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Lee JK, Hong JH, Kang S, Kim DY, Kim BG, Kim SH, Kim YM, Kim JW, Kim JH, Kim TJ, Kim HJ, Kim HS, Ryu HS, Song JY, Ahn HS, Yoo CW, Yoon HK, Lee KH, Lee A, Lee Y, Lee IH, Lee JW, Lee TS, Lim MC, Chang SJ, Chung HH, Ju W, Joo HJ, Hur SY, Hong SR, Nam JH. Practice guidelines for the early detection of cervical cancer in Korea: Korean Society of Gynecologic Oncology and the Korean Society for Cytopathology 2012 edition. J Gynecol Oncol 2013; 24:186-203. [PMID: 23653837 PMCID: PMC3644696 DOI: 10.3802/jgo.2013.24.2.186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 11/30/2022] Open
Abstract
The consensus guideline development committee of Korean Society of Gynecologic Oncology was reconvened in March 2012. The committee consisted of 36 experts representing 12 university hospitals and professional organizations. The objective of this committee was to develop standardized guidelines for cervical cancer screening tests for Korean women and to distribute these guidelines to every clinician, eventually improving the quality of medical care. Since the establishment of the consensus guideline development committee, evidence-based guidelines have either been developed de novo considering specific Korean situations or by adaptation of preexisting consensus guidelines from other countries. Recommendations for cervical cancer screening tests, management of atypical squamous and glandular cells, and management of low-grade and high-grade squamous intraepithelial lesions were developed. Additionally, recommendations for human papillomavirus DNA testing and recommendations for adolescent and pregnant women with abnormal cervical screening test results were also included.
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Affiliation(s)
- Jae Kwan Lee
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae-Yeon Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Hoon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Man Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Jin Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Institute for Evidence-Based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Sun Kim
- Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Hee-Sug Ryu
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyeong Sik Ahn
- Institute for Evidence-Based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chong Woo Yoo
- Department of Pathology, Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hye-Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keun-Ho Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ahwon Lee
- Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yonghee Lee
- Department of Pathology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - In Ho Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Woong Ju
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Jae Joo
- Department of Pathology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Soo-Young Hur
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung-Ran Hong
- Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Joo-Hyun Nam
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Affiliation(s)
- Canadian Task Force on Preventive Health Care
- From the Departments of Family Medicine and Community Health Sciences (Dickinson), University of Calgary, Calgary, AB; the Public Health Agency of Canada (Connor Gorber, Tsakonas), Ottawa, Ont.; Department of Medicine (Tonelli), University of Alberta, Edmonton, AB; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, and Department of Medical Oncology and Hematology, Cancer Care Manitoba, Winnipeg, MB; Department of Family Medicine and Community Health and Epidemiology (Birtwhistle), Queen’s University, Kingston, Ont.; Department of Family Medicine (Shaw), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Joffres), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Canadian Partnership Against Cancer (Mai), Toronto, Ont.; and the Department of Pathology (McLachlin), Western University, London, Ont
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Insinga RP, Dasbach EJ, Elbasha EH. Epidemiologic natural history and clinical management of Human Papillomavirus (HPV) Disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model. BMC Infect Dis 2009; 9:119. [PMID: 19640281 PMCID: PMC2728100 DOI: 10.1186/1471-2334-9-119] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 07/29/2009] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Natural history models of human papillomavirus (HPV) infection and disease have been used in a number of policy evaluations of technologies to prevent and screen for HPV disease (e.g., cervical cancer, anogenital warts), sometimes with wide variation in values for epidemiologic and clinical inputs. The objectives of this study are to: (1) Provide an updated critical and systematic review of the evidence base to support epidemiologic and clinical modeling of key HPV disease-related parameters in the context of an HPV multi-type disease transmission model which we have applied within a U.S. population context; (2) Identify areas where additional studies are particularly needed. METHODS Consistent with our and other prior HPV natural history models, the literature review was confined to cervical disease and genital warts. Between October 2005 and January 2006, data were gathered from the published English language medical literature through a search of the PubMed database and references were examined from prior HPV natural history models and review papers. Study design and data quality from individual studies were compared and analyses meeting pre-defined criteria were selected. RESULTS Published data meeting review eligibility criteria were most plentiful for natural history parameters relating to the progression and regression of cervical intraepithelial neoplasia (CIN) without HPV typing, and data concerning the natural history of HPV disease due to specific HPV types were often lacking. Epidemiologic evidence to support age-dependency in the risk of progression and regression of HPV disease was found to be weak, and an alternative hypothesis concerning the time-dependence of transition rates is explored. No data were found on the duration of immunity following HPV infection. In the area of clinical management, data were observed to be lacking on the proportion of clinically manifest anogenital warts that are treated and the proportion of cervical cancer cases that become symptomatic by stage. CONCLUSION Knowledge of the natural history of HPV disease has been considerably enhanced over the past two decades, through the publication of an increasing number of relevant studies. However, considerable opportunity remains for advancing our understanding of HPV natural history and the quality of associated models, particularly with respect to examining HPV age- and type-specific outcomes, and acquired immunity following infection.
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Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
| | - Erik J Dasbach
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
| | - Elamin H Elbasha
- Department of Health Economic Statistics, Merck Research Laboratories, North Wales, PA, USA
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Elie C, Coste J. A methodological framework to distinguish spectrum effects from spectrum biases and to assess diagnostic and screening test accuracy for patient populations: application to the Papanicolaou cervical cancer smear test. BMC Med Res Methodol 2008; 8:7. [PMID: 18291032 PMCID: PMC2291065 DOI: 10.1186/1471-2288-8-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 02/21/2008] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A spectrum effect was defined as differences in the sensitivity or specificity of a diagnostic test according to the patient's characteristics or disease features. A spectrum effect can lead to a spectrum bias when subgroup variations in sensitivity or specificity also affect the likelihood ratios and thus post-test probabilities. We propose and illustrate a methodological framework to distinguish spectrum effects from spectrum biases. METHODS Data were collected for 1781 women having had a cervical smear test and colposcopy followed by biopsy if abnormalities were detected (the reference standard). Logistic models were constructed to evaluate both the sensitivity and specificity, and the likelihood ratios, of the test and to identify factors independently affecting the test's characteristics. RESULTS For both tests, human papillomavirus test, study setting and age affected sensitivity or specificity of the smear test (spectrum effect), but only human papillomavirus test and study setting modified the likelihood ratios (spectrum bias) for clinical reading, whereas only human papillomavirus test and age modified the likelihood ratios (spectrum bias) for "optimized" interpretation. CONCLUSION Fitting sensitivity, specificity and likelihood ratios simultaneously allows the identification of covariates that independently affect diagnostic or screening test results and distinguishes spectrum effect from spectrum bias. We recommend this approach for the development of new tests, and for reporting test accuracy for different patient populations.
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Affiliation(s)
- Caroline Elie
- Department of Biostatistics, Groupe hospitalier Cochin - Saint Vincent de Paul and Université Paris-Descartes, Paris, France.
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Abstract
The cytological test issue mostly from individual opportunistic or for some department from organized screening programme, must benefit of the same quality in all the procedures. Pathologists are very implicated in. The purpose of this document is to summarize cytopathologists' initiatives and to present their specific tools for that. The French association for quality assurance in pathology (AFAQAP) has been validated by HAS in March 2006 for EPP. Commission 1 of AFAQAP organized an annual voluntary test for diagnostic evaluation since 2000 with the adoption of new technologies (CD-rom, virtual digital slides), and in 2005 a test of Pap Smear reporting quality concerning TBS 2001 use. A referring evaluation on this theme is in press. Furthermore pathologists made tools are available to codify lesions they diagnose (ADICAP), to collect and to study data (FCRISAP), to standardize the histological and cytological reports (CRFS), to evaluate the procedures and structural requirements and techniques. Pathologists participate in the elaboration of national guidelines (ANAES 1998 et 2002, DGS 2006) and performance indicators with InVS. The cervix cancer screening programme must take in account and valorises the role of pathologists according to assessment of efficacy and evaluation of the screening.
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Affiliation(s)
- Marie-Cécile Vacher-Lavenu
- Service central d'Anatomie et de Cytologie Pathologiques, CHU Cochin-Port-Royal, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14.
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Cochand-Priollet B, Cartier I, de Cremoux P, Le Galès C, Ziol M, Molinié V, Petitjean A, Dosda A, Merea E, Biaggi A, Gouget I, Arkwright S, Vacher-Lavenu MC, Vielh P, Coste J. Cost-effectiveness of liquid-based cytology with or without hybrid-capture II HPV test compared with conventional Pap smears: A study by the French society of clinical cytology. Diagn Cytopathol 2005; 33:338-43. [PMID: 16240398 DOI: 10.1002/dc.20283] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many articles concerning conventional Pap smears, ThinPrep liquid-based cytology (LBC) and Hybrid-Capture II HPV test (HC II) have been published. This study, carried out by the French Society of Clinical Cytology, may be conspicuous for several reasons: it was financially independent; it compared the efficiency of the conventional Pap smear and LBC, of the conventional Pap smear and HC II, and included an economic study based on real costs; for all the women, a "gold standard" reference method, colposcopy, was available and biopsies were performed whenever a lesion was detected; The conventional Pap smear, the LBC (split-sample technique), the colposcopy, and the biopsies were done at the same time. This study included 2,585 women shared into two groups: a group A of a high-risk population, a group B of a screening population. The statistical analysis of the results showed that conventional Pap smears consistently had superior or equivalent sensitivity and specificity than LBC for the lesions at threshold CIN-I (Cervical Intraepithelial Neoplasia) or CIN-II or higher. It underlined the low specificity of the HC II. Finally, the LBC mean cost was never covered by the Social Security tariff.
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Affiliation(s)
- Béatrix Cochand-Priollet
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris 7, France
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Coste J, Cochand-Priollet B, de Cremoux P, Le Galès C, Cartier I, Molinié V, Labbé S, Vacher-Lavenu MC, Vielh P. Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening. BMJ 2003; 326:733. [PMID: 12676841 PMCID: PMC152633 DOI: 10.1136/bmj.326.7392.733] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the sensitivity, specificity, and interobserver reliability of conventional cervical smear tests, monolayer cytology, and human papillomavirus testing for screening for cervical cancer. DESIGN Cross sectional study in which the three techniques were performed simultaneously with a reference standard (colposcopy and histology). SETTING Public university and private practices in France, with complete independence from the suppliers. PARTICIPANTS 828 women referred for colposcopy because of previously detected cytological abnormalities and 1757 women attending for routine smears. MAIN OUTCOME MEASURES Clinical readings and optimised interpretation (two blind readings followed, if necessary, by consensus). Sensitivity, specificity, and weighted kappa computed for various thresholds of abnormalities. RESULTS Conventional cervical smear tests were more often satisfactory (91% v 87%) according to the Bethesda system, more reliable (weighted kappa 0.70 v 0.57), and had consistently better sensitivity and specificity than monolayer cytology. These findings applied to clinical readings and optimised interpretations, low and high grade lesions, and populations with low and high incidence of abnormalities. Human papillomavirus testing associated with monolayer cytology, whether systematic or for atypical cells of undetermined significance, performed no better than conventional smear tests. CONCLUSIONS Monolayer cytology is less reliable and more likely to give false positive and false negative results than conventional cervical smear tests for screening for cervical cancer.
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Affiliation(s)
- Joël Coste
- Département de Biostatistique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Cochin-Port Royal, Université Paris V, Paris, France.
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Abstract
Survival rates for cancer of the uterine cervix have improved over the last 40 years largely because of the impact of screening measures such as the Pap smear. The ability to screen and treat women for preinvasive disease, cervical dysplasia, is the key factor leading to the reduction in the incidence of invasive cervical cancer. More recently, the ability to test women for the causative agent, the human papilloma virus, has emerged as a potential screening tool. New research has focused on new technologies for Pap smear screening such as thin layer technology, the appropriate intervals for screening, and the appropriate methods of incorporation of human papilloma virus testing into the screening protocols. Reviews of published studies evaluating the efficacy of new technologies suggest that there is still insufficient information to confirm improved outcome; however, results to date suggest that thin layer Pap smear technology may improve sensitivity in the detection of cervical dysplasia. Automated rescreening technologies in use may decrease the number of false-negative Pap smears and are an option for laboratories. Various professional groups and countries have differing recommendations on the interval for screening, primarily on the basis of cost-effectiveness. Some of the most important new information this year regarding cervical cancer screening includes the new Bethesda System for the reporting of Pap smears and the new guidelines for the management of the abnormal Pap smear by the American Society of Colposcopy and Cervical Pathology. These guidelines incorporate human papilloma virus testing based on a multicenter trial documenting its efficacy in the triage of women with atypical squamous cells on Pap smear. These recommendations are reviewed along with the current literature on cervical cancer screening.
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Affiliation(s)
- Anne T O'Meara
- Keck School of Medicine, University of California, Los Angeles 90033, USA.
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