318例高级别宫颈上皮内瘤变及宫颈癌患者的TCT和hrHPV检测分析

  目的  探讨如何使用现有的筛查方法, 减少高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 2 or 3, CIN2/3)及宫颈癌的漏诊。  方法  回顾性分析2014年6月至2018年8月318例中国医科大学附属航空总医院治疗的CIN2/3及宫颈癌患者的临床资料, 其中CIN2/3为296例、宫颈癌为22例, 采用宫颈液基薄层细胞学检查(thinprep cytology test, TCT)及高危型人乳头瘤病毒(high risk human papilloma virus, hrHPV)检测方法, 分析患者的年龄、TCT和hrHPV。  结果  296例CIN2/3患者中30~39岁患者为130例(43.92%)、占第1位, 20~29岁年轻患者为69例(23.31%)、占第3位。318例患者中TCT阳性为199例(62.58%), hrHPV阳性为308例(96.86%), 两者联合筛查阳性为313例, 阳性率为98.43%(313/318)。hrHPV分型检测主要亚型依次为16、52、58、33、18、31型。  结论  CIN2/3及宫颈癌的发病年龄年轻化, 年轻患者筛查不容忽视。TCT单独筛查较hrHPV单独筛查易漏诊高级别病变, TCT联合hrHPV筛查可提高检出率。TCT阴性, hrHPV非16、18亚型的其他hrHPV阳性, 尤其是hrHPV52、58、33、31亚型阳性患者也建议行阴道镜检查。      

妊娠合并子宫颈上皮内瘤变患者高危型人乳头状瘤病毒感染的临床研究

目的探讨妊娠合并子宫颈上皮内瘤变患者高危型人乳头状瘤病毒（HPV）感染情况。方法将2011年11月至2012年10月间收治的118例妊娠合并子宫颈上皮内瘤变患者（实验组）和118例宫颈健康的妊娠女性（对照组）作为研究对象,比较两组高危型HPV的感染情况。结果妊娠合并宫颈上皮内瘤变（CIN）患者感染的HPV主要类型为HPV16和HPV18,两者在宫颈癌发生发展中可能起重要作用,宫颈病变的级别与HPV的阳性率和载荷量呈显著正相关,两者可以作为妊娠合并CIN患者早期诊断的临床指标之一。结论妊娠合并子宫颈上皮内瘤变患者的高危型HPV感染可以作为诊断宫颈癌的重要要指标,值得临床大力推广。     

P16蛋白在子宫颈上皮内瘤变中表达意义与高危型HPV感染的相关性分析

  目的  研究P16蛋白在宫颈上皮内瘤变（CIN）中表达的意义, 探讨其与高危型人类乳头状瘤病毒（HPV）感染的相关性, 以期用P16蛋白的表达预测CIN进展。  方法  收集大连大学附属医院2009年1月至2011年5月宫颈活检及手术切除标本137例, 免疫组织化学方法检测P16蛋白的表达并评分, HC2方法检测高危型HPV-DNA, 并对数据进行分析。  结果  P16蛋白表达在慢性子宫颈炎伴鳞状上皮化生中均阴性（0/40）, CINⅠ阳性90.91%（20/22）, CINⅡ阳性为95.00%（19/20）, CINⅢ阳性为100.00%（25/25）, 浸润性鳞癌阳性为100.00%（30/30）。在慢性子宫颈炎伴鳞化中高危型HPV阳性1例, CINⅠ12例, CINⅡ14例, CINⅢ22例, 浸润性鳞癌29例。CIN中感染高危型HPV的病例, P16蛋白均呈阳性表达。  结论  P16蛋白可作为区分子宫颈癌及癌前病变与良性反应性增生的标记物, 其表达的分层现象能够很好的反映出CIN的分级, P16蛋白阳性表达的评分有助于区分出有高危发展倾向的CIN。      

人乳头状瘤病毒感染与宫颈病变的相关性分析？

目的：分析宫颈上皮内瘤变（ CIN）及宫颈癌（ CC）中人乳头状瘤病毒（ HPV）亚型,探讨HPV感染与宫颈病变的相关性。方法：慢性宫颈炎或液基细胞学异常的妇女检测21种HPV基因亚型和阴道镜下宫颈定位活检,分析2481例CC和CIN患者的HPV感染情况。结果：在2481例CIN和CC患者中,HPV感染率85．0%,HPV感染与宫颈组织学结果有较强的相关性（P〈0．001,Pearson列联系数=0．648）。 CC及CINⅢ、CINⅡ患者以HPV16、18感染最多见,其次见HPV58、33、31、52、45、59、68等亚型。304例患者宫颈感染HPV16、18、58、52、33等亚型后,发生高度鳞状上皮内病变（HSIL）、不明意义的非典型鳞状细胞（ASCUS）及低度鳞状上皮内病变（LSIL）的频率增加,TCT分型与HPV分型有较弱的相关关系（P=0．002,Pearson列联系数=0．322）。细胞学结果提示HSIL、AS-CUS,宫颈组织学诊断以CC、CINIII和CINII为多,TCT分型与组织学分型也有较弱的相关性（ P=0．026,Pearson列联系数=0．172）。结论：HPV16、18、58、33、52、31、45等高危型HPV感染是宫颈癌（ CC）及癌前病变（ CIN）最常见的风险因素。高危型HPV单独或混合感染宫颈后,细胞学检测HSIL、ASCUS及LSIL的发生率增加,细胞学结果与组织学分型的相关性促进了CC和CIN的及时诊治。     

膜式液基薄层细胞学检测联合高危型人乳头状瘤病毒分型检测在宫颈癌筛查中的应用

目的探讨膜式液基薄层细胞学检测技术(TCT)联合高危型人乳头状瘤病毒(HPV)分型检测技术在宫颈癌筛查中的应用价值。方法选取2160例有性生活史患者的宫颈脱落细胞作为筛检标本,采用TCT联合基因杂交捕获法(HC-II)对细胞学异常或临床存在高危症状的患者进行HPV分型检测,HPV阳性患者再行阴道镜下宫颈活组织病理学检查。结果 2160例受试标本中,259例(12.0%)患者TCT检查结果异常。TCT检查结果异常患者中,118例(45.6%)患者HPV分型检测阳性。宫颈活检病理结果显示,无上皮内病变或恶性病变(NILN)患者29例,宫颈上皮内瘤变(CIN)I级患者40例,CIN II级以上患者49例。宫颈癌的发生率随宫颈内病变程度的增加而升高,差异有统计学意义(P<0.05)。结论 HPV感染是诱发女性宫颈癌变的关键因素,临床应用TCT联合HPV基因分型检测技术筛查宫颈病变和早期宫颈癌更为精准、快捷、敏锐。     

cobas 4800 HPV检测在宫颈癌筛查中的应用价值

  目的  评价cobas 4800 HPV检测技术在宫颈癌及癌前病变筛查中的可行性及应用价值。  方法  对河南省新密市856例年龄 > 21岁有性生活的妇女进行宫颈癌筛查。每位妇女均接受了cobas 4800 HPV检测、高危型HPV第二代杂交捕获试验(hy brid capture 2 technology, HC2)检测、ThinPrep液基细胞学和阴道镜检查。阴道镜下在可见病变处直接取活检; 任意筛查结果阳性但无可见病变时, 于宫颈外口鳞柱交界处行四象限随机活检和宫颈管搔刮术(endocervical curettage, ECC)。  结果  cobas 4800HPV检测与HC2检测对宫颈上皮内瘤变(cervical intraepithelial neoplasia, CIN)2级以上(CIN2、CIN3及宫颈癌)患者的灵敏度均为94.4%(34/36), 特异度分别为63.2%(516/817)和63.9%(522/817);一致率为83.4%(711/853), 两者具有高度一致性(Kappa=0.65)。cobas 4800 HPV检测对于液基细胞学检查漏诊的患者具有100%检出率。cobas 4800 HPV16及18分型检测对于CIN2以上患者的阳性预测值21.9%为HC2检测10.3%的2.13倍。妇女感染HPV16及18型患CIN2以上病变的年龄比感染其他类型平均小5.4岁。  结论  cobas 4800 HPV检测与HC2检测具有相似的准确性和良好的一致性, 比ThinPrep液基细胞学检查更为灵敏, 并且能鉴别HPV16及18两种高风险类型HPV感染, 利于医生更有针对性地随访宫颈病变中的高危病例。      

阴道镜结果正常或低度病变妇女发生宫颈癌前病变的前瞻性风险分层研究

  目的  探讨细胞学、高危型人乳头瘤病毒（high risk human papillomavirus,hrHPV）分型对于阴道镜结果正常或低级别鳞状上皮内病变（low-grade squamous intraepithelial lesion,LSIL）妇女的风险预测作用。  方法  基于1999年6月在山西省建立的宫颈癌筛查队列,以2005年随访时阴道镜结果为正常或低度病变的596例妇女为研究对象,于2010年和2014年进行随访。分析hrHPV阴性组、hrHPV阳性组、HPV16/18阳性组、细胞学LSIL以下组和细胞学LSIL及以上组发生宫颈上皮内瘤样病变2级及以上（cervical intraepithelial neoplasia grade 2 or worse,CIN2+）的瞬时、5年和9年累积风险和相对危险度。  结果  细胞学LSIL以下组发生CIN2+的瞬时、5年和9年累积风险分别为0.2%、2.8%和4.2%,细胞学LSIL及以上组相应的风险分别为14.7%（RR=73.8,95% CI为9.7~561.5）、40.0%（RR=16.0,95% CI为8.2~31.1）和51.4%（RR=15.0,95% CI为8.3~27.0）。hrHPV阴性组发生CIN2+的瞬时风险、5年和9年累积风险较低,分别为0.6%、2.7%和3.8%,hrHPV阳性和HPV16/18阳性组发生CIN2+的风险逐渐升高,其中HPV16/18阳性组的相应风险分别为13.2%（RR=23.4,95% CI为5.1~106.9）、36.9%（RR=15.4,95% CI为6.9~34.3）和42.6%（RR=14.1,95% CI为6.8~29.2）。  结论  阴道镜结果正常或LSIL妇女,若细胞学结果为LSIL及以上或HPV16/18阳性,未来进展为高度宫颈癌前病变的风险较高,细胞学和HPV16/18分型可用于该人群的临床分流管理。      

DNA定量分析联合高危型HPV检测对高级别CIN的检出价值

目的:研究宫颈细胞DNA定量分析联合高危型HPV检测在诊断高级别宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）的应用价值。方法:收集220例有DNA定量分析、宫颈薄层液基细胞学检查（thinprep cytology test,TCT）、二代杂交捕获（hybrid capture II,HC2)检测高危型人乳头瘤病毒（human papillomavirus,HPV）及宫颈活检资料的病例。结果:以宫颈活检组织病理学为诊断标准,220例活检中60例病理组织学为高级别宫颈上皮内瘤变的病例,DNA定量分析对检测高级别CIN的敏感性为96.7%,特异性为25.0%,阳性预测值为32.6%,阴性预测值为95.2%,而TCT及HC2的敏感性、特异性、阳性预测值及阴性预测值分别为96.7%、3.8%、27.4%、75.0%及98.3%、38.8%、37.6%、98.4%。DNA定量分析除敏感性以外,其他指标均高于TCT检测,而低于HC2检测。DNA定量分析及HC2检测均阴性的病例,阴道镜活检无高级别鳞状上皮内瘤变病例。结论:DNA定量分析在诊断高级别宫颈上皮内瘤变中优于TCT,与HC2检测联用可提高诊断高级别宫颈上皮内瘤变的敏感性和特异性。     

薄层液基细胞学及人乳头状瘤病毒亚型检测在宫颈病变诊断中的应用

[目的]探讨薄层液基细胞学（TCT）、人乳头状瘤病毒（HPV）检测在宫颈病变诊断中的价值。[方法]2007年11月至2008年3月280例患者行TCT、HPV亚型检测以及阴道镜下宫颈活检,以阴道镜下病理结果为标准,分析TCT、HPV检测对宫颈病变诊断的准确率。[结果]TCT及HPV检测两者之一阳性的78例患者中,病理学诊断为CIN及宫颈癌20例,检出率25.64%（20/78）;两者检测均阴性者,CIN检出率0.49%（1/202）;两者检测均阳性者,CIN及宫颈癌检出率61.54%（16/26）。两者之一检测阳性组CIN及宫颈癌检出率显著性高于两者检测均阴性组（χ2=42.88,P〈0.01）。TCT检测阳性42例中,CIN及宫颈癌18例,检出率42.86%（18/42）;HPV检测阳性62例中,CIN及宫颈癌检出率29.03%（18/62）。[结论]无创性的TCT、HPV检测是宫颈阴道镜活检的有效补充,个体化应用于宫颈癌前病变及宫颈癌的检测有一定临床价值。     

HPV基因型与宫颈病变的关系探讨

  目的  了解HPV基因型与宫颈病变的关系。  方法  选取2010年3月至2011年1月在广州中山大学第三医院妇科就诊并愿意接受HPV检查和问卷调查的妇女为对象。剔除标准:1）已切除子宫;2）已行宫颈锥切;3）不愿意参加本研究。入选360例,年龄为19~66岁,平均为35.6岁,户籍均为广州地区。利用核酸分子杂交技术检测21种HPVDNA。宫颈正常/炎症组为256例,CIN1组为34例,CIN2/3组为61例,宫颈癌组为9例。  结果  HPV感染率宫颈正常/炎症组为18.4%（47/256）,CIN1组为67.6%（23/34）,CIN2/3组为96.7%（59/61）,宫颈癌组为100%（9/9）。CIN1组、CIN2/3组HPV感染率均比正常/炎症组高（P < 0.001）;CIN2/ 3组的HPV感染率比CIN1组高（P < 0.001）。CIN主要感染类型依次为HPV16（44.2%）、HPV58（24.2%）、HPV52（11.6%）、HPV33（8.4%）。宫颈癌主要感染类型为HPV16（88.9%）。  结论  随着宫颈病变程度进展HPV感染率呈升高的趋势,HPV16、58、52、33相关的感染与宫颈癌前病变关系密切,应引起足够重视,其中HPV16感染易致病变进展及癌变发生。      

Usefulness of liquid-based cytology specimens for the immunocytochemical study of p16 expression and human papillomavirus testing: a comparative study using simultaneously sampled histology materials

BACKGROUND: In cervical lesions, the overexpression of p16 is reported to be closely associated with high-risk human papillomavirus (HPV) infection. The objective of the current study was to confirm the usefulness of liquid-based cervical specimens for p16 staining as well as tissue sections. METHODS: A total of 98 patients with cervical lesions were entered into the current study. After the cytologic examination using liquid-based cervical smears, the same slides were immunostained for p16 and were compared with slides of simultaneously obtained, immunohistologically stained tissue sections. Moreover, the status of the HPV infection was examined by polymerase chain reaction using residual cytologic samples. RESULTS: Using liquid-based Pap smears, 98 cases were diagnosed as atypical squamous cells of undetermined significance (38 cases), low-grade squamous intraepithelial lesion (12 cases), high-grade squamous intraepithelial lesion (HSIL) (33 cases), and invasive carcinoma (15 cases). The concordance rate between the cytologic and histologic diagnoses was found to be higher in high-grade lesions compared with low-grade lesions. Immunohistochemistry revealed that all HSIL and invasive carcinoma cases contained p16-positive cells in the liquid-based Pap smears and diffuse p16 staining was observed in all high-grade lesions with greater than CIN Grade 3 cervical intraepithelial neoplasia except for two adenocarcinoma cases. Of the 98 cases, 60 were found to be positive for high-risk HPV and 55 of these 60 HPV-positive cases were found to be p16 positive on cytologic examination. There were 16 cases that demonstrated marked discrepancies between the cytologic and histologic diagnoses. CONCLUSIONS: The results of the current study confirmed that the immunohistochemical detection of p16 was more sensitive and specific than HPV status in cervical lesions using a liquid-based method as well as tissue samples, suggesting that p16 should be used as a satisfactory biomarker for the primary screening of cervical cytology.     

LCT联合HR-HPV检测在宫颈上皮内瘤变Ⅲ级LLETZ术后随访中的价值

  目的  评价HR-HPV(high-risk human papillomavirus)检测在CINⅢ(cervical intraepithelial neoplasia gradeⅢ)行宫颈移行区大环切除术(LLETZ)后随访中的价值。  方法  采用临床病例分析的方法, 选取北京大学深圳医院2003年5月至2009年5月间诊断为CINⅢ接受LLETZ(large loop excision of the transformation zone)手术的567例患者, 术后3、6个月及以后每6~12个月随访1次, 以LCT(liquid-based cytologic test)及HCⅡ(hybrid captured-Ⅱ)法HR-HPV DNA检测作为随访的监测指标, 评估LCT联合HR-HPV检测在术后随访中的价值。  结果  1) 术后LCT预测病变残留灵敏度60.00%, 特异度88.15%, 阳性预测值8.30%, 阴性预测值99.19%;HPV预测病变残留灵敏度100%, 特异度85.64%, 阳性预测值11.11%, 阴性预测值100%;LCT预测病变复发灵敏度63.64%, 特异度92.27%, 阳性预测值14.00%, 阴性预测值99.23%;HPV预测病变复发灵敏度72.73%, 特异度85.97%, 阳性预测值9.30%, 阴性预测值99.38%。2)术后HPV持续阳性患者复发几率高于非HPV持续感染患者, 差异有统计学意义(P < 0.05)。术后复发率在HPV持续阳性组与再次感染组为高, HPV持续阴性组术后无复发。  结论  术后LCT联合HR-HPV检测预测残留或复发有重要价值, 是一种有效的随诊方法。术后HPV感染状态与复发相关, 临床需严密随访。      

妊娠期生理特点与宫颈癌的关系及围妊娠期宫颈癌筛查的意义

目的探讨妊娠期生理特点与宫颈癌的关系及加强宫颈疾病史妇女围妊娠期宫颈癌筛查的意义。方法选取2018年1月至2020年1月间陕西省西安医学院第二附属医院妇产科门诊建立档案并接受正规产前检查的22141例孕妇作为研究对象,根据是否处于妊娠期进行分组,妊娠期3328例,非妊娠期18813例。按照自愿原则,受检者接受液基细胞学检查(TCT),共计3328例。TCT异常者及发现宫颈病变的孕妇,在产后6周进行TCT复查。对选择同期接受宫颈癌筛查项目的非孕期妇女开展TCT检查结果分析。结果TCT检查结果显示,妊娠期和非妊娠期妇女细胞学阳性比组间比较,差异无统计学意义(P>0.05)。非妊娠组患者高度鳞状上皮内病变(HSIL)高于妊娠组,差异有统计学意义(P<0.05)。两组患者的不典型鳞状细胞(ASC-US)、低度上皮内病变(LSIL)、不典型鳞状细胞(ASC-H)、鳞状细胞癌(SCC)和不典型腺细胞(AGC)比较,差异无统计学意义(P>0.05)。两组患者宫颈组织学结果中,宫颈上皮内瘤样病变(CIN)及宫颈癌发生率、活检率和阳性率比较,差异无统计学意义(P>0.05)。随访134例细胞学异常的妊娠期妇女,细胞学转阴率为68.7%(92/134),阴道镜检查结果显示,炎症或人乳头瘤状病毒(HPV)感染6例,CINⅠ5例、CINⅡ3例,CINⅢ2例,没有浸润癌出现。结论多数妊娠合并宫颈病变患者在产后可自行缓解或无进展,预后效果良好。     

高危型HPV E6/E7mRNA检测在宫颈机会性筛查中应用价值研究

目的 人乳头瘤病毒(human papillomavirus,HPV) DNA能提高检测宫颈上皮内瘤变2级+(cervical intraepithelial neoplasia 2+,CIN2+)的灵敏度,但也增加了一过性HPV感染的检出率.本研究应用高危型HPV(high risk human papillomavirus,hrHPV) E6/E7 mRNA对比二代杂交捕获(hybrid CaptureⅡ,HC2)、HPV分型,描述机会性筛查人群中HPV感染及宫颈病变分布特征,探讨其用于宫颈筛查的可行性.方法 选取2013-01-01-2015-12-31在青岛大学附属青岛市立医院(6 138例)和青岛市城阳区人民医院(1 653例)妇科门诊行宫颈液基细胞学筛查的女性共计7 791例,年龄21～65岁.所有筛查女性行液基细胞学检查的同时行HPV检测,根据HPV检测方法的不同分为HC2组、HPV分型组和E6/E7组共3组.计算各组细胞学结果异常率、HPV阳性率和宫颈病变检出率,比较E6/E7所描述的流行病学特征与HPV-DNA方法的不同.结果 E6/E7组各级细胞学结果分别为,未见上皮内瘤变及恶性病变(negative for intraepithelial lesion or malignancy,NILM) 87.51％,意义不明的非典型鳞状细胞(atypical squamous cells of undetermined significance,ASCUS)5.47％,低级别鳞状上皮内瘤变(low-grade squamous intraepithelial lesion,LSIL)3.51％,不除外高级别鳞状上皮内瘤变的非典型细胞(atypical squamous cells cannot exclude HSIL,ASC-H)0.52％,高级别鳞状上皮内瘤变(high-grade squamous intraepithelial lesion,HSIL)2.99％.HPV阳性中异常细胞学结果的比例明显高于HPV阴性,而NILM的比例低于HPV阴性,P＜0.001.随着细胞学异常程度的加重,HPV阳性率逐渐增高,差异有统计学意义,x2值分别为611.089、512.036和767.260,P值均＜0.001.E6/E7组中NILM的HPV阳性率为8.02％,合计阳性率为14.73％,均较HC2及分型组低,x2=30.174,P=0.000;x2 =22.991,P＜0.001. E6/E7组CIN2+/CIN3+检出率分别为5.92％和1.20％,3组间比较差异无统计学意义,x2值分别为1.499和0.711,P值分别为0.473和0.701.E6/E7阳性率在正常至浸润性宫颈癌(invasive cervical cancer,ICC)之间随病变程度加重而升高,P＜0.05.在正常病理结果中E6/E7阳性率为61.36％,低于HC2和HPV分型,x2=15.767,P＜0.001;其余病理结果中各组间HPV阳性率差异无统计学意义,P＞0.05.结论 hrHPV E6/E7 mRNA较之HC2和HPV分型能在不降低宫颈病变检出率的前提下减少一过性HPV感染的检出率,提示其在宫颈筛查中具有潜在应用价值.     

Human papillomavirus testing using hybrid capture II with SurePath collection: initial evaluation and longitudinal data provide clinical validation for this method

BACKGROUND: Testing for human papillomavirus (HPV) is an integral part of equivocal cervical cytology triage. Clinical validation of non-FDA (Food and Drug Administration)-approved methods is therefore important because of the high volume of such tests and the implications for missed high-grade lesions if test performance is not optimal. METHODS: A preinitiation study and 17 months of follow-up data using Hybrid Capture II (HC II) HPV detection with SurePath (SP) sample collection were analyzed. Results of HPV tests on abnormal cytology samples were collected and compared with follow-up results. HPV-positive rates were determined in cases of low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL), and follow-up rates of cervical intraepithelial neoplasia (CIN) were determined in HPV-positive and -negative cases of atypical squamous cells of unknown significance (ASC-US). Rates were compared with published data using FDA-validated methods. RESULTS: The preinitiation study showed the test method to be 100% sensitive for the detection of LSIL (20 cases) and HSIL (8). The ASC-US follow-up study (2319 cases with 625 having biopsy results) showed that the rate of CIN III+ in HPV +/- cases was 7.8%/1.4%, and of CIN II+ was 17.5%/4.3%, respectively. The positive predictive values/negative predictive values (PPV/NPVs) (CIN II+) for the test were 17.5%/95.7%, respectively. CONCLUSIONS: Published FDA-validated HPV testing follow-up data show that the expected rates of CIN III+ and CIN II+ in the HPV-negative ASC-US population are 1.4% and 5%, respectively, with PPV/NPVs (CIN II+) of 20%/99%, respectively. By comparison, the present data using HC II with SP show strong similarity, indicating clinical validity for the use of this method.     

Combined use of cytology,p16 immunostaining and genotyping for triage of women positive for high-risk human papillomavirus at primary screening

Human papillomavirus (HPV) testing is very sensitive for primary cervical screening but has low specificity. Triage tests that improve specificity but maintain high sensitivity are needed. Women enrolled in the experimental arm of Phase 2 of the New Technologies for Cervical Cancer randomized controlled cervical screening trial were tested for high-risk HPV (hrHPV) and referred to colposcopy if positive. hrHPV-positive women also had HPV genotyping (by polymerase chain reaction with GP5+/GP6+ primers and reverse line blotting), immunostaining for p16 overexpression and cytology. We computed sensitivity, specificity and positive predictive value (PPV) for different combinations of tests and determined potential hierarchical ordering of triage tests. A number of 1,091 HPV-positive women had valid tests for cytology, p16 and genotyping. Ninety-two of them had cervical intraepithelial neoplasia grade 2+ (CIN2+) histology and 40 of them had CIN grade 3+ (CIN3+) histology. The PPV for CIN2+ was >10% in hrHPV-positive women with positive high-grade squamous intraepithelial lesion (61.3%), positive low-grade squamous intraepithelial lesion (LSIL+) (18.3%) and positive atypical squamous cells of undetermined significance (14.8%) cytology, p16 positive (16.7%) and, hierarchically, for infections by HPV33, 16, 35, 59, 31 and 52 (in decreasing order). Referral of women positive for either p16 or LSIL+ cytology had 97.8% sensitivity for CIN2+ and women negative for both of these had a 3-year CIN3+ risk of 0.2%. Similar results were seen for women being either p16 or HPV16/33 positive. hrHPV-positive women who were negative for p16 and cytology (LSIL threshold) had a very low CIN3+ rate in the following 3 years. Recalling them after that interval and referring those positive for either test to immediate colposcopy seem to be an efficient triage strategy. The same applies to p16 and HPV16.