Question: 1 2 3 4 5 6 7 8

1. Which of the following is true about HPV testing? Your peers GP Panel
HPV testing is not indicated in women under 30 years 91%
Not indicated for post menopausual women 5%
All LBC specimens will now also be automatically tested for HPV 9%
Is indicated for all women older than 30 years 17%

Question 1 comments

The correct answer is that routine HPV testing is not indicated in women under 30 because of the high prevalence of HPV in this age group. However, regardless of age it may be required for the ongoing management of women who have been treated for a high-grade lesion, and for women with discordant cytology and colposcopy results. There is no indication to test all women over 30 years.

A number of respondents thought that all LBC specimens would automatically be tested for HPV. This only occurs when a woman older than 30 years is identified by the laboratory to have low grade changes in her cervical cytology.

2. What are considered the main advantages of moving to liquid based cytology? Your peers GP Panel
Reduction in number of unsatisfactory smears 99%
Quicker laboratory turnaround time 81%
Ability to use same sample for HPV 91%
Collection devices cause less trauma to the cervix 4%

Question 2 comments

The main advantages of moving to LBC are:

  • A reduction in number of unsatisfactory smears
  • Quicker lab turnaround time
  • The ability to use same sample for HPV

The panel felt the main practical benefit to general practice of laboratories adopting LBC, was the ability to use the same specimen for HPV testing if required. However, it was noted that the change to LBC in itself is unlikely to reduce the incidence of or mortality from cervical cancer in New Zealand. The most important factor in the short to medium term is improving screening coverage. In the long term, vaccination against HPV infection should reduce cervical cancer incidence and mortality.

3. Which of these collection devices are recommended for use with liquid based cytology? Your peers GP Panel
Wooden spatula + cytobrush (in combination) 4%
Plastic spatula + cytobrush (in combination) 91%
Cytobrush (on its own) 11%
Cervibroom (on its own) 92%

Question 3 comments

The plastic spatula + cytobrush (in combination) or cervibroom (on its own) are the collection devices recommended for use with LBC. Neither the cytobrush nor plastic spatula on their own are recommended and wooden spatulas are unsuitable for use with LBC. On a practical note the panel said they tended to use just the cervibroom, since it meant only one sample had to be collected.

4. For young sexually active women, which of the following ranges best estimates the rate of acquisition of HPV infection per year? Your peers GP Panel
>80% 1%
60-80% 7%
40-60% 2%
20-40% 7%
<20% 84%

Question 4 comments

HPV is one of the most common sexually transmitted infections in the world with 15-20% of all young sexually active women acquiring the infection per year.

5.Which of the following is true about the liquid based cytology systems used in New Zealand? Your peers GP Panel
Is at least as sensitive as conventional cervical cytology 90%
Is more prone to interference from blood and cervical mucus 1%
Offers some advantage for recurrent inflammatory smears 91%
Collection devices are interchangeable between systems 5%

Question 5 comments

LBC is at least as sensitive as conventional cervical cytology and more sensitive for women with recurrent inflammatory smears. LBC can reduce the amount of obscuring blood and inflammation in cervical samples compared to conventional smears, however routine screening smears should still be avoided at the time of menses.

Note: Collection devices are not interchangeable between the Surepath and Thinprep systems.

6. Which of the following is true about collection of the specimen for cervical cytology? Your peers GP Panel
The ideal sample consists of all squamous cells 18%
For an abnormal looking cervix, it is important to use LBC to exclude the presence of precancerous lesions 12%
Cytobrush is indicated where previously no endocervical cells were obtained 90%
Cervibroom is indicated for post menopausal women 11%

Question 6 comments

There was some concern expressed at the high proportion of respondents who answered this question incorrectly. All cervical smears should contain some endocervical cells to indicate that the squamocolumnar junction has been sampled. Squamous cell carcinoma begins as cervical intraepithelial neoplasia (CIN) at the squamocolumnar junction which is why it is important to sample this site to detect early changes. If a previous smear is reported as containing no endocervical cells, a cytobrush is recommended for the repeat smear.

It is important that if the cervix looks abnormal or there are abnormal symptoms, the women should be referred for colposcopy, irrespective of the cytology report. If the cervix looks abnormal due to known benign changes (eg nabothian cysts) referral for colposcopy may not be required.

7. What follow up is indicated for a women over 30 years found to have a low grade lesion? Your peers GP Panel
HPV testing is indicated 94%
Should be referred automatically for colpolscopy 13%
Watchful waiting and retest cervical cytology in 12 months 29%
Confirm with conventional Pap smear <1%

Question 7 comments

Almost all respondents correctly answered that HPV testing is indicated for all women > 30 years with low grade abnormalities. This is generally initiated by the laboratory. Referral for colposcopy should be made following a positive HPV result and watchful waiting would be appropriate following a negative HPV result, with repeat HPV testing at 12 months.

8. Which of the following areas of management are most likely to benefit from the inclusion of HPV tests? Your peers GP Panel
The triage of women 30 years and over with low grade changes 96%
The follow-up of women who have been treated for a high-grade lesion 88%
Post colposcopy management of women with discordant results 89%
Follow-up of a woman under 30 years with low grade changes on first smear 8%

Question 8 comments

HPV results will be of benefit when managing women who:

  • Are 30 years and over with low grade changes
  • have been treated for a high-grade lesion
  • have discordant colposcopy and cervical cytology results

HPV testing will hopefully reduce the number of patients who receive unnecessary specialist referral and colposcopy. HPV testing is not indicated for women less than 30 years with low grade changes. Follow-up will depend on previous patient history.

Other comments on cervical screening

Some additional questions arose out the panel discussion and these were put to pathologist Peter Fitzgerald for his comment.

Who is responsible for requesting HPV testing?

The laboratory is responsible for performing HPV testing in women over the age of 30 years with ASCUS/LSIL cytology. When HPV testing is used as proof of cure, the smear taker is responsible for gaining patient consent and requesting the test. And when there is discordance between laboratory results and colposcopy, the colposcopists are responsible for requesting HPV testing.

How long is the LBC sample stored for, and can HPV testing be requested at a later date?

The vials may be used for HPV testing for several months after the sample is taken. However for most laboratories storage beyond about 4 weeks is not practical.

Do the laboratories perform HPV testing if it is requested as part of an STI screen?

HPV is not an appropriate test for STI screening, as it is only indicated for triage in conjunction with cervical cytology. Current HPV testing in New Zealand is only designed for use within an organised cervical screening program.


GP Review Panel:

  • Dr Janine Bailey, Motueka
  • Dr Suzie Lawless, Dunedin
  • Dr Neil Whittaker, Nelson
  • Dr Marie Neylon, Dunedin


bpacnz would like to thank the GP review panel and Dr Peter Fitzgerald for their expertise and guidance on the development of this quiz feedback.