Summary of commentary from: Arbyn M, Martin-Hirsch P, Wentzensen N. HPV-based triage of women showing a cervical cytology result of borderline or mild dyskaryosis. BJOG 2010117:641–644.
In TOMBOLA, the sensitivity of hrHPV triage of borderline and mild dyskaryosis was 69.9% and 75.2% for detection of underlying CIN2+ (see research item for 21st March 2010). All other studies, including the ASCUS-LSIL Triage Study (ALTS) showed substantially higher sensitivities.
The differences may be explained by differences in HPV test sensitivity or differences in outcome assessment. Notable in TOMBOLA was the reliance on community based histology outcomes, compared with the more stringent approaches to histological assessment in other studies. Overcalling of CIN1 or squamous metaplasia as CIN2 or CIN3 may mave been an important contributor to the observed results.