Current and prior human papillomavirus (HPV) type and cytology results enable risk assessment for triage to colposcopy

The findings reported by Gustafson et al., that, among Danish women aged 45+, the rate of cervical intraepithelial neoplasia grade 2+ (CIN2+) was significantly higher (32.4%) in specimens from large loop excision of the transforma-tion zone (LLETZ) than in colposcopic biopsies (14.7%), is based on a thoughtful analysis. Patients were screened and managed using Danish guidelines, which included predominantly cytology- based screening during the period of study for most women, with human papillomavirus (HPV) testing only being offered to some women aged 30– 59 years, and to those older than 60 years. Although the HPV test used in the study (cobas®) automatically provides HPV16 and HPV18 genotyping, this information was not used for triage. In this study all women underwent colposcopy and diagnostic LLETZ at the same visit. Although the Danish guidelines recommend four blind quadrant biopsies for those without a visible lesion, endocervical curettage, which is included in many other guidelines (Perkins et al. J Low Genit Tract Dis 2020;24:102– 31), is not offered in Denmark. Although the diagnostic LLETZ picked up more CIN2+ than biopsy alone, as the authors have stated the majority of women would not have needed the LLETZ if their risk could have been better predicted.Can we use currently available technology and information to more effectively and safely triage patients to detect and treat high- grade lesions but avoid aggressive and costly treatment for the majority? Many studies have suggested knowledge of a