EC Gynaecology

Introduction: Cervical cancer screening has evolved towards the combined use of cytology and HPV testing (cotest). This study evaluates the usefulness of the cotest in women with negative cytology in Villa Clara, Cuba.

Methods: Three hundred women with negative cytology who underwent HPV testing were included. Those with positive HPV tests (174) underwent colposcopy and repeated cytology. The distribution of genotypes (16, 18, others) and their association with intraepithelial lesions (CIN I-III, Ca in situ, microinfiltrating) were analyzed.

Results: 58% (174/300) were HPV+. Genotyping showed 16.1% (28/174) HPV-16, 10.3% (18/174) HPV-18, 72.4% (126/174) other genotypes and 4.6% (8/174) coinfections. A total of 73 lesions were detected: 30 CIN I, 18 CIN II, 14 CIN III, 9 in situ carcinoma, and 2 microinfiltrating lesions. Of the high-grade lesions (CIN II-III, carcinoma, microinfiltrating), 67.1% (49/73) were associated with HPV-16/18, although these genotypes represented only 26.4% (46/174) of HPV+ cases (p < 0.001).

Conclusion: The cotest identifies women at high risk despite negative cytology, highlighting the importance of genotyping to prioritize clinical management in HPV-16/18 carriers.

 Keywords: Cervical Cancer; HPV-16/18; HPV Testing (Cotest); Carcinoma; Microinfiltrating

1. World Health Organization (WHO). “Global strategy to accelerate the elimination of cervical cancer” (2020).
2. Ministry of Public Health of Cuba (MINSAP). “National Program for the Prevention and Control of Cervical Cancer”. Havana, Cuba (2021).
3. Arbyn M., et al. “Accuracy of artificial intelligence-assisted detection of cervical precancer: A systematic review and meta-analysis”. Journal of the National Cancer Institute 10 (2020): 1001-1011.
4. Cuzick J., et al. “Role of HPV testing in primary screening for cervical cancer”. Lancet Oncology5 (2019): e252-e263.
5. Wentzensen N and Schiffman M. “The promise of artificial intelligence in cervical cancer screening”. Journal of the National Cancer Institute 11 (2018): 1152-1153.
6. Rodríguez-Salazar A., et al. “Application of artificial intelligence in colposcopy: a systematic review”. Revista Cubana de Obstetricia y Ginecología 2 (2022): e1234.
7. American Society for Colposcopy and Cervical Pathology (ASCCP). “Risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors”. Journal of Lower Genital Tract Disease 2 (2019): 87-101.
8. “Technological innovations in Cuban public health: Artificial intelligence in cancer prevention” (2023).
9. García F., et al. “Artificial intelligence in cervical cancer screening: A new era in women's health”. International Journal of Gynecology and Obstetrics 3 (2021): 345-350.
10. Peralta L., et al. “Impact of artificial intelligence-assisted colposcopy on the detection of cervical lesions in Cuba”. Revista Habanera de Ciencias Médicas 4 (2020): e3456.