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Karisani N, Aminimoghaddam S, Kashanian M, Baradaran HR, Moradi Y. Diagnostic accuracy for alternative cervical cancer screening strategies: A systematic review and meta-analysis. Health Care Women Int 2022; 45:323-362. [PMID: 35084291 DOI: 10.1080/07399332.2021.1998059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 10/21/2021] [Indexed: 12/26/2022]
Abstract
We performed a systematic review and meta-analysis to evaluate the accuracy of screening cervical cancer tests as alternative standalone methods. The combined estimates of sensitivity of visual inspection with acetic acid, visual inspection with lugol's iodine, conventional pap smear, liquid-based cytology, High risk HPV testing by clinician, High risk HPV testing by self- sampling, cervicography were 64%, 80%, 55%, 70%, 70% and 67% respectively; the combine values of specificity of these screening strategies were 88%, 88%, 96%, 59%, 94%, and 95% respectively. Our findings draw attention to an attractive opinion to facilitate the collection of specimens for DNA HPV by patients in settings where they don't have access to a regular screening programs.
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Affiliation(s)
- Narmin Karisani
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Soheila Aminimoghaddam
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Maryam Kashanian
- Gynecologist Oncologist, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, Aberdeen, Scotland
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Peace SM, Jennings AJ. Prevalence of high-grade dysplasia in cytology-negative, HPV-positive cervical cancer screening. Arch Gynecol Obstet 2021; 305:87-93. [DOI: 10.1007/s00404-021-06208-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
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Kong TW, Kim M, Kim YH, Kim YB, Kim J, Kim JW, Park MH, Park JH, Rhee JH, Lim MC, Hong JS. High-risk human papillomavirus testing as a primary screening for cervical cancer: position statement by the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology. J Gynecol Oncol 2019; 31:e31. [PMID: 31789003 PMCID: PMC6918897 DOI: 10.3802/jgo.2020.31.e31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 01/08/2023] Open
Abstract
Based on emerging data and current knowledge regarding high-risk human papillomavirus (hrHPV) testing as a primary screening for cervical cancer, the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology support the following scientific facts: • Compared to cytology, hrHPV screening has higher sensitivity and detects more cases of high-grade cervical intraepithelial neoplasia. • Qualified hrHPV testing can be considered as an alternative primary screening for cervical cancer to the current cytology method. • The starting age of primary hrHPV screening should not be before 25 years because of possible overtreatment in this age, which has a high human papillomavirus (HPV) prevalence but rarely progresses to cancer. The screening interval should be no sooner than every 3 years and no longer than every 5 years. • Before the introduction of hrHPV screening in Korea, research into comparative effectiveness of primary hrHPV screening for cervical cancer should be conducted to determine the appropriate HPV assay, starting age, and screening interval.
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Affiliation(s)
- Tae Wook Kong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
| | - Young Han Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jayeon Kim
- Department of Obstetrics and Gynecology, CHA Seoul Fertility Center, CHA University School of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Hye Park
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Joo Hyun Park
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Ho Rhee
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | - Myong Cheol Lim
- Cancer Healthcare Research Branch and Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Joon Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
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Zhu Y, Wang Y, Hirschhorn J, Welsh KJ, Zhao Z, Davis MR, Feldman S. Human Papillomavirus and Its Testing Assays, Cervical Cancer Screening, and Vaccination. Adv Clin Chem 2017. [PMID: 28629588 DOI: 10.1016/bs.acc.2017.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Human papillomavirus (HPV) was found to be the causative agent for cervical cancer in the 1980s with almost 100% of cervical cancer cases testing positive for HPV. Since then, many studies have been conducted to elucidate the molecular basis of HPV, the mechanisms of carcinogenesis of the virus, and the risk factors for HPV infection. Traditionally, the Papanicolaou test was the primary screening method for cervical cancer. Because of the discovery and evolving understanding of the role of HPV in cervical dysplasia, HPV testing has been recommended as a new method for cervical cancer screening by major professional organizations including the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology. In order to detect HPV infections, many sensitive and specific HPV assays have been developed and used clinically. Different HPV assays with various principles have shown their unique advantages and limitations. In response to a clear causative relationship between high-risk HPV and cervical cancer, HPV vaccines have been developed which utilize virus-like particles to create an antibody response for the prevention of HPV infection. The vaccines have been shown in long-term follow-up studies to be effective for up to 8 years; however, how this may impact screening for vaccinated women remains uncertain. In this chapter, we will review the molecular basis of HPV, its pathogenesis, and the epidemiology of HPV infection and associated cervical cancer, discuss the methods of currently available HPV testing assays as well as recent guidelines for HPV screening, and introduce HPV vaccines as well as their impact on cervical cancer screening and treatments.
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Affiliation(s)
- Yusheng Zhu
- Pennsylvania State University Hershey Medical Center, Hershey, PA, United States.
| | - Yun Wang
- Medical University of South Carolina, Charleston, SC, United States
| | - Julie Hirschhorn
- Pennsylvania State University Hershey Medical Center, Hershey, PA, United States
| | - Kerry J Welsh
- National Institute of Health, Bethesda, MD, United States
| | - Zhen Zhao
- National Institute of Health, Bethesda, MD, United States
| | - Michelle R Davis
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah Feldman
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Zhao J, Guo Z, Wang Q, Si T, Pei S, Wang C, Qu H, Zhong J, Ma Y, Nie C, Zhang D. Human papillomavirus genotypes associated with cervical precancerous lesions and cancer in the highest area of cervical cancer mortality, Longnan, China. Infect Agent Cancer 2017; 12:8. [PMID: 28138337 PMCID: PMC5264338 DOI: 10.1186/s13027-017-0116-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/04/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The mortality of cervical cancer in Longnan is as high as 39/10 million, ranking first in China. METHODS Between 2012 to 2016, 329 samples with cervicitis, cervical intraepithelial neoplasia grade 1 to 3 (CINI to III), and invasive squamous cell carcinoma (SCC) were collected. HPV genotypes were examined with a validated kit for 23 different HPV subtypes. RESULTS Compared to cervicitis, the HPV positivity is significantly higher in CINI, CIN II/III, and SCC (38.60%, 74.60%, 87.50% and 89.05%, P < 0.001) and the positivity is also higher in SCC compared to CINI (P < 0.01). The most frequently detected genotypes were HPV16 in cervicitis, HPV16, 58 and 52 in CINI and CIN II/III, and HPV16, 58 and 18 in SCC groups. HPV16 positivity in cervicitis, CINI, CIN II/III, and SCC patients were 45.46%, 46.81%, 60.32% and 78.69%, respectively. Compared to cervicitis and CINI, the odds ratios (OR) for SCC in HPV16 positive patients were 2.96 (95% confidence interval [CI]: 1.09-8.00, P < 0.05) and 4.20 (95% confidence interval [CI]: 2.05-8.61, P < 0.001), respectively. In addition, the multiple infections in cervicitis, CINI, CINII/III and SCC group are 9.09%, 27.66%, 26.98% and 25.41% and HPV16 + 58 was the most common combinations. CONCLUSION These findings highlight the key role of HPV16, 58, 52 and 18 in the development of CIN and SCC in Longnan women and a fully aware of regional differences in HPV genotype distribution are tasks for cervical cancer control and prevention.
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Affiliation(s)
- Jin Zhao
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
| | - Zhong Guo
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
| | - Qiang Wang
- No.1 Hospital of Longnan City, Longnan, 746000 People’s Republic of China
| | - Tianbin Si
- Gansu Provincial Cancer Hospital, Lanzhou, 730050 People’s Republic of China
| | - Shuyan Pei
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
| | - Chenjing Wang
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
| | - Hongmei Qu
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
| | - Jianbin Zhong
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
| | - Ying Ma
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
| | - Cong Nie
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
| | - Dan Zhang
- Medical College of Northwest University for Nationalities, Lanzhou, 730030 People’s Republic of China
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Doxtader EE, Brainard JA, Underwood D, Chute DJ. Knowledge of the HPV status biases cytotechnologists' interpretation of Pap tests originally diagnosed as negative for intraepithelial lesion or malignancy. Cancer Cytopathol 2016; 125:60-69. [DOI: 10.1002/cncy.21783] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Dawn Underwood
- Department of Pathology; Cleveland Clinic; Cleveland Ohio
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Hui Y, Hansen K, Murthy J, Chau D, Sung CJ, Quddus MR. Relevance of the Pap Test: A Report of HPV-DNA Test-Negative High-Grade Squamous Intraepithelial Lesions of the Female Lower Genital Tract. Acta Cytol 2016; 60:445-450. [PMID: 27578366 DOI: 10.1159/000448470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/14/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A vast majority of cervicovaginal intraepithelial lesions are caused by high-risk human papillomaviruses (HPVs). The Pap test has been the sole method used for the screening of cervicovaginal squamous intraepithelial lesions (SIL). Recently, the FDA approved an HPV-DNA assay as a method of primary screening. We report on a series of FDA-approved HPV-DNA test-negative SIL with HPV genotyping, using an alternative method on the corresponding surgical biopsy specimens. STUDY DESIGN A retrospective review identified cytology-positive HPV-negative cases over a 15-month period at a tertiary care gynecologic oncology institution. Corresponding biopsies were reviewed and genotyped for high-risk HPVs. RESULTS Of the 18,200 total cases, 17 patients meeting the study criteria were selected with 27 surgical specimens corresponding to their cytologic diagnoses. Four patients with high-grade lesions were identified, 3 of whom (75%) were positive for HPV. One of these 4 patients (25%) showed high-grade SIL on biopsies from 4 separate sites in the cervix and vagina. Multiviral HPV infections were frequent. CONCLUSIONS We discuss the relevance of cotesting for screening cervical SILs and emphasize that false-negative results are possible with the FDA-approved HPV screening assay, also in patients with high-grade SIL. These cases may be detectable by cytologic examination and this suggests that the Pap test remains an important diagnostic tool.
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Affiliation(s)
- Yiang Hui
- Department of Pathology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, R.I., USA
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Gu Y, Ma C, Zou J, Zhu Y, Yang R, Xu Y, Zhang Y. Prevalence characteristics of high-risk human papillomaviruses in women living in Shanghai with cervical precancerous lesions and cancer. Oncotarget 2016; 7:24656-63. [PMID: 27013587 PMCID: PMC5029731 DOI: 10.18632/oncotarget.8262] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/04/2016] [Indexed: 11/25/2022] Open
Abstract
A complete understanding of the natural history of infection with high-risk human papillomaviruses (HPVs) in cervical cancer requires data from regional and ethnic studies. The prevalence of high-risk HPVs was evaluated retrospectively in 2040 patients with cervicitis, 239 with cervical intraepithelial neoplasia grade 1 (CIN1), 242 with CIN2/3, and 42 patients with invasive squamous cell carcinoma (SCC) based on data from patients who visited our hospital between May 2013 and May 2015. The rates of high-risk HPV infection in patients with cervicitis, CIN1, CIN2/3, and invasive SCC were 40.8%, 74.9%, 70.2%, and 83.3%, respectively. The three most dominant HPV genotypes were HPV16, 58, and 52. HPV16 and HPV58 positivity in cervicitis, CIN1, CIN2/3, and SCC patients were 20.9% and 16.4%, 19.0% and 20.1%, 44.1% and 23.5%, and 60.0% and 31.4%, respectively. Compared to cervicitis, the odds ratios (ORs) for CIN2/3 in HPV16- and HPV58-positive patients were 2.99 (95% confidence interval [CI]: 1.32-4.33) and 1.56 (1.11-3.21), respectively; for SCC, the corresponding values were 5.68 (2.31-7.893) and 2.33 (1.41-3.87). Further identifying of carcinogenic HPVs and a fully aware of regional differences in HPV genotype distribution are tasks of top priority for cervical cancer control and prevention.
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Affiliation(s)
- Ying Gu
- Department of Gynaecology and Obstetrics, The Seventh People's Hospital of Shanghai University of TCM, The New Pudong District, Shanghai 200137, China
| | - Chenyun Ma
- Clinical Laboratory, The Seventh People's Hospital of Shanghai University of TCM, The New Pudong District, Shanghai 200137, China
| | - Jue Zou
- Department of Pathology, The Seventh People's Hospital of Shanghai University of TCM, The New Pudong District, Shanghai 200137, China
| | - Yi Zhu
- Department of Gynaecology and Obstetrics, The Seventh People's Hospital of Shanghai University of TCM, The New Pudong District, Shanghai 200137, China
| | - Rong Yang
- Department of Gynaecology and Obstetrics, The Seventh People's Hospital of Shanghai University of TCM, The New Pudong District, Shanghai 200137, China
| | - Yan Xu
- Department of Gynaecology and Obstetrics, The Seventh People's Hospital of Shanghai University of TCM, The New Pudong District, Shanghai 200137, China
| | - Yu Zhang
- Department of Gynaecology and Obstetrics, The Seventh People's Hospital of Shanghai University of TCM, The New Pudong District, Shanghai 200137, China
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