Colposcopy referral rate can be reduced by high risk human papillomavirus (HPV) triage in the management of low-grade cytological lesions

INTERVENTION: Group A: colposcopy with punch biopsy, pap smear and hrHPV test within 2 ‐ 3 months from referral pap smear. Group B: same procedures were performed with delayed schedule, within 6 months from referral. Group C: repeat pap smear and hrHPV test were performed first and colposcopy was offered to only women who were either hrHPV positive, or to those hrHPV negative women who had pap smear LSIL or worse. If women were diagnosed with CIN 2 or worse, she was treated with LLETZ. Also CIN1 lesions were treated with LLETZ among women older than 30 years. All women had pap smear and hrHPV test in 6 ‐ 12 months. CONDITION: Cervical intraepithelial neoplasia (CIN) ; Cancer ; In situ neoplasms PRIMARY OUTCOME: 1. Number of hrHPV positives in different study groups; 2. Number of high‐grade CIN; ; Assessed at primary colposcopy (Group A at 2 ‐ 3 months from referral pap smear, Group B within 6 months from referral pap smear and Group C at primary colposcopy, within 6 months from referral pap smear) among those women who had colposcopy. Also followed up with pap smear and hrHPV at 6 ‐ 12 months from primary colposcopy visit. SECONDARY OUTCOME: Number of low‐grade CIN (CIN1).; ; Assessed at primary colposcopy (Group A at 2 ‐ 3 months from referral pap smear, Group B within 6 months from referral pap smear and Group C at primary colposcopy, within 6 months from referral pap smear) among those women who had colposcopy. Also followed up with pap smear and hrHPV at 6 ‐ 12 months from primary colposcopy visit. INCLUSION CRITERIA: 1. Female patients aged 16 ‐ 72 years 2. Referred to colposcopy because of low‐grade pap smear abnormality (repeated atypical squamous cells of undetermined significance [ASCUS] or low‐grade squamous intraepithelial lesion [LSIL])