LETTERS

Best triage for ASCUS?

DR. COX REPLIES: I disagree with Dr. Lonky’s assumptions regarding the relative advantages of immediate colposcopy.

The unusually poor performance of HC2 in his study was restricted to CIN 2. Sensitivity for the more important and certain diagnosis of CIN 3 was 93.3% (14/15), consistent with the world literature.¹ The poor sensitivity that Dr. Lonky reports for the 6 cases of CIN 2 is not consistent with the multicenter findings in the ALTS trial, which had almost 20 times as many cases.² The 4.3% risk of CIN 2 or 3 reported by Lonky et al may be elevated by unusually poor assay performance, small numbers of the important (and well detected) CIN 3 histologic endpoint, and/or excessive emphasis on a few cases of less important, missed, or misclassified CIN 2.³ I propose that we de-emphasize CIN 2 for estimation of cancer risk. The risk of CIN 3 in oncogenic HPV-negative women with ASCUS in ALTS was less than 2%.