HPV16 and multiparity as significant predictors of CIN2+ lesions.