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Malagón T, Franco EL, Tejada R, Vaccarella S. Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination. Nat Rev Clin Oncol 2024; 21:522-538. [PMID: 38760499 DOI: 10.1038/s41571-024-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.
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Affiliation(s)
- Talía Malagón
- Department of Oncology, McGill University, Montréal, Quebec, Canada.
- St Mary's Research Centre, Montréal West Island CIUSSS, Montréal, Quebec, Canada.
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada.
| | - Eduardo L Franco
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Romina Tejada
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
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2
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Chung PYJ, Dhillon SK, Cortoos S, Hamerlinck H, Pereira R, Padalko E, Vanden Broeck D, Arbyn M. Evaluation of the Allplex HPV assay's adherence to international guidelines for cervical cancer screening in clinician-collected samples. Microbiol Spectr 2024:e0033224. [PMID: 38916332 DOI: 10.1128/spectrum.00332-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/02/2024] [Indexed: 06/26/2024] Open
Abstract
Clinically validated human papillomavirus (HPV) assays are crucial in cervical cancer screening. In this study, we evaluated the Allplex HPV HR Detection assay (Seegene, SouthKorea) for its clinical accuracy and reproducibility according to the international criteria, using the RealTime High Risk HPV m2000 assay (Abbott, USA) as standard comparator. The Allplex HPV HR assay exhibits significant non-inferior sensitivity to detect cervical intraepithelial neoplasia grade (CIN) 2 or worse (CIN2+) with a ratio of 1.00 (95% CI: 0.97-1.03, P = 0.006), insignificant non-inferior sensitivity to detect CIN3+ with a ratio of 1.00 (95% CI: 0.88-1.13, P = 0.098), and non-inferior specificity to exclude CIN2+ with a ratio of 0.99 (95% CI: 0.99-1.00, P < 0.001) compared to the standard comparator. In addition, the assay shows an excellent reproducibility within the same laboratory [96.5% (95% CI: 94.6-97.9) with a kappa value of 0.91 (95% CI: 0.87-0.95)] and between laboratories [96.7% (95% CI: 94.8-98.0) with a kappa value of 0.91 (95% CI: 0.87-0.95)] for overall high-risk HPV positivity as well as for each individual HPV type. Pooling our study data with those of another independent study supports the consistency of our findings. We conclude that both the clinical accuracy to detect cervical precancer and the reproducibility of Allplex HPV HR Detection assay fulfill the international validation criteria of use in cervical cancer screening.IMPORTANCEThe clinical validation of human papillomavirus (HPV) assays in accordance with well-established international guidelines is crucial to ensure that only validated assays are used in the context of screening (Meijer et al., Int J Cancer, 2009). The guidelines, developed by an international consortium, require that a novel HPV assay has non-inferior accuracy against a standard comparator test for the detection of cervical intraepithelial neoplasia grade (CIN) 2 or worse (CIN2+). Additionally, a new HPV assay should meet specific criteria for both intra- and inter-laboratory reproducibility to ensure the assay consistently exhibits technical precision and robust performance. Pooling our study data with those of another independent study supports the consistency of our findings. In conclusion, both the clinical accuracy to detect cervical precancer and the reproducibility of Allplex HPV HR Detection assay fulfill the international validation criteria of use in cervical cancer screening.
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Affiliation(s)
- Pui Yan Jenny Chung
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Sharonjit K Dhillon
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Selina Cortoos
- Department of Molecular Diagnostics, Sonic Healthcare Benelux - AML, Antwerp, Belgium
| | - Hannelore Hamerlinck
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostics Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Rita Pereira
- Department of Molecular Diagnostics, Sonic Healthcare Benelux - AML, Antwerp, Belgium
| | - Elizaveta Padalko
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostics Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Davy Vanden Broeck
- Department of Molecular Diagnostics, Sonic Healthcare Benelux - AML, Antwerp, Belgium
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- National Reference Centre for HPV, Brussels, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Shanaube K, Ndubani R, Kelly H, Webb E, Mayaud P, Lamberti O, Fitzpatrick J, Kasese N, Sturt A, Van Lieshout L, Van Dam G, Corstjens PLAM, Kosloff B, Bond V, Hayes R, Terris-Prestholt F, Webster B, Vwalika B, Hansingo I, Ayles H, Bustinduy AL. Zipime-Weka-Schista study protocol: a longitudinal cohort study and economic evaluation of an integrated home-based approach for genital multipathogen screening in women, including female genital schistosomiasis, human papillomavirus, Trichomonas and HIV in Zambia. BMJ Open 2024; 14:e080395. [PMID: 38858160 PMCID: PMC11168163 DOI: 10.1136/bmjopen-2023-080395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Multiplathogen home-based self-sampling offers an opportunity to increase access to screening and treatment in endemic settings with high coinfection prevalence of sexually transmitted (HIV, Trichomonas vaginalis (Tv), human papillomavirus (HPV)) and non-sexually transmitted pathogens (Schistosoma haematobium (Sh)). Chronic coinfections may lead to disability (female genital schistosomiasis) and death (cervical cancer). The Zipime-Weka-Schista (Do self-testing sister!) study aims to evaluate the validity, acceptability, uptake, impact and cost-effectiveness of multipathogen self-sampling for genital infections among women in Zambia. METHODS AND ANALYSIS This is a longitudinal cohort study aiming to enrol 2500 non-pregnant, sexually active and non-menstruating women aged 15-50 years from two districts in Zambia with 2-year follow-up. During home visits, community health workers offer HIV and Tv self-testing and cervicovaginal self-swabs for (1) HPV by GeneXpert and, (2) Sh DNA detection by conventional (PCR)and isothermal (recombinase polymerase assay) molecular methods. Schistosoma ova and circulating anodic antigen are detected in urine. At a clinic follow-up, midwives perform the same procedures and obtain hand-held colposcopic images. High-risk HPV positive women are referred for a two-quadrant cervical biopsy according to age and HIV status. A cost-effectiveness analysis is conducted in parallel. ETHICS AND DISSEMINATION The University of Zambia Biomedical Research Ethics Committee (UNZABREC) (reference: 1858-2021), the London School of Hygiene and Tropical Medicine (reference: 25258), Ministry of Health and local superintendents approved the study in September 2021.Written informed consent was obtained from all participants prior to enrolment. Identifiable data collected are stored securely and their confidentiality is protected in accordance with the Data Protection Act 1998.
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Affiliation(s)
| | | | - Helen Kelly
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Webb
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Olimpia Lamberti
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Amy Sturt
- Department of Infectious Diseases, Veterans Affairs Health Care System, Palo Alto, UK
| | | | - Govert Van Dam
- Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Barry Kosloff
- Zambart, Lusaka, Zambia
- Longhorn Vaccines & Diagnostics, Bethesda, Maryland, USA
| | - Virginia Bond
- Zambart, Lusaka, Zambia
- London School of Hygiene & Tropical Medicine Centre of Global Change and Health, London, UK
| | - Richard Hayes
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Bellington Vwalika
- Department of Obstetrics & Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Isaiah Hansingo
- Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Poljak M, Oštrbenk Valenčak A, Cuschieri K, Bohinc KB, Arbyn M. 2023 global inventory of commercial molecular tests for human papillomaviruses (HPV). J Clin Virol 2024; 172:105671. [PMID: 38518504 DOI: 10.1016/j.jcv.2024.105671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
To suit the needs of the human papillomaviruses (HPV) community comprehensively, a range of commercial HPV tests with different performance characteristics are required. Four periodic inventories of commercial HPV molecular tests present in the global market were published previously in 2010, 2012, 2015 and 2020. For the fifth inventory, data were retrieved from internal files and a detailed search using the main bibliographic databases as well as general internet search without period or language restrictions was performed in December 2023. At least 264 distinct HPV tests (and 511 test variants) were available globally in December 2023. A small 2020-2023 net increase in total numbers was observed, but with a strong introduction/withdrawal dynamic: 86 new distinct HPV tests (and 141 variants) were introduced and 76 tests (and 55 variants) were withdrawn from the market in the last four years. Although quality improvement of some tests was recorded, half of all HPV tests are still without a single peer-reviewed publication, and 79 % of tests are without published evidence that demonstrate performance characteristics are in line with requirements agreed in the HPV community. Only a relatively small pool of tests fulfill the operational/performance characteristics required to meet the global cervical cancer screening challenge. Although clinical and analytical performance characteristics of many commercial HPV tests are largely unknown, such tests are used worldwide in daily clinical practice and research, with potentially deleterious consequences. Due to this long-lasting unfavorable situation, significant scope for improvement persists for both manufacturers of HPV tests and the HPV community.
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Affiliation(s)
- Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Anja Oštrbenk Valenčak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Klara B Bohinc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marc Arbyn
- Belgian Cancer Centre / Unit of Cancer Epidemiology, Sciensano, Brussels, Belgium
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Fobian SF, Mei X, Crezee J, Snoek BC, Steenbergen RDM, Hu J, Ten Hagen TLM, Vermeulen L, Stalpers LJA, Oei AL. Increased human papillomavirus viral load is correlated to higher severity of cervical disease and poorer clinical outcome: A systematic review. J Med Virol 2024; 96:e29741. [PMID: 38922964 DOI: 10.1002/jmv.29741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 05/14/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
Cervical cancer is the fourth most common cancer in women worldwide and is caused by persistent infection with high-risk types of human papillomavirus (HPV). HPV viral load, the amount of HPV DNA in a sample, has been suggested to correlate with cervical disease severity, and with clinical outcome of cervical cancer. In this systematic review, we searched three databases (EMBASE, PubMed, Web of Science) to examine the current evidence on the association between HPV viral load in cervical samples and disease severity, as well as clinical outcome. After exclusion of articles not on HPV, cervical cancer, or containing clinical outcomes, 85 original studies involving 173 746 women were included. The vast majority (73/85 = 85.9%) reported that a higher viral load was correlated with higher disease severity or worse clinical outcome. Several studies reported either no correlation (3/85 = 3.5%), or the opposite correlation (9/85 = 10.6%); possible reasons being different categorization of HPV viral load levels, or the use of specific sampling methods. Despite variations in study design and populations, the above findings suggest that HPV viral load is correlated to clinical outcome, and may become an important biomarker for treatment selection and response monitoring for cervical cancer.
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Affiliation(s)
- Seth-Frerich Fobian
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Laboratory for Experimental Oncology and Radiobiology (LEXOR), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Precision Medicine in Oncology (PrMiO), Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Xionge Mei
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Laboratory for Experimental Oncology and Radiobiology (LEXOR), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Barbara C Snoek
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Laboratory for Experimental Oncology and Radiobiology (LEXOR), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | | | - Jiafen Hu
- Jake Gittlen Laboratories of Cancer Research, Department of Pathology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Timo L M Ten Hagen
- Precision Medicine in Oncology (PrMiO), Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Louis Vermeulen
- Center for Experimental and Molecular Medicine (CEMM), Laboratory for Experimental Oncology and Radiobiology (LEXOR), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Laboratory for Experimental Oncology and Radiobiology (LEXOR), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Laboratory for Experimental Oncology and Radiobiology (LEXOR), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
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Hermansson RS, Lillsunde-Larsson G, Helenius G, Karlsson MG, Kaliff M, Olovsson M, Lindström AK. History of HPV in HPV-positive elderly women. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100297. [PMID: 38496379 PMCID: PMC10944087 DOI: 10.1016/j.eurox.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Background The aim of this study was to examine the natural course of HPV infection in women of 60 years and older who were HPV positive at inclusion, and any association between HPV positivity in historical samples and dysplasia outcome. Methods Eighty-nine women aged 60-82 years, who tested positive for HPV between 2012 and 2016 were included. Sampling for cytology and/or histology was also performed. HPV genotyping was carried out on archived material back to 1999. Results Of the 89 HPV-positive women 16 had HSIL, 34 had LSIL and 39 were benign at inclusion. Of the women with HSIL, 50.0% had the same HPV type in the archive samples, 12.5% had another type, and 37.5% were HPV negative. Among the 34 women with LSIL, 47.1% had the same HPV type in archive samples, 5.8% had another type, and 47.1% were HPV negative. Of the 39 women without dysplasia at inclusion, 25.6% had the same HPV type in archive samples, 5.1% had another HPV type and 69.2% were HPV negative. Conclusion Surprisingly few of the elderly women thus seem to have a history with the same or any HPV infection the years before being diagnosed with an HPV infection and dysplasia. The significance of an HPV infection for dysplasia development in elderly women is still not fully understood.
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Affiliation(s)
- Ruth S. Hermansson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriella Lillsunde-Larsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Gisela Helenius
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats G. Karlsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Malin Kaliff
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Matts Olovsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Annika K. Lindström
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Adams RA, Botha MH. Cervical cancer prevention in Southern Africa: A review of national cervical cancer screening guidelines in the Southern African development community. J Cancer Policy 2024; 40:100477. [PMID: 38593950 DOI: 10.1016/j.jcpo.2024.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Cervical cancer poses a significant burden, particularly in low-and-middle income countries (LMIC) with limited access to healthcare. High-income countries have made progress in prevention, while LMIC face unacceptably high incidence and mortality rates, often lacking official screening recommendations. We analysed the presence and content of cervical cancer screening guidelines for the secondary prevention of cervical cancer in the Southern African Development Community (SADC) and compared it to the current World Health Organization (WHO) guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. METHODS A review of national cervical cancer guidelines across the SADC region was conducted. Data was obtained from government websites, international cancer control platforms, and WHO resources. Search terms included "cervical cancer" and "cervical cancer control guidelines", amongst others. There were no limitations on publication years, and the most recent versions of the guidelines were analysed, regardless of language. Each guideline was assessed for specific screening and treatment recommendations, in relation to the current WHO guidelines. Points were assigned for each data element. RESULTS While most countries contributed data to this analysis there was a notable absence of adherence to the WHO guidelines. The most common screening method was naked eye visual inspection. There was a consensus on the age of screening initiation. Most countries recommended treatment by cryotherapy and loop excision. CONCLUSION Effective cervical cancer screening programmes, guided by evidence-based recommendations, can enhance early intervention and outcomes. This study highlights the need for standardized and evidence-based cervical cancer screening guidelines in the SADC region, to reduce the burden of cervical cancer and improve the health outcomes of women in these areas.
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Affiliation(s)
- R A Adams
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Clinical Building, Faculty of Medicine and Health Sciences, Francie Van Zijl, Stellenbosch University, 7505, South Africa.
| | - M H Botha
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Clinical Building, Faculty of Medicine and Health Sciences, Francie Van Zijl, Stellenbosch University, 7505, South Africa
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Castrillo-Diez JL, Rivera-Santiago C, Ávila-Flores SM, Barrera-Barrera SA, Barrera-Saldaña HA. Findings and Challenges in Replacing Traditional Uterine Cervical Cancer Diagnosis with Molecular Tools in Private Gynecological Practice in Mexico. Viruses 2024; 16:887. [PMID: 38932179 PMCID: PMC11209306 DOI: 10.3390/v16060887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol.
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Affiliation(s)
| | - Carolina Rivera-Santiago
- Columbia Biotec, Columbia Laboratories, Tlalpan 14090, Mexico;
- Columbia Laboratories, Basic Scientific Research Division, Mexico City 04000, Mexico
| | | | - Silvia A. Barrera-Barrera
- Innbiogem SC/Vitagenesis SA at National Laboratory for Services of Research, Development, and Innovation for the Pharma and Biotech Industries (LANSEIDI) of CONACyT Vitaxentrum Group, Monterrey 64630, Mexico;
| | - Hugo A. Barrera-Saldaña
- Columbia Laboratories, Basic Scientific Research Division, Mexico City 04000, Mexico
- Innbiogem SC/Vitagenesis SA at National Laboratory for Services of Research, Development, and Innovation for the Pharma and Biotech Industries (LANSEIDI) of CONACyT Vitaxentrum Group, Monterrey 64630, Mexico;
- Facultades de Medicina y Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza 66455, Mexico
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Mungo C, Guliam A, Chinula L, Inturrisi F, Msowoya L, Mkochi T, Jawadu S, de Sanjosé S, Schiffman M, Tang JH, Smith JS. Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi. Infect Agent Cancer 2024; 19:24. [PMID: 38760798 PMCID: PMC11100048 DOI: 10.1186/s13027-024-00585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/03/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The World Health Organization recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi. METHODS We utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis-cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to RESULTS 315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses, of which 279 and 36 were HPV positive and HPV negative, respectively, on Xpert self-collection. Of the 315, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Of the 245 with normal pathology, 213 (87%) and 188 (77%) were HPV-positive on Xpert and ScreenFire self-collected specimens, respectively. Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50-0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens. CONCLUSION In this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.
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Affiliation(s)
- Chemtai Mungo
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Anagha Guliam
- Barnard College of Columbia University, New York City, NY, USA
| | - Lameck Chinula
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Federica Inturrisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Lizzie Msowoya
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tawonga Mkochi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Siniya Jawadu
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jennifer H Tang
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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10
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Sahasrabuddhe VV. Cervical Cancer: Precursors and Prevention. Hematol Oncol Clin North Am 2024:S0889-8588(24)00032-7. [PMID: 38760198 DOI: 10.1016/j.hoc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Cervical cancer, caused due to oncogenic types of human papillomavirus (HPV), is a leading preventable cause of cancer morbidity and mortality globally. Chronic, persistent HPV infection-induced cervical precursor lesions, if left undetected and untreated, can progress to invasive cancer. Cervical cancer screening approaches have evolved from cytology (Papanicolaou test) to highly sensitive HPV-based molecular methods and personalized, risk-stratified, management guidelines. Innovations like self-collection of samples to increase screening access, innovative triage methods to optimize management of screen positives, and scalable and efficacious precancer treatment approaches will be key to further enhance the utility of prevention interventions.
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Affiliation(s)
- Vikrant V Sahasrabuddhe
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 5E-338, Rockville, MD, USA.
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11
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Li J, Adobo SD, Shi H, Judicael KAW, Lin N, Gao L. Screening Methods for Cervical Cancer. ChemMedChem 2024:e202400021. [PMID: 38735844 DOI: 10.1002/cmdc.202400021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/15/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
Cervical cancer seriously affects the health of women worldwide. Persistent infection of high-risk HPV (Human Papilloma Virus) can lead to cervical cancer. There is a great need for timely and efficient screening methods for cervical cancer. The current screening methods for cervical cancer are mainly based on cervical cytology and HPV testing. Cervical cytology is made of Pap smear and liquid-based cytology, while HPV testing is based on immunological and nucleic acid level detection methods. This review introduces cervical cancer screening methods based on cytology and human papillomavirus testing in detail. The advantages and limitations of the screening methods are also summarized and compared.
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Affiliation(s)
- Jingyan Li
- School of Life Sciences, Jiangsu University, Zhenjiang, 212013, China
| | | | - Hui Shi
- Jiangsu Provincial Health Development Research Center, Nanjing, 210003, China
| | | | - Ning Lin
- Jiangsu Provincial Health Development Research Center, Nanjing, 210003, China
| | - Li Gao
- School of Life Sciences, Jiangsu University, Zhenjiang, 212013, China
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12
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Son A, Kim W, Lee W, Park J, Kim H. Applicability of selected reaction monitoring for precise screening tests. Expert Rev Proteomics 2024:1-10. [PMID: 38697802 DOI: 10.1080/14789450.2024.2350975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/27/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION The proactive identification of diseases through screening tests has long been endorsed as a means to preempt symptomatic onset. However, such screening endeavors are fraught with complications, such as diagnostic inaccuracies, procedural risks, and patient unease during examinations. These challenges are amplified when screenings for multiple diseases are administered concurrently. Selected Reaction Monitoring (SRM) offers a unique advantage, allowing for the high-throughput quantification of hundreds of analytes with minimal interferences. AREAS COVERED Our research posits that SRM-based assays, traditionally tailored for single-disease biomarker profiling, can be repurposed for multi-disease screening. This innovative approach has the potential to substantially alleviate time, labor, and cost demands on healthcare systems and patients alike. Nonetheless, there are formidable methodological hurdles to overcome. These include difficulties in detecting low-abundance proteins and the risk of model overfitting due to the multiple functionalities of single proteins across different disease spectrums - issues especially pertinent in blood-based assays where detection sensitivity is constrained. As we move forward, technological strides in sample preparation, online extraction, throughput, and automation are expected to ameliorate these limitations. EXPERT OPINION The maturation of mass spectrometry's integration into clinical laboratories appears imminent, positioning it as an invaluable asset for delivering highly sensitive, reproducible, and precise diagnostic results.
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Affiliation(s)
- Ahrum Son
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Woojin Kim
- Department of Bio-AI convergence Chungnam National University,Daejeon, South Korea
| | - Wonseok Lee
- Department of Bio-AI convergence Chungnam National University,Daejeon, South Korea
| | - Jongham Park
- Department of Bio-AI convergence Chungnam National University,Daejeon, South Korea
| | - Hyunsoo Kim
- Department of Bio-AI convergence Chungnam National University,Daejeon, South Korea
- Department of Convergent Bioscience and Informatics, Chungnam National University, Daejeon, Republic of Korea
- SCICS, Daejeon, Republic of Korea
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13
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Rebolj M, Brentnall AR, Cuschieri K. Predictable changes in the accuracy of human papillomavirus tests after vaccination: review with implications for performance monitoring in cervical screening. Br J Cancer 2024; 130:1733-1743. [PMID: 38615108 PMCID: PMC11130303 DOI: 10.1038/s41416-024-02681-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024] Open
Abstract
Vaccination against human papillomavirus (HPV) is changing the performance of cytology as a cervical screening test, but its effect on HPV testing is unclear. We review the effect of HPV16/18 vaccination on the epidemiology and the detection of HPV infections and high-grade cervical lesions (CIN2+) to evaluate the likely direction of changes in HPV test accuracy. The reduction in HPV16/18 infections and cross-protection against certain non-16/18 high-risk genotypes, most notably 31, 33, and/or 45, will likely increase the test's specificity but decrease its positive predictive value (PPV) for CIN2+. Post-vaccination viral unmasking of non-16/18 genotypes due to fewer HPV16 co-infections might reduce the specificity and the PPV for CIN2+. Post-vaccination clinical unmasking exposing a higher frequency of CIN2+ related to non-16/18 high-risk genotypes is likely to increase the specificity and the PPV of HPV tests. The effect of HPV16/18 vaccination on HPV test sensitivity is difficult to predict based on these changes alone. Programmes relying on HPV detection for primary screening should monitor the frequency of false-positive and false-negative tests in vaccinated (younger) vs. unvaccinated (older) cohorts, to assess the outcomes and performance of their service.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Screening, Prevention, and Early Detection, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Adam R Brentnall
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian Scotland, Edinburgh, UK
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14
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Yin J, Zhang S, Li Z, Li Y, Wang H, Zhang X, Pan Q, Chen W, Luo X, Sun X, Zhao F, Qiao Y. Impact of high-performance human papillomavirus testing to improve cervical cancer screening in China: a prospective population-based multicentre cohort study. Clin Microbiol Infect 2024:S1198-743X(24)00166-6. [PMID: 38599463 DOI: 10.1016/j.cmi.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/04/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES The aim of the study was to evaluate the clinical performance of HBRT-H14, a real-time PCR-based assay that separates human papillomavirus (HPV) 16 and HPV18 from 12 other high-risk (HR) HPV types, in population according to Chinese guideline. METHODS A total of 9829 eligible women aged 21-64 years from Henan, Shanxi, and Guangdong provinces were performed by HBRT-H14 testing and liquid-based cytology (LBC) screening at baseline and followed up for 3-year. The sensitivity, specificity, positive predictive value (absolute risk), and negative predictive value of LBC diagnosis and HPV testing were calculated for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) Lesions. RESULTS At baseline, 80 (0.81%) participants were diagnosed with CIN2+. HR-HPV with reflex LBC had a significantly higher sensitivity (78/80, 97.50% [95% CI, 91.34-99.31%] vs. 62/80, 77.50% [67.21-85.27%], McNemar's test p < 0.001), and a slightly lower specificity (8528/9749, 87.48% [86.80-88.12%] vs. 8900/9749, 91.29% [90.72-91.83%], McNemar's test p < 0.001) than LBC with reflex HR-HPV for CIN2+. 7832 (79.6%) participants completed 3-year follow-up and 172 (2.20%) participants were cumulatively diagnosed with CIN2+. Compared with LBC with reflex HR-HPV, HR-HPV with reflex LBC significantly increased the sensitivity (161/172, 93.60% [88.91-96.39%] vs. 87/172, 50.58% [43.18-57.96%], McNemar's test p < 0.001), but marginally decreased the specificity (6776/7660, 88.46% [87.72-89.16%] vs. 6933/7660, 90.51% [89.83-91.15], McNemar's test p < 0.001). In addition, the absolute 3-year risk of CIN2+ in HPV16/18-positive individuals was as high as 33% (80/238), whereas the risk in the HPV-negative population was only 0.16% (11/6787), much lower than those in the negative for intraepithelial lesion or malignancy population (1.21%, 85/7018). Moreover, similar results were found in women ≥30 years old. DISCUSSION The study has indicated that HBRT-14 has a reliable clinical performance for use in cervical screening. The validated HPV test would improve the quality of population screening.
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Affiliation(s)
- Jian Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaokai Zhang
- Department of Cancer Prevention and Control, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Zhifang Li
- Department of Preventive Medicine, Changzhi Medical College, Changzhi, China
| | - Yufei Li
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Hong Wang
- Department of Cancer Prevention and Control, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xun Zhang
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinjing Pan
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen Chen
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiping Luo
- Department of Gynecology, Guangdong Provincial Women and Child Health Hospital, Guangzhou, China
| | - Xibin Sun
- Department of Cancer Prevention and Control, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Fanghui Zhao
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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15
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Heideman DAM, Berkhof J, Verhoef L, Ouwerkerk C, Smit PW, Oštrbenk Valenčak A, Mlakar J, Poljak M, Steenbergen RDM, Bleeker MCG. Validation of the clinical performance and reproducibility of the NeuMoDx HPV assay self-sample workflow. J Clin Virol 2024; 171:105649. [PMID: 38335717 DOI: 10.1016/j.jcv.2024.105649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) testing on self-samples is a valid tool for cervical cancer screening. HPV self-sample workflows need to be clinically validated to ensure safe use in screening. OBJECTIVE This study evaluated the fully automated NeuMoDx HPV Assay self-sample workflow that is compiled of the NeuMoDx HPV assay and the NeuMoDx 96/288 Molecular Systems, for clinical performance and reproducibility on Evalyn Brush-collected self-samples. METHODS The clinical performance of the NeuMoDx HPV Assay self-sample workflow for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3+ was evaluated on 987 self-samples obtained from women attending national organized HPV-based cervical cancer screening by a noninferiority analysis relative to reference workflows using either HPV-Risk Assay or high-risk HPV GP5+/6+-PCR. Intra- and inter-laboratory reproducibility of the NeuMoDx HPV Assay self-sample workflow using both NeuMoDx 96 and 288 Molecular Systems was assessed on 520 self-samples in three laboratories. RESULTS The clinical sensitivity and specificity of the NeuMoDx HPV Assay self-sample workflow for the detection of CIN2+ and CIN3+ were found to be non-inferior to the reference workflows using either HPV-Risk Assay or high-risk HPV GP5+/6+-PCR, with all p-values <0.034. The NeuMoDx HPV Assay self-sample workflow exhibited an intra-laboratory reproducibility of 94.4 % (95 %CI:92.5-96.1 %) with kappa value 0.86 (95 %CI:0.81-0.91). Inter-laboratory agreement was high (all ≥93.4 % and all kappa values ≥0.83). CONCLUSIONS The NeuMoDx HPV Assay self-sample workflow demonstrated high clinical accuracy for CIN2+/3+ and high reproducibility. The NeuMoDx HPV Assay self-sample workflow can be considered suitable for cervical cancer screening purposes.
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Affiliation(s)
- D A M Heideman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands.
| | - J Berkhof
- Amsterdam UMC location Vrije Universiteit Amsterdam, Data Sciences, De Boelelaan 1117, Amsterdam, Netherlands
| | - L Verhoef
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | - C Ouwerkerk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | - P W Smit
- Molecular Diagnostics Unit, Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, Netherlands
| | - A Oštrbenk Valenčak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - J Mlakar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - R D M Steenbergen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | - M C G Bleeker
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
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16
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Bellosillo B, Ibáñez R, Roura E, Monfil L, Asensio-Puig L, Álvarez I, Muset M, Florencia Y, Paytubi S, de Andrés-Pablo Á, Calvo S, Serrano-Munné L, Pavón MÁ, Lloveras B. Clinical Validation of the Vitro HPV Screening Assay for Its Use in Primary Cervical Cancer Screening. Cancers (Basel) 2024; 16:1322. [PMID: 38611001 PMCID: PMC11011158 DOI: 10.3390/cancers16071322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Many scientific societies have issued guidelines to introduce population-based cervical cancer screening with HPV testing. The Vitro HPV Screening assay is a fully automatic multiplex real-time PCR test targeting the L1 GP5+/GP6+ region of HPV genome. The assay detects 14 high risk (HR) HPV genotypes, identifying individual HPV16 and HPV18 genotypes, and the HPV-positive samples for the other 12 HR HPV types are subsequently genotyped with the HPV Direct Flow Chip test. Following international guidelines, the aim of this study was to validate the clinical accuracy of the Vitro HPV Screening test on ThinPrep-collected samples for its use as primary cervical cancer screening, using as comparator the validated cobas® 4800 HPV test. The non-inferiority analysis showed that the clinical sensitivity and specificity of the Vitro HPV Screening assay for a diagnosis of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were not inferior to those of cobas® 4800 HPV (p = 0.0049 and p < 0.001 respectively). The assay has demonstrated a high intra- and inter-laboratory reproducibility, also among the individual genotypes. The Vitro HPV Screening assay is valid for cervical cancer screening and it provides genotyping information on HPV-positive samples without further sample processing in a fully automated workflow.
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Affiliation(s)
- Beatriz Bellosillo
- Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain; (B.B.); (I.Á.); (M.M.); (S.C.); (L.S.-M.)
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), University Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Raquel Ibáñez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (R.I.); (E.R.); (L.M.); (L.A.-P.); (Y.F.); (S.P.); (Á.d.A.-P.); (M.Á.P.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública—CIBERESP, 28029 Madrid, Spain
| | - Esther Roura
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (R.I.); (E.R.); (L.M.); (L.A.-P.); (Y.F.); (S.P.); (Á.d.A.-P.); (M.Á.P.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública—CIBERESP, 28029 Madrid, Spain
| | - Laura Monfil
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (R.I.); (E.R.); (L.M.); (L.A.-P.); (Y.F.); (S.P.); (Á.d.A.-P.); (M.Á.P.)
| | - Laura Asensio-Puig
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (R.I.); (E.R.); (L.M.); (L.A.-P.); (Y.F.); (S.P.); (Á.d.A.-P.); (M.Á.P.)
| | - Isabel Álvarez
- Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain; (B.B.); (I.Á.); (M.M.); (S.C.); (L.S.-M.)
| | - Mercè Muset
- Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain; (B.B.); (I.Á.); (M.M.); (S.C.); (L.S.-M.)
| | - Yolanda Florencia
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (R.I.); (E.R.); (L.M.); (L.A.-P.); (Y.F.); (S.P.); (Á.d.A.-P.); (M.Á.P.)
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (R.I.); (E.R.); (L.M.); (L.A.-P.); (Y.F.); (S.P.); (Á.d.A.-P.); (M.Á.P.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública—CIBERESP, 28029 Madrid, Spain
| | - Álvaro de Andrés-Pablo
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (R.I.); (E.R.); (L.M.); (L.A.-P.); (Y.F.); (S.P.); (Á.d.A.-P.); (M.Á.P.)
| | - Susana Calvo
- Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain; (B.B.); (I.Á.); (M.M.); (S.C.); (L.S.-M.)
| | - Laia Serrano-Munné
- Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain; (B.B.); (I.Á.); (M.M.); (S.C.); (L.S.-M.)
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Miguel Ángel Pavón
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology—Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain; (R.I.); (E.R.); (L.M.); (L.A.-P.); (Y.F.); (S.P.); (Á.d.A.-P.); (M.Á.P.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública—CIBERESP, 28029 Madrid, Spain
| | - Belen Lloveras
- Department of Pathology, Hospital del Mar, 08003 Barcelona, Spain; (B.B.); (I.Á.); (M.M.); (S.C.); (L.S.-M.)
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), University Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain
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17
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Carozzi FM, Royder Yanez R, Paganini I, Sani C, Cannistrà S, Matucci M, von Borries S, Traina S. Cervical cancer prevention: Feasibility of self-sampling and HPV testing in rural and urban areas of Bolivia: An observational study. PLoS One 2024; 19:e0292605. [PMID: 38451956 PMCID: PMC10919649 DOI: 10.1371/journal.pone.0292605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/25/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Cervical cancer is a major health problem in Latin America. In 2019, the Italian Agency for Development Cooperation (La Paz regional site) conducted a pilot study to estimate the prevalence of high-risk human papillomavirus (HPV) and the feasibility of HPV screening in Bolivia through self-sampling and portable and transportable laboratory instruments for HPV testing in urban and rural areas. METHODS Women aged 20-65 years from La Paz (urban area), Toro Toro (rural area), and Acasio (rural area) were enrolled in local public health centers between Dec 1, 2019, and June 30, 2021. Self-sampling was carried out with the Viba-Brush system (Rovers, Oss, Netherlands) and samples were preserved in ThinPrep containers (Hologic Corporation, San Diego, CA, USA). The GeneXpert system (Cepheid, Sunnyvale, CA, USA) for high-risk HPV testing detects HPV E6 and E7 DNA via real-time PCR in a mobile system of easy execution requiring minimal manual intervention. The system provides results in about 1 h. The hr- HPV prevalence data, overall and partial genotyping, were analyzed considering the following age groups: 20-34, 35-44, and 45-65 years old. FINDINGS 2168 women were enrolled: 614 (28.3%) in La Paz, 743 (34.3%) in Toro Toro, and 811 (37.4%) in Acasio. Only one sample was collected from each participant. 2043 (94.2%) of 2168 samples were adequate for HPV testing. 255 (12.5%) samples were positive for high-risk HPV. Comparing the urban area (La Paz) versus rural combined areas (Acasio+Toro Toro), using a logistic model, the HPV total rate was statistically significantly higher in the city of La Paz (15.0% vs 11.4%; OR:1.37;95% CI: 1.04-1.80). Furthermore, the HPV prevalence was declining by age, and the urban/rural odds ratio was 1.50; (95% IC 1.13-19). The overall HPV 16 positivity was 2.7% (55/2043) and for HPV 18/45 was 1.8% (37/2043) without any statistically significant differences between the three BHU enrolling centers. Only the prevalence of HPV group '39/56/66/68' was significantly higher in La Paz (p<0,001) in comparison to Acasio and Toro Toro. INTERPRETATION The total and age-adjusted prevalence of high-risk HPV infection in rural and urban areas in Bolivia, as measured with a validated test for screening, is similar to that observed in Europe and the USA. Our study shows that a screening protocol for HPV testing with self-sampling would be feasible in urban and rural areas in Bolivia, and that the reported high occurrence of cervical cancer in Bolivia is not related to a higher rate of high-risk HPV infections. Carrying out HPV tests locally avoids the issues associated with transportation and storage of the collected material and allows the participant to wait in the clinic for the test result, overcoming the very long response time for screening test in Bolivia.
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Affiliation(s)
- Francesca Maria Carozzi
- Regional Laboratory of Cancer Prevention Unit, Institute for Cancer research, Prevention and Oncological Network ISPRO, Florence, Italy
| | - Ricardo Royder Yanez
- Italian Agency for Development Cooperation (AICS), La Paz Regional Site, Bolivia
| | - Irene Paganini
- Regional Laboratory of Cancer Prevention Unit, Institute for Cancer research, Prevention and Oncological Network ISPRO, Florence, Italy
| | - Cristina Sani
- Regional Laboratory of Cancer Prevention Unit, Institute for Cancer research, Prevention and Oncological Network ISPRO, Florence, Italy
| | - Stefania Cannistrà
- Regional Laboratory of Cancer Prevention Unit, Institute for Cancer research, Prevention and Oncological Network ISPRO, Florence, Italy
| | - Marzia Matucci
- Regional Laboratory of Cancer Prevention Unit, Institute for Cancer research, Prevention and Oncological Network ISPRO, Florence, Italy
| | - Sandra von Borries
- Regional Laboratory of Cancer Prevention Unit, Institute for Cancer research, Prevention and Oncological Network ISPRO, Florence, Italy
| | - Silvia Traina
- Italian Agency for Development Cooperation (AICS), La Paz Regional Site, Bolivia
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Martinelli M, Latsuzbaia A, Bonde J, Pedersen H, Iacobone AD, Bottari F, Piana AF, Pietri R, Cocuzza CE, Arbyn M. Performance of BD Onclarity HPV assay on FLOQSwabs vaginal self-samples. Microbiol Spectr 2024; 12:e0287223. [PMID: 38323823 PMCID: PMC10913526 DOI: 10.1128/spectrum.02872-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
This study assessed the accuracy of high-risk human papillomavirus testing of BD Onclarity HPV (Onclarity) assay on vaginal self-collected FLOQSwab versus cervical samples to ensure similar accuracy to detect cervical intraepithelial neoplasia. Testing was performed on two automated platforms, BD Viper LT and BD COR, to evaluate the effect of machine and using two vaginal self-samples to analyze the influence of collection, transport, and freezing-unfreezing on the results. A cervical sample and two self-samples were collected from 300 women. The first collected vaginal and the cervical sample were tested on BD Viper LT, and the second swab was frozen and subsequently tested on both automated systems. Test results on vaginal and cervical specimens were considered the index and comparator, respectively; colposcopy and histology were reference standards. Relative sensitivity for ≥CIN2 on vaginal samples analyzed versus the cervical sample was 1.01 (0.97-1.06), 1.01 (0.97-1.06), and 1.00 (0.95-1.05), for the first, second self-collected sample tested on BD VIPER LT, and second self-collected sample tested on BD COR, respectively. Relative specificity was 0.83 (0.73-0.94), 0.76 (0.67-0.87), and 0.82 (0.73-0.92) using the three different workflows. Cut-off optimization for human papillomavirus (HPV) positivity defined at Ct ≤38.3 for HPV16, ≤ 34.2 for HPV18, and ≤31.5 for all other types showed an increased relative specificity with similar sensitivity. No significant difference was observed between self-samples tested with the two platforms and between first- and second-collected swabs. Onclarity assay on FLOQSwab using both platforms showed similar sensitivity but lower specificity to detect ≥CIN2 compared to cervical samples. By cut-off optimization, non-inferior specificity could be reached. IMPORTANCE Human papillomavirus (HPV) testing on self-collected vaginal samples has been shown to improve women's participation to cervical cancer screening programs, particularly in regions with limited access to health care. Nevertheless, the introduction of self-sampling in cervical cancer screening programs requires prior clinical validation of the HPV assay in combination with a self-sample collection device, including also the laboratory workflow and automation required for high-throughput testing in screening. In this study, the performance of BD Onclarity HPV on FLOQSwab-collected vaginal self-samples has been compared to clinician-taken liquid-based cytology samples, to detect high-grade cervical intraepithelial neoplasia using two high-throughput platforms, BD Viper LT and BD COR. The study findings have shown a similar performance of BD Onclarity on testing self-collected samples, confirming the validation of the proposed pre-analytical and analytical protocols for their use in cervical cancer screening programs based on self-collected vaginal samples.
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Affiliation(s)
- Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ardashel Latsuzbaia
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Jesper Bonde
- Department of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital, AHH-Hvidovre Hospital, Hvidovre, Denmark
| | - Helle Pedersen
- Department of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital, AHH-Hvidovre Hospital, Hvidovre, Denmark
| | - Anna D. Iacobone
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Bottari
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea F. Piana
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Roberto Pietri
- U.O. Coordinamento Consultori Familiari, ASSL Sassari – ATS Sardegna, Sassari, Italy
| | | | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Extended Valhudes Study GroupGiubbiChiara1Brask SonneSi2Korsgaard AndreaseEmilie2MartellaSilvia3PretiEleonora Petra3GuerrieriMaria Elena3PasseriniRita4MuresuNarcisa5SechiIllari5DettoriArianna5GhiMaria Eugenia6BagellaMaria Paola6MarrazzuAdriano6Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyDepartment of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital, Hvidovre, DenmarkPreventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, ItalyDivision of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, ItalyDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, ItalyU.O. Coordinamento Consultori Familiari, ASSL Sassari – ATS Sardegna, Sassari, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital, AHH-Hvidovre Hospital, Hvidovre, Denmark
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- U.O. Coordinamento Consultori Familiari, ASSL Sassari – ATS Sardegna, Sassari, Italy
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
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Downham L, Jaafar I, Rol ML, Nyawira Nyaga V, Valls J, Baena A, Zhang L, Gunter MJ, Arbyn M, Almonte M. Accuracy of HPV E6/E7 oncoprotein tests to detect high-grade cervical lesions: a systematic literature review and meta-analysis. Br J Cancer 2024; 130:517-525. [PMID: 37973957 PMCID: PMC10876647 DOI: 10.1038/s41416-023-02490-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Cervical carcinogenesis is mediated by the HPV-E6 and E7 oncoproteins, considered as biomarkers usable in managing screen-positive women. METHODS We conducted a systematic review and meta-analysis assessing the accuracy of HPV-E6/E7-oncoprotein tests to detect underlying cervical-precancer and cancer. We included studies reporting data on oncoprotein test accuracy detecting cervical intraepithelial neoplasia grade 3 or worse. Random effects logistic regression models were applied for pooling absolute and relative accuracy. RESULTS Twenty-two studies were included. Sensitivity and specificity estimates ranged from 54.2% (95%CI: 45.2-63.0) to 69.5% (95%CI:60.8-76.9) and from 82.8% (95%CI: 50.4-95.8) to 99.1 (95%CI: 98.8-99.3), respectively in the population irrespective of HPV status. Higher sensitivity estimates ranging from 60.8% (95%CI: 49.6-70.9) to 75.5% (95%CI: 71.7-78.9) but lower specificity estimates ranging from 83.7% (95%CI: 76.1-89.3) to 92.1% (95%CI: 88.5-94.6) were observed in studies enrolling high-risk-HPV-positive women. Studies recruiting only HIV-positive women showed a pooled sensitivity of 46.9% (95%CI: 30.6-63.9) with a specificity of 98.0% (95%CI: 96.8-98.7). CONCLUSIONS The high specificity of oncoprotein tests supports its use for triaging HPV-positive women. However, oncoprotein-negative women would not be recommended to undertake routine screening, requiring further follow-up. Large-scale and longitudinal studies are needed to further investigate the role of E6/E7-oncoprotein detection in predicting the risk of developing cervical pre-cancer and cancer.
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Affiliation(s)
- Laura Downham
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
| | - Iman Jaafar
- Department of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Mary Luz Rol
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Victoria Nyawira Nyaga
- Department of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Idibell, Barcelona, Spain
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Li Zhang
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Marc Arbyn
- Department of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, France
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Zhang L, Ju Y, Hu H, Ma C, Yu Y, Huang Y, Gong L, Zhao W, Liu Y, Liu Y, Bian L. Analytical evaluation of the automated genotyping system (GenPlex) compared to a traditional real-time PCR assay for the detection of high-risk human papillomaviruses. J Med Virol 2024; 96:e29496. [PMID: 38402627 DOI: 10.1002/jmv.29496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/09/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
The detection of high-risk human papillomaviruses (HPVs) is crucial for early screening and preventing cervical cancer. However, the substantial workload in high-level hospitals or the limited resources in primary-level hospitals hinder widespread testing. To address this issue, we explored a sample-to-answer genotyping system and assessed its performance by comparing it with the traditional real-time polymerase chain reaction (PCR) method conducted manually. Samples randomly selected from those undergoing routine real-time PCR detection were re-analyzed using the fully automatic GenPlex® system. This system identifies 24 types of HPV through a combination of ordinary PCR and microarray-based reverse hybridization. Inconsistent results were confirmed by repeated testing with both methods, and the κ concordance test was employed to evaluate differences between the two methods. A total of 365 samples were randomly selected from 7259 women. According to real-time PCR results, 76 were high-risk HPV negative, and 289 were positive. The GenPlex® system achieved a κ value greater than 0.9 (ranging from 0.920 to 1.000, p < 0.0001) for 14 types of high-risk HPV, except HPV 51 (κ = 0.697, p < 0.0001). However, the inconsistent results in high-risk HPV 51 were revealed to be false positive in real-time PCR by other method. When counting by samples without discriminating the high-risk HPV type, the results of both methods were entirely consistent (κ = 1.000, p < 0.0001). Notably, the GenPlex® system identified more positive cases, with 73 having an HPV type not covered by real-time PCR, and 20 potentially due to low DNA concentration undetectable by the latter. Compared with the routinely used real-time PCR assay, the GenPlex® system demonstrated high consistency. Importantly, the system's advantages in automatic operation and a sealed lab-on-chip format respectively reduce manual work and prevent aerosol pollution. For widespread use of GenPlex® system, formal clinical validation following international criteria should be warranted.
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Affiliation(s)
- Lijuan Zhang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan Ju
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haixu Hu
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chunhui Ma
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Faculty of Medical Imaging, Naval Medical University, Shanghai, China
| | - Yanju Yu
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan Huang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lili Gong
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wei Zhao
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yujia Liu
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yi Liu
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lihong Bian
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
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Mungo C, Guliam A, Chinula L, Inturrisi F, Msowoya L, Mkochi T, Jawadu S, de Sanjosé S, Schiffman M, Tang JH, Smith JS. Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.21.24303142. [PMID: 38617305 PMCID: PMC11014639 DOI: 10.1101/2024.02.21.24303142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Background The World Health Organization (WHO) recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries (LMICs) account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi. Methods We utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis - cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to Results 315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses. Of these, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50-0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens. Conclusion In this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.
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Affiliation(s)
- Chemtai Mungo
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill
| | | | - Lameck Chinula
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Federica Inturrisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Lizzie Msowoya
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tawonga Mkochi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Siniya Jawadu
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jennifer H. Tang
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Jennifer S. Smith
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill
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22
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Chung PYJ, Dhillon SK, Simoens C, Cuypers L, Laenen L, Bonde J, Corbisier P, Buttinger G, Cocuzza CE, Van Gucht S, Van Ranst M, Arbyn M. Assessment of the clinical and analytical performance of three Seegene Allplex SARS-CoV-2 assays within the VALCOR framework. Microbiol Spectr 2024; 12:e0239723. [PMID: 38189291 PMCID: PMC10846132 DOI: 10.1128/spectrum.02397-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic demonstrated the need for accurate diagnostic testing for the early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the pandemic has ended, accurate assays are still needed to monitor viral spread at national levels and beyond through population and wastewater surveillance. To enhance early detection, SARS-CoV-2 assays should have high diagnostic accuracy and should be validated to assure accurate results. Three distinct SARS-CoV-2 assays were evaluated with clinical samples using the VALCOR (VALidation of SARS-CORona Virus-2 assays) framework, with the TaqPath COVID-19 assay (ThermoFisher Scientific, USA) as a comparator. We evaluated clinical sensitivity, specificity, limit of detection (LOD), and overall concordance between comparator and three index Allplex SARS-CoV-2 assays (Seegene, South Korea): Allplex-SC2, Allplex-SC2Fast (Fast PCR), and Allplex-SC2FabR (SARS-CoV-2/FluA/FluB/respiratory syncytial virus). Analytical performance and LOD of index assays were assessed using a dilution series of three synthetic SARS-CoV-2 sequence reference materials (RMs). Ninety SARS-CoV-2 positives and 90 SARS-CoV-2 negatives were tested. All Allplex assays had 100.0% sensitivity (95%CI = 95.9%-100.0%). Allplex-SC2 and Allplex-SC2Fast assays had 97.8% specificity (95%CI = 92.3%-99.7%) and 98.9% overall concordance [κ = 0.978 (95%CI = 0.947-1.000)]. Allplex-SC2FabR assay showed 100.0% specificity (95%CI = 95.9%-100.0%) and 100.0% overall concordance [κ = 1.000 (95%CI = 1.000-1.000)]. LOD assessment of index assays revealed detection down to 2.61 × 102 copies/mL in clinical samples, while the analytical LOD was 9.00 × 102 copies/mL. In conclusion, the evaluation of the three Seegene Allplex SARS-CoV-2 assays showed high sensitivity and specificity and an overall good assay concordance with the comparator. The assays showed low analytical LOD using RM and even a slightly lower LOD in clinical samples. Non-overlapping target gene sequences between SARS-CoV-2 assays and RMs emphasize the need for aligning targeted sequences of diagnostic assays and RMs.IMPORTANCEThe coronavirus disease 2019 pandemic has a significant impact on global public health, economies, and societies. As shown through the first phases of the pandemic, accurate and timely diagnosis is crucial for disease control, prevention, and monitoring. Though the pandemic phase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has concluded, diagnostic assays remain in demand to monitor SARS-CoV-2 at the individual patient level, regionally, and nationally, as well as to remain an infectious disease preparedness instrument to monitor any new SARS-CoV-2 dissemination across borders using population and wastewater surveillance. The anticipation by WHO and central health care policy entities such as the Center for Disease Control, EMA, and multiple national health authorities is that SARS-CoV-2 will reside as an endemic respiratory disease for years to come. The key strategic consideration is hence shifting from combating a pandemic situation with a high number of patients to instead allowing precise diagnostics of suspected patients with the intention of correct management in a low-prevalence setting.
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Affiliation(s)
- Pui Yan Jenny Chung
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Sharonjit K. Dhillon
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Cindy Simoens
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Lize Cuypers
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Lies Laenen
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, AHH-Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Clementina E. Cocuzza
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Marc Van Ranst
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
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23
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Brentnall AR, Cuschieri K, Sargent A, Berkhof J, Rebolj M. Staged design recommendations for validating relative sensitivity of self-sample human papillomavirus tests for cervical screening. J Clin Epidemiol 2024; 166:111227. [PMID: 38065518 DOI: 10.1016/j.jclinepi.2023.111227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To ensure that the emerging methods for human papillomavirus (HPV) testing on self-collected samples in cervical screening are evaluated robustly. STUDY DESIGN AND SETTING We assess paired study designs for relative sensitivity of self-collected vs. traditional clinician-collected samples in detection of high-grade cervical intraepithelial neoplasia. RESULTS Designs considered are (D1) both samples at screening, with clinical actions triggered by HPV positivity; (D2) offering a self-sample test to clinician-collected HPV-positive women; (D3) as D2 but using a repeat clinician-sample as comparator; (D4) offering a choice of self- vs. clinician-sampling, and the alternative test in HPV-positive women; (D5) paired samples at referral appointment. D1 is simple to analyze but requires the largest sample size and referral of self-sample positive, clinician-sample negative women. D2 requires a much smaller sample size, and no change to clinical practice, and could be used to rule-in a test because estimates are conservative (against self-sampling). D3 mitigates this bias but requires a second clinician sample. D4 is only manageable where self-sampling already occurs. The liberal D5 might be used to rule-out a self-sampling test. CONCLUSION A universal recommendation for an optimal study design is challenging. Staged validation might be useful with D5 as a gatekeeper for D1-D4.
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Affiliation(s)
- Adam R Brentnall
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary Universityof London, Charterhouse Square, London EC1M 6BQ, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Alexandra Sargent
- Cytology Department, Clinical Sciences Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Johannes Berkhof
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Location VUMC, Amsterdam, The Netherlands
| | - Matejka Rebolj
- Centre for Cancer Screening, Prevention and Early Detection, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK.
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Cocuzza CE, Dhillon SK, Martinelli M, Giubbi C, Njoku RC, Bhatia R, Cuschieri K, Arbyn M. Clinical performance of the novel full-genotyping OncoPredict HPV Quantitative Typing assay using the VALGENT framework. Int J Cancer 2024; 154:538-547. [PMID: 37855030 DOI: 10.1002/ijc.34754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
Clinical validation of human papillomavirus (HPV) assays according to international criteria is prerequisite for their implementation in cervical cancer screening. OncoPredict HPV Quantitative Typing (QT) assay (Hiantis Srl, Milan, Italy) is a novel full-genotyping multiplex real-time PCR quantitative assay targeting E6/E7 genes, allowing individual viral load determination of 12 high-risk (HR) HPV types. Quality controls for sample adequacy, efficiency of nucleic acid extraction and PCR inhibition are included in the assay. Clinical performance of OncoPredict HPV QT test was assessed as part of the "Validation of HPV Genotyping Tests" (VALGENT-2) framework, consisting of 1300 cervical liquid-based cytology (LBC) samples of women aged between 20 and 60 years who had originally attended for routine cervical screening in Scotland. The clinical accuracy of the OncoPredict HPV QT (index test) for the detection of CIN2+ was assessed relative to the GP5+/6+ Enzyme ImmunoAssay (GP5+/6+ EIA) (comparator test), using noninferiority criteria. Intra- and interlaboratory reproducibility of the assay was assessed on a subpopulation, comprising 526 samples. The relative sensitivity and specificity for OncoPredict HPV QT vs GP5+/6+-PCR-EIA were 1.01 (95% CI: 0.99-1.03) and 1.03 (95% CI: 1.0-1.06) respectively. The P-values for noninferiority were ≤0.001. The intra- and inter-laboratory reproducibility demonstrated a high concordance (>98.7%) with kappas for individual types ranging from 0.66 to 1.00. OncoPredict HPV QT fulfills the international validation criteria for the use of HPV tests in cervical cancer screening.
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Affiliation(s)
| | | | - Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Chiara Giubbi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ruth Chinyere Njoku
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ramya Bhatia
- HPV Research Group, Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Kate Cuschieri
- HPV Research Group, Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
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25
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Bartosik M, Moranova L, Izadi N, Strmiskova J, Sebuyoya R, Holcakova J, Hrstka R. Advanced technologies towards improved HPV diagnostics. J Med Virol 2024; 96:e29409. [PMID: 38293790 DOI: 10.1002/jmv.29409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
Persistent infection with high-risk types of human papillomaviruses (HPV) is a major cause of cervical cancer, and an important factor in other malignancies, for example, head and neck cancer. Despite recent progress in screening and vaccination, the incidence and mortality are still relatively high, especially in low-income countries. The mortality and financial burden associated with the treatment could be decreased if a simple, rapid, and inexpensive technology for HPV testing becomes available, targeting individuals for further monitoring with increased risk of developing cancer. Commercial HPV tests available in the market are often relatively expensive, time-consuming, and require sophisticated instrumentation, which limits their more widespread utilization. To address these challenges, novel technologies are being implemented also for HPV diagnostics that include for example, isothermal amplification techniques, lateral flow assays, CRISPR-Cas-based systems, as well as microfluidics, paperfluidics and lab-on-a-chip devices, ideal for point-of-care testing in decentralized settings. In this review, we first evaluate current commercial HPV tests, followed by a description of advanced technologies, explanation of their principles, critical evaluation of their strengths and weaknesses, and suggestions for their possible implementation into medical diagnostics.
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Affiliation(s)
- Martin Bartosik
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Ludmila Moranova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Nasim Izadi
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Johana Strmiskova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- National Centre for Biomolecular Research, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Ravery Sebuyoya
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- National Centre for Biomolecular Research, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Jitka Holcakova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Roman Hrstka
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
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Oštrbenk Valenčak A, Cuschieri K, Connor L, Zore A, Smrkolj Š, Poljak M. Allplex HPV HR Detection assay fulfils all clinical performance and reproducibility validation requirements for primary cervical cancer screening. J Clin Virol 2024; 170:105638. [PMID: 38183829 DOI: 10.1016/j.jcv.2023.105638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
Human papillomavirus (HPV)-based screening offers better protection against cervical cancer compared to cytology, but HPV screening assays must adhere to validation requirements of the international guidelines to ensure optimal performance. Allplex HPV HR Detection (Allplex) assay, launched in the late 2022, is a fully automated real-time PCR-based assay utilizing innovative technology that enables quantification and concurrent distinction of 14 high-risk HPV genotypes (HPV16,18,31,33,35,39,45,51,52,56,58,59,66 and 68). We assessed the validity of the Allplex for cervical cancer screening purposes, via comparison to a clinically validated comparator assay (Hybrid Capture 2; HC2), and through assessment of intra-laboratory reproducibility and inter-laboratory agreement. A clinical validation panel comprised of 973 residual ThinPrep samples was obtained from women aged 30-64 years participating in the organized Slovenian screening program, of these 863 were from women undergoing their regular screening visit after a previous negative screen test while 110 were from women with underlying cervical intraepithelial neoplasia grade 2 or worse (CIN2+) lesions. The Allplex's relative clinical sensitivity for detection of CIN2+ and CIN3+ were 1.01 (95%CI;0.98-1.04) and 0.98 (95%CI;0.95-1.02), compared to that of HC2. At recommended thresholds of ≥98% and ≥90%, the Allplex's clinical sensitivity and specificity (p=0.0004 and p=0.02, respectively) were non-inferior to HC2. High intra-laboratory reproducibility and inter-laboratory agreement, both overall (98.1% and 97.9%, respectively) and at genotype level (>98.7%) was observed. In addition, analytical genotype-specific performance of Allplex was compared to that of its predecessor Anyplex HPV HR; high overall agreement was observed (96.3%; kappa value 0.88), with some variations in performance. In conclusion, Allplex met all validation criteria described in the international guidelines on sensitivity, specificity and laboratory reproducibility and can be considered clinically validated for primary cervical cancer screening.
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Affiliation(s)
- Anja Oštrbenk Valenčak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Linzi Connor
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Andrej Zore
- Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia; Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Špela Smrkolj
- Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia; Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Node J, Dor F, Puget L, Ramanah R, Cot S, Bibeau F, Di Domizio N, Prétet JL, Lepiller Q. Prevalence and significance of HPV DNA detection below the clinical threshold of the commercial kit Alinity m HR-HPV assay (Abbott). J Med Virol 2024; 96:e29465. [PMID: 38323725 DOI: 10.1002/jmv.29465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
The positive clinical threshold of human papillomavirus (HPV) tests validated for primary cervical cancer screening (CCS) is designed to offer an optimal balance between clinical sensitivity and specificity. However, there may be a gap between the analytical sensitivity of the test and the positive clinical threshold, referred to here as the "gray-zone." This study aims to determine the prevalence and significance of HPV results obtained in the gray-zone in routine practice. Cervical samples obtained in our institution for CCS over a 22-month-period were tested with the Alinity m HR-HPV Assay (Abbott). Clinical and biological data, including cytological results and patients' HPV history were collected. Of the 6101 samples collected, 1.7% had an HPV result in the gray-zone (102 patients). The proportion of gray-zone results varied according to HPV genotype, reaching 11.8% of samples with detectable HPV DNA in the case of HPV31/33/52/58 genotypes. Reflex cytologies showed no abnormalities or Atypical Squamous Cells of Undetermined Significance results in 74.6% and 17.9% of cases, respectively. A previous or subsequent HPV-positive result with a (possibly) identical genotype was observed in 58% and 38% of cases, respectively. Two women with a history of persistent HPV detection had a CIN2+ lesion 1 year after the gray-zone result. In conclusion, the proportion of HPV results in the gray-zone varies according to genotype. No cytological abnormality is observed in the majority of cases, but a few rare patients with a history of persistent HPV infection should be closely monitored even if the HPV result is transiently located in the gray-zone.
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Affiliation(s)
- Juliette Node
- Laboratoire de virologie, CHU de Besançon, Besançon, France
- CNR Papillomavirus, CHU Besançon, Besancon, France
| | - Fanny Dor
- Laboratoire de biologie cellulaire, CHU Besançon, Besancon, France
| | - Line Puget
- Laboratoire de virologie, CHU de Besançon, Besançon, France
- CNR Papillomavirus, CHU Besançon, Besancon, France
| | - Rajeev Ramanah
- Service de Gynécologie-Obstétrique, CHU Besançon, Besancon, France
| | - Sophie Cot
- Service de Gynécologie-Obstétrique, CHU Besançon, Besancon, France
| | - Frédéric Bibeau
- Laboratoire d'anatomie Pathologique, CHU Besançon, Besancon, France
| | | | - Jean-Luc Prétet
- CNR Papillomavirus, CHU Besançon, Besancon, France
- Laboratoire de biologie cellulaire, CHU Besançon, Besancon, France
- EA3181, UBFC, LabEx LipSTIC ANR-11-LABX-0021, Besancon, France
| | - Quentin Lepiller
- Laboratoire de virologie, CHU de Besançon, Besançon, France
- CNR Papillomavirus, CHU Besançon, Besancon, France
- EA3181, UBFC, LabEx LipSTIC ANR-11-LABX-0021, Besancon, France
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Koussouri A, Baraquin A, Desmarets M, Diallo K, Puget L, Lepiller Q, Prétet JL. Comparison of high-risk HPV detection by the AmpFire® HPV Screening 16/18/HR technique (Atila Biosystems) and the hybrid capture 2 test (Qiagen). Mol Biol Rep 2024; 51:52. [PMID: 38165483 DOI: 10.1007/s11033-023-08939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Detection of high-risk human papillomaviruses (hrHPV) is widely used at the first line of cervical cancer screening, requiring rigorous validation of the clinical performance of commercial kits designed for this indication. METHODS Performance of the AmpFire HPV Screening 16/18/HR test (AF, Atila Biosystems) and the Hybrid Capture 2 test (HC2, Qiagen) for detecting hrHPV was cross-compared in 200 cervical samples in our institution. RESULTS The global percentage of agreement between the 2 techniques was 95.0% (95%CI 92-98%) with a Cohen's kappa coefficient of 0.85 (95%CI 0.75-0.94). Ten samples showed discordant results between the 2 techniques in both directions (5 HC2+/AF- and 5 HC2-/AF+). Among possible explanations for these discrepancies was the detection of HPV66 and HPV53 genotypes in two samples, since these genotypes are targeted by the Ampfire test but not by the HC2 test, as well as intrinsic differences in analytical performance to target specific genotypes. CONCLUSIONS A high level of agreement was observed between the two techniques, which encourages further testing in order to definitively validate the use of the Ampfire kit for primary cervical cancer screening.
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Affiliation(s)
- Anais Koussouri
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, F-25000, France
- Laboratoire de biologie cellulaire, CHU Besançon, Besançon, F-25000, France
| | - Alice Baraquin
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, F-25000, France
- Laboratoire de biologie cellulaire, CHU Besançon, Besançon, F-25000, France
| | - Maxime Desmarets
- Inserm CIC1431, CHU Besançon, Besançon, France
- UMR 1098 Right, Inserm, Établissement Français du Sang, Université de Franche-Comté, Besançon, France
| | | | - Line Puget
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, F-25000, France
- Laboratoire de virologie, CHU de Besançon, 3, Boulevard Fleming, 25 030, Besançon, F-25000, France
| | - Quentin Lepiller
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, F-25000, France.
- Laboratoire de virologie, CHU de Besançon, 3, Boulevard Fleming, 25 030, Besançon, F-25000, France.
- EA3181, Université de Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, Besançon, F-25000, France.
| | - Jean-Luc Prétet
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, F-25000, France
- Laboratoire de biologie cellulaire, CHU Besançon, Besançon, F-25000, France
- EA3181, Université de Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, Besançon, F-25000, France
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Vahteristo M, Leinonen MK, Sarkeala T, Anttila A, Heinävaara S. Similar effectiveness with primary HPV and cytology screening - Long-term follow-up of randomized cervical cancer screening trial. Gynecol Oncol 2024; 180:146-151. [PMID: 38091774 DOI: 10.1016/j.ygyno.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Long-term effects of primary human papillomavirus (HPV) screening on cervical cancer incidence and mortality are still missing. We conducted a long-term follow-up of the Finnish randomized HPV screening trial, the first HPV screening trial run within the routine screening program, to assess these measures. METHODS During 2003-2008, over 236,000 individuals were randomized (1:1) to HPV and cytology screening arms in Southern Finland. To compare the study arms, we calculated the cervical cancer incidence and mortality rate ratios using Poisson regression. RESULTS During a total of 3.5 million person-years of follow-up, we observed 129 cervical cancers and 32 cervical cancer deaths in the cytology arm, 139 cervical cancers and 32 cervical cancer deaths in the HPV arm. Compared to the cytology arm, in the HPV arm, the incidence rate ratio was 1.08 (95% CI 0.85-1.37), and the mortality rate ratio was 1.01 (95% CI 0.61-1.64). CONCLUSIONS We studied the effects of HPV screening on both cervical cancer incidence and mortality for the first time in a setting with an already well-established, high-quality cytology screening program. In this kind of setting with a low incidence of cervical cancer, HPV and cytology screening showed similar effectiveness. HPV screening provides, however, an objective, validated test system and enables self-sampling which can improve screening coverage. More attention is needed yet to ensure the balance between the harms and benefits of HPV screening.
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Affiliation(s)
- Maija Vahteristo
- Finnish Cancer Registry, 00130 Helsinki, Finland; Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland.
| | - Maarit K Leinonen
- Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Ahti Anttila
- Finnish Cancer Registry, 00130 Helsinki, Finland
| | - Sirpa Heinävaara
- Finnish Cancer Registry, 00130 Helsinki, Finland; Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
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White C, Reynolds S, Murphy K, Keegan H, Naik P, O'Brien R, Pilkington L, Sharkey Ochoa I, Glesson G, Russell N, Nuttall D, Tewari P, Wright F, O'Toole S, Sharp L, Flannelly G, O'Leary JJ, Martin CM. Performance of the HPV E6/E7 mRNA Aptima HPV assay combined with partial genotyping compared with the HPV DNA Cobas 4800 HPV test for use in primary screening: Results from the CERVIVA HPV primary screening study in Ireland. Int J Cancer 2024; 154:53-64. [PMID: 37632406 DOI: 10.1002/ijc.34685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 08/28/2023]
Abstract
There are currently several validated HPV tests. However, longitudinal data which spans appropriate age ranges, as well as evaluation of potential screening algorithms are necessary for screening programmes choice of test. The objective of our study was to evaluate the performance of HPV mRNA and HPV DNA testing, including partial genotyping, in routine cervical screening. As part of the CERVIVA HPV Primary Screening Study, ThinPrep samples from 10 150 women were tested for HPV mRNA using the Aptima HPV assay and HPV DNA using the Cobas 4800 HPV test. HPV mRNA-positive women were further assessed with the Aptima genotyping assay for HPV 16/18/45. Baseline cytology and prospective follow-up data were collected. The performance of the two tests was examined over 42 months (to date). HPV mRNA demonstrated equivalent sensitivity to HPV DNA testing for detection of CIN2+ (93.2% [92.4-93.9] vs 92.8% [92.0-93.6], respectively) and CIN3+ (94.6% [93.8-95.3] vs 94.6% [93.8-95.3]). HPV mRNA testing had significantly higher specificity compared to HPV DNA for detection of CIN2+ (84.0% [83.5-84.5] vs 80.8% [80.2-81.4], respectively) and CIN3+ (88.44% [88.2-88.6] vs 85.62 [85.4-85.9]). The proportion of CIN2+ and CIN3+, over 3 years (42 months), in HPV-negative women was comparable for both RNA (0.20% and 0.10%) and DNA (0.22% and 0.11%). Genotyping data was comparable across both assay platforms. In the context of HPV primary screening HPV mRNA testing has potential to reduce triage tests and follow-up tests at 12 months compared to DNA testing, with no significant difference in detection of CIN2+ and CIN3+.
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Affiliation(s)
- Christine White
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
| | - Stephen Reynolds
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
| | - Katherine Murphy
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
| | - Helen Keegan
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
| | - Padma Naik
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
| | | | - Loretto Pilkington
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
| | - Imogen Sharkey Ochoa
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
| | - Grainne Glesson
- CervicalCheck, National Screening Service, Kings Inns House, Dublin 1, Ireland
| | - Noirin Russell
- CervicalCheck, National Screening Service, Kings Inns House, Dublin 1, Ireland
| | - David Nuttall
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
| | - Prerna Tewari
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Fiona Wright
- CervicalCheck, National Screening Service, Kings Inns House, Dublin 1, Ireland
| | - Sharon O'Toole
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - John J O'Leary
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Cara M Martin
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
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Song Y, Zhang M, Zhang C, Du S, Zhai F. HPV E6/E7 mRNA combined with thin-prep cytology test for the diagnosis of residual/recurrence after loop electrosurgical excision procedure in patients with cervical intraepithelial neoplasia. Diagn Microbiol Infect Dis 2024; 108:116119. [PMID: 37890308 DOI: 10.1016/j.diagmicrobio.2023.116119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
To evaluate the diagnostic value of combining HPV E6/E7 mRNA testing with Thin-Prep cytology (TCT) for residual/recurrence detection, a total of 289 patients who underwent loop electrosurgical excision procedure (LEEP) for high-grade cervical lesions were included. Patients were followed up at different time points, and residual/recurrent lesions were confirmed through vaginoscopy. TCT, HPV-DNA, and HPV E6/E7 mRNA tests were conducted. Diagnostic performance, including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, was assessed. Among the patients, 76 cases showed residual lesions/recurrence, while 213 cases showed no residual/recurrence. Positive margins in the cervical-vaginal and cervical canal areas were associated with a higher risk of residual/recurrence. The combined HPV E6/E7 mRNA and TCT test showed higher diagnostic efficacy than individual tests at 6-, 12-, and 24-months follow-up. The combined test consistently demonstrated higher specificity and sensitivity, with significantly larger area under the curve (AUC) values compared to the individual tests.
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Affiliation(s)
- Yinghui Song
- Department of Gynecology, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China.
| | - Min Zhang
- Department of Gynecology, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
| | - Cui Zhang
- Department of Gynecology, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
| | - Shiyu Du
- Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
| | - Furui Zhai
- Department of Gynecology, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou 061000, Hebei, China
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Wittenborn J, Flasshove EM, Kupec T, Najjari L, Stickeler E, Maurer J. A Glimmer of Hope for Patients with a T3 Transformation Zone: miRNAs Are Potential Biomarkers for Cervical Dysplasia. Diagnostics (Basel) 2023; 13:3599. [PMID: 38132183 PMCID: PMC10742976 DOI: 10.3390/diagnostics13243599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This pilot study assesses the potential use of miRNAs in the triage of colposcopy patients with type 3 (nonvisible) cervical transformation zone (TZ). Type 3 TZ is a constitutional finding associated with many problems and controversies in colposcopy patient management. Here, we present miRNAs as a potential biomarker for the detection of CIN3 in these cases. MATERIALS AND METHODS Cervical mucosa samples (CMS) were collected from patients presenting with T3 transformation zone during routine workup using the Cytobrush. Depending on the histological and cytological result, as well as the result of the routinely performed HPV PCR, patients were divided into three groups: patients with a high-grade intraepithelial lesion (CIN3) and a positive high-risk HPV test (CIN3 group), patients without an intraepithelial lesion and a positive high-risk HPV test (HPV group), and healthy controls (N = no intraepithelial lesion and negative HPV test). The cervical mucus samples included in the study were tested for their expression levels of distinct miRNAs using qPCR. RESULTS All investigated miRNAs were consistently detectable in every sample. The CMSs of histologically graded CIN 3 showed consistently high expression levels of all eight miRNAs, whereas the CMSs from healthy patients (N) show generally lower expression levels. However, CMSs from patients of the HPV group represented a very heterogeneous group. CONCLUSIONS The data presented here can provide a solid basis for future research into a triage test for patients with a T3 transformation zone on the basis of commonly used clinical equipment.
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Affiliation(s)
- Julia Wittenborn
- Department of Obstetrics and Gynecology, University Hospital of the RWTH Aachen, 52074 Aachen, Germany (J.M.)
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Latsuzbaia A, Van Keer S, Vanden Broeck D, Weyers S, Donders G, De Sutter P, Tjalma W, Doyen J, Vorsters A, Arbyn M. Clinical Accuracy of Alinity m HR HPV Assay on Self- versus Clinician-Taken Samples Using the VALHUDES Protocol. J Mol Diagn 2023; 25:957-966. [PMID: 37865293 DOI: 10.1016/j.jmoldx.2023.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/25/2023] [Accepted: 09/14/2023] [Indexed: 10/23/2023] Open
Abstract
The VALHUDES protocol was established to evaluate clinical accuracy of human papillomavirus (HPV) assays to detect cervical precancer on first-void urine (FVU) and vaginal self-samples versus matched clinician-collected cervical samples (CCSs). Here we evaluated clinical performance of Alinity m HR HPV assay in a colposcopy referral population. Home-collected FVU (Colli-Pee FV 5020) 1 day before colposcopy (n = 492), at-clinic collected dry vaginal self-samples [multi-Collect Swab (mC; n = 493), followed by Evalyn Brush (EB; n = 233) or Qvintip (QT; n = 260)] and matched CCSs, were available for the study. Sensitivity to detect cervical intraepithelial neoplasia grade 2 or higher (CIN2+) of Alinity testing on FVU (ratio, 0.94; 95% CI, 0.85-1.03), mC (ratio, 1.00; 95% CI, 0.94-1.06), and EB/QT (ratio, 0.92; 95% CI, 0.85-1.00) was not different to CCSs. Specificity on FVU was similar to CCS (ratio, 1.02; 95% CI, 0.95-1.10), whereas specificity on mC was lower (ratio, 0.83; 95% CI, 0.76-0.90), but on EB/QT was higher (ratio, 1.08; 95% CI, 1.01-1.15) than on CCS. Accuracy on EB (sensitivity ratio, 0.96; 95% CI, 0.87-1.05; specificity ratio, 1.18; 95% CI, 1.06-1.31) was slightly better than on QT (sensitivity ratio, 0.88; 95% CI, 0.75-1.03; specificity ratio, 1.00; 95% CI, 0.92-1.09). In conclusion, clinical sensitivity of Alinity assay on all self-sample types was similar to cervical specimens. Adjustment of signal thresholds improved assay's accuracy to detect CIN2+ in all self-sample types.
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Affiliation(s)
- Ardashel Latsuzbaia
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Severien Van Keer
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem (Antwerp), Belgium
| | - Davy Vanden Broeck
- AMBIOR, Laboratory for Cell Biology and Histology, University of Antwerp, Edegem (Antwerp), Belgium; Laboratory of Molecular Pathology, University Hospital Liège, Liège, Belgium Sonic Healthcare, Antwerp, Belgium; National Reference Centre for HPV, Brussels, Belgium; International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Gilbert Donders
- Department of Obstetrics and Gynaecology, General Regional Hospital Heilig Hart, Tienen, Belgium; Femicare vzw, Clinical Research for Women, Tienen, Belgium; Department of Obstetrics and Gynaecology, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital, Edegem, Belgium
| | | | - Wiebren Tjalma
- Molecular Imaging, Pathology, Radiotherapy, Oncology, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium; Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital, Edegem, Belgium
| | - Jean Doyen
- Department Gynaecology-Obstetrics, University Hospital Liège, Liège, Belgium
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem (Antwerp), Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Pasquier C, Raymond S, Duchanois D, Sauné K, Oliveira-Mendes K, Vayssiere C, Izopet J. Human papillomavirus testing using HPV APTIMA® assay and an external cellularity control in self-collected samples. J Med Virol 2023; 95:e29283. [PMID: 38088528 DOI: 10.1002/jmv.29283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/06/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
In cervical cancer screening programs, the detection of high-risk human papillomavirus (HR-HPV) is now widely implemented on physician-collected samples and has expanded to include self-collected samples. The use of a cellularity control (CC) is needed to reduce false-negative HPV results. An external mRNA CC for the HPV APTIMA® assay was assessed for its analytical performance and the results were compared with both cervix cytobrush samples taken by physicians and self-collected vaginal samples from 148 women. The performance of the CC was adjusted to control for the presence of cellular mRNA in the ThinPrep® and Multitest® transport media. This CC is user-friendly but implies to perform two independent assays on PANTHER® automate. Self-collected vaginal sampling gives a lower median CC results (13.2 vs. 16.9 min) but a higher risk of negative CC results (3.3 vs. 0%). The usefulness of the CC for the HR-HPV assay may be optimized by the definition of a threshold for a minimum cell number to be tested to increase confidence in HPV-negative results. The systematic use of an RNA CC increases confidence for HPV RNA assays on self-collected vaginal samples.
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Affiliation(s)
| | - Stéphanie Raymond
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | - Delphine Duchanois
- Research Unit in Obstetrics and Gynaecology (UROG), Toulouse University Hospital, Toulouse, France
| | - Karine Sauné
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | | | - Christophe Vayssiere
- Research Unit in Obstetrics and Gynaecology (UROG), Toulouse University Hospital, Toulouse, France
| | - Jacques Izopet
- Department of Virology, Toulouse University Hospital, Toulouse, France
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Simms KT, Keane A, Nguyen DTN, Caruana M, Hall MT, Lui G, Gauvreau C, Demke O, Arbyn M, Basu P, Wentzensen N, Lauby-Secretan B, Ilbawi A, Hutubessy R, Almonte M, De Sanjosé S, Kelly H, Dalal S, Eckert LO, Santesso N, Broutet N, Canfell K. Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population. Nat Med 2023; 29:3050-3058. [PMID: 38087115 PMCID: PMC10719104 DOI: 10.1038/s41591-023-02600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/19/2023] [Indexed: 12/17/2023]
Abstract
In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health problem. To support the strategy, the WHO published updated cervical screening guidelines in 2021. To inform this update, we used an established modeling platform, Policy1-Cervix, to evaluate the impact of seven primary screening scenarios across 78 low- and lower-middle-income countries (LMICs) for the general population of women. Assuming 70% coverage, we found that primary human papillomavirus (HPV) screening approaches were the most effective and cost-effective, reducing cervical cancer age-standardized mortality rates by 63-67% when offered every 5 years. Strategies involving triaging women before treatment (with 16/18 genotyping, cytology, visual inspection with acetic acid (VIA) or colposcopy) had close-to-similar effectiveness to HPV screening without triage and fewer pre-cancer treatments. Screening with VIA or cytology every 3 years was less effective and less cost-effective than HPV screening every 5 years. Furthermore, VIA generated more than double the number of pre-cancer treatments compared to HPV. In conclusion, primary HPV screening is the most effective, cost-effective and efficient cervical screening option in LMICs. These findings have directly informed WHO's updated cervical screening guidelines for the general population of women, which recommend primary HPV screening in a screen-and-treat or screen-triage-and-treat approach, starting from age 30 years with screening every 5 years or 10 years.
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Affiliation(s)
- Kate T Simms
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
| | - Adam Keane
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Diep Thi Ngoc Nguyen
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michaela T Hall
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Gigi Lui
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Cindy Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- SUCCESS Project, Expertise France, Paris, France
| | - Owen Demke
- Global Diagnostics, Clinton Health Access Initiative, Kigali, Rwanda
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Silvia De Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Helen Kelly
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shona Dalal
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Linda O Eckert
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
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Giuffrè G, Iacobellis M. Re: '2020 list of human papillomavirus assays suitable for primary cervical cancer screening' by Arbyn et al. Clin Microbiol Infect 2023; 29:1606-1607. [PMID: 37595800 DOI: 10.1016/j.cmi.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Giuseppe Giuffrè
- Laboratory of Molecular Pathologic Anatomy, Department of Human Pathology in Adult and Developmental Age "G. Barresi", University of Messina, Messina, Italy.
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Arbyn M, Cuschieri K, Poljak M, Bonde J. Can REALQUALITY RQ-HPV screen be considered as a clinically validated HPV test for use in cervical cancer screening? Clin Microbiol Infect 2023; 29:1608-1609. [PMID: 37634865 DOI: 10.1016/j.cmi.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium.
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
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Liu Y, Chen Y, Xiong J, Zhu P, An Y, Li S, Chen P, Li Q. Performance of DNA methylation analysis in the detection of high-grade cervical intraepithelial neoplasia or worse (CIN3+): a cross-sectional study. Infect Agent Cancer 2023; 18:77. [PMID: 38031140 PMCID: PMC10687787 DOI: 10.1186/s13027-023-00555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
It is commonly accepted that host genes show high methylation in cervical intraepithelial neoplasia 3 (CIN3) or worse (CIN3+). However, study quality varies, as does the clinical performance of markers in different populations. We aimed to validate candidate gene DNA methylation with standardized testing methods in the same batch of samples. We first compared the performance of 16 DNA methylation markers for detecting CIN3+ in the 82-sample training set, including 24 subjects with ≤ CIN1, 10 subjects with CIN2, 23 subjects with CIN3, and 25 subjects with cervical cancer (CC). Then five methylation markers were selected and subsequently validated among an independent set of 74 subjects, including 47 subjects with ≤ CIN1, 13 subjects with CIN2, 6 subjects with CIN3, and 8 subjects with CC. The results in the validation set revealed that methylation analysis of the SOX1 (SOX1m) showed a superior level of clinical performance (AUC = 0.879; sensitivity = 85.7%; specificity = 90.0%). SOX1m had better accuracy than cytology, with a reduced referral rate (23.0% vs. 31.4%) and a lower number of overtreatment (5 vs. 13) cases among high-risk human papillomavirus (hrHPV)-positive women. Importantly, among hrHPV-positive and SOX1m-negative women, only 1 CIN3 patient was at risk for follow-up after 1 year, whereas 1 CIN3 patient and 1 CC patient were at risk among hrHPV-positive and cytology-negative women. In this investigation, we screened 16 reported methylation markers to provide a basis for future studies related to potential precancerous lesion/cancer methylation markers in the Chinese population. The study also revealed that SOX1m has optimal CIN3+ detection performance, suggesting that it may be a promising biomarker for detecting CIN3+ in the Chinese population.
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Affiliation(s)
- Yuxiang Liu
- Department of Gynaecology and Obstetrics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, People's Republic of China
| | - Yan Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China
- Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China
- Xiangya Medical Laboratory, Central South University, 110 Xiangya Road, Changsha, 410078, People's Republic of China
| | - Jing Xiong
- Department of Gynaecology and Obstetrics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, People's Republic of China
| | - Peng Zhu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China
- Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China
| | - Yuhang An
- Xiangya Medical Laboratory, Central South University, 110 Xiangya Road, Changsha, 410078, People's Republic of China
| | - Shu Li
- Xiangya Medical Laboratory, Central South University, 110 Xiangya Road, Changsha, 410078, People's Republic of China
| | - Puxiang Chen
- Department of Gynaecology and Obstetrics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, People's Republic of China.
| | - Qing Li
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China.
- Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China.
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China.
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Glinska P, Komerska K, Janik B, Olkowicz J, Jedrzejewska I, Macios A, Wieszczy P, Kaminski MF, Arbyn M, Nowakowski A. HPV testing in Polish population-based cervical cancer screening programme (HIPPO project)-study protocol of a randomised healthcare policy trial. BMC Cancer 2023; 23:1118. [PMID: 37978452 PMCID: PMC10655392 DOI: 10.1186/s12885-023-11597-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND An Organised Cervical Cancer Screening Programme (OCCSP) was started in Poland in 2006/2007. Each woman aged 25 to 59 is eligible for a free Pap test every 3 years in OCCSP. Despite implementation of the OCCSP, the age-standardised cervical cancer (CC) incidence and mortality rates in 2019 were 7.3/100 000 and 3.9/100 000 respectively and were still higher than those in Western European countries with well-organised screening programmes. Apart from low coverage of the OCCSP, suboptimal performance of the screening test (conventional cytology) may be partially responsible for this situation. Several countries have already incorporated high risk Human Papillomavirus (hrHPV) testing in CC screening as a more sensitive tool reducing the risk of missing precancerous lesions and allowing for extension of screening intervals. The European Guidelines for Quality Assurance in Cervical Cancer Screening recommend pilot evaluation of a new screening test in country-specific conditions before its implementation. METHODS The HIPPO project (HPV testing In Polish POpulation-based cervical cancer screening program) is a randomised health services study nested in the OCCSP in Poland. The project will randomise 33 000 women aged 30-59 years to cytology or hrHPV testing (ratio: 1:1) with age stratification. In the cytology arm women with repeated Atypical Squamous Cells of Undetermined Significance (ASC-US) or ≥ Low-Grade Squamous Intraepithelial Lesions (LSIL) are referred for colposcopy. In the other arm, hrHPV ( +) women with ≥ ASC-US reflex Liquid-Based Cytology (LBC) are referred for colposcopy. Primary endpoints include detection rates of histologically confirmed high grade intraepithelial lesions or worse (CIN2 +) in each arm. DISCUSSION This pilot randomised healthcare study nested in the OCCSP in Poland will assess and compare the performance of hrHPV testing to current standard-cytology in order to make decisions on implementation of HPV-based screening in the country. TRIAL REGISTRATION This randomised healthcare service study was prospectively registered at https://clinicaltrials.gov/ (identifier: NCT04111835, protocol ID 28/2019) on 19th of September 2019.
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Affiliation(s)
- Patrycja Glinska
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland.
- Warsaw PhD School in Natural and BioMedical Sciences, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland.
| | - Katarzyna Komerska
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland
| | - Beata Janik
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland
| | - Julia Olkowicz
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartanska Street 1, Warsaw, Poland
| | - Ilona Jedrzejewska
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland
| | - Anna Macios
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland
- Doctoral School of Translational Medicine, Centre of Postagraduate Medical Education, Marymoncka Street 99/103, Warsaw, Poland
| | - Paulina Wieszczy
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Roentgen Street 5, Warsaw, Poland
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Forskningsveien Street 3A, Oslo, Norway
| | - Michal F Kaminski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Roentgen Street 5, Warsaw, Poland
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Forskningsveien Street 3A, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Forskningsveien Street 3A, Oslo, Norway
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J. Wytsmanstreet 14, B1050, Brussels, Belgium
| | - Andrzej Nowakowski
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, Warsaw, Poland
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Chan AHY, Ngu SF, Lau LSK, Tsun OKL, Ngan HYS, Cheung ANY, Chan KKL. Evaluation of an Isothermal Amplification HPV Assay on Self-Collected Vaginal Samples as Compared to Clinician-Collected Cervical Samples. Diagnostics (Basel) 2023; 13:3297. [PMID: 37958193 PMCID: PMC10647996 DOI: 10.3390/diagnostics13213297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to evaluate the concordance of HPV results between the SentisTM HPV assay (Sentis) (BGI Group, Shenzhen, China), an isothermal amplification-based HPV assay, on self-collected and clinician-collected samples and the agreement of Sentis on self-collected samples with the BD OnclarityTM HPV assay (Onclarity) (Becton, Dickinson, and Company, Franklin Lakes, New Jersey, USA), a PCR-based HPV assay, on clinician-collected samples. This was a prospective study of 104 women attending the colposcopy clinic for abnormal smears. After informed consent, participants self-collected vaginal samples before having clinician-collected cervical samples. Self-collected samples underwent HPV testing with Sentis (Self-Sentis HPV) and clinician-collected samples were tested with Sentis (Clinician-Sentis HPV) and Onclarity (Clinician-Onclarity), which was used as a reference standard. The concordance was assessed using Cohen's kappa. The prevalence of HPV and the acceptability of self-sampling were also evaluated. The concordance rate between Self-Sentis HPV and Clinician-Sentis HPV was 89.8% with a kappa of 0.769. The concordance rate between Self-Sentis HPV and Clinician-Onclarity was 84.4% with a kappa of 0.643. The prevalence of HPV was 26.0% on Clinician-Onclarity, 29.3% on Clinician-Sentis HPV, and 35.6% on Self-Sentis HPV. Overall, 65% of participants would undergo self-sampling again. This was attributed to mainly not feeling embarrassed (68%) and being convenient (58%). Our study showed a substantial agreement between Self-Sentis HPV with Clinician-Sentis HPV and Clinician-Onclarity. Self-sampling was also shown to be a generally well-accepted method of screening.
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Affiliation(s)
- Aaron H. Y. Chan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
| | - Siew-Fei Ngu
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
| | - Lesley S. K. Lau
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
| | - Obe K. L. Tsun
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (O.K.L.T.); (A.N.Y.C.)
| | - Hextan Y. S. Ngan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
| | - Annie N. Y. Cheung
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (O.K.L.T.); (A.N.Y.C.)
| | - Karen K. L. Chan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
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Wang J, Elfström KM, Lagheden C, Eklund C, Sundström K, Sparén P, Dillner J. Impact of cervical screening by human papillomavirus genotype: Population-based estimations. PLoS Med 2023; 20:e1004304. [PMID: 37889928 PMCID: PMC10637721 DOI: 10.1371/journal.pmed.1004304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/10/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Cervical screening programs use testing for human papillomavirus (HPV) genotypes. Different HPV types differ greatly in prevalence and oncogenicity. We estimated the impact of cervical screening and follow-up for each HPV type. METHODS AND FINDINGS For each type of HPV, we calculated the number of women needed to screen (NNS) and number of women needing follow-up (NNF) to detect or prevent one cervical cancer case, using the following individual level input data (i) screening and cancer data for all women aged 25 to 80 years, resident in Sweden during 2004 to 2011 (N = 3,568,938); (ii) HPV type-specific prevalences and screening histories among women with cervical cancer in Sweden in 2002 to 2011(N = 4,254); (iii) HPV 16/18/other HPV prevalences in the population-based HPV screening program (N = 656,607); and (iv) exact HPV genotyping in a population-based cohort (n = 12,527). Historical screening attendance was associated with a 72% reduction of cervical cancer incidence caused by HPV16 (71.6%, 95% confidence interval (CI) [69.1%, 73.9%]) and a 54% reduction of cancer caused by HPV18 (53.8%, 95% CI [40.6%, 63.1%]). One case of HPV16-caused cervical cancer could be prevented for every 5,527 women attending screening (number needed to screen, NNS). Prevention of one case of HPV16-caused cervical cancer required follow-up of 147 HPV16-positive women (number needed to follow-up, NNF). The NNS and NNF were up to 40 to 500 times higher for HPV types commonly screened for with lower oncogenic potential (HPV35,39,51,56,59,66,68). For women below 30 years of age, NNS and NNF for HPV16 were 4,747 and 289, respectively, but >220,000 and >16,000 for HPV35,39,51,56,59,66,68. All estimates were either age-standarized or age-stratified. The primary limitation of our study is that NNS is dependent on the HPV prevalence that can differ between populations and over time. However, it can readily be recalculated in other settings and monitored when HPV type-specific prevalence changes. Other limitations include that in some age groups, there was little data and extrapolations had to be made. Finally, there were very few cervical cancer cases associated with certain HPV types in young age group. CONCLUSIONS In this study, we observed that the impact of cervical cancer screening varies depending on the HPV type screened for. Estimating and monitoring the impact of screening by HPV type can facilitate the design of effective and efficient HPV-based cervical screening programs. TRIAL REGISTRATION ClinicalTrials.gov with numbers NCT00479375, NCT01511328.
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Affiliation(s)
- Jiangrong Wang
- Division of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - K. Miriam Elfström
- Division of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla Lagheden
- Division of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Carina Eklund
- Division of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Sundström
- Division of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Division of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
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Cuschieri K, Palmer T, Graham C, Cameron R, Roy K. The changing nature of HPV associated with high grade cervical lesions in vaccinated populations, a retrospective study of over 1700 cases in Scotland. Br J Cancer 2023; 129:1134-1141. [PMID: 37563221 PMCID: PMC10539290 DOI: 10.1038/s41416-023-02386-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Understanding the pattern and dominance of HPV types in high grade cervical disease within increasingly vaccinated populations will help inform the development of appropriate screening and management protocols. METHODS Over 1700 cases of cervical intraepithelial neoplasia (CIN) diagnosed between 2011 and 2017 in women younger than 25 were genotyped for HPV. Logistic regression was used to assess the association between HPV 16/18 positivity with biopsy-collection year, birth year, deprivation and vaccination status. Regression analysis was repeated for cross-protective types (31, 33 and 45). Type specific detail of non-vaccine types by vaccination status was presented descriptively. RESULTS Detection of HPV 16/18 or 16/18/31/33 and 45 was lower in CIN2 associated with full vaccination vs no vaccination (OR 0.3; 95% CI 0.2-0.5 & 0.4; 95% CI 0.3-0.6 respectively) Similar observations were made for CIN3. The relative contribution of non-established high-risk types including those considered low risk was greater among vaccinated women with CIN2+ vs unvaccinated women with CIN2+. CONCLUSIONS The change in HPV distribution in CIN2+ in vaccinated populations is a further marker of vaccine impact. Additionally, the progression rate of CIN2+ in vaccinated populations may be lower given the shift in type distribution. The definition of high grade disease in vaccinated populations may warrant reassessment.
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Affiliation(s)
- Kate Cuschieri
- Scottish HPV Reference Laboratory, Dept of Lab Medicine Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, EH16 4SA, UK.
| | - Tim Palmer
- Public Health Scotland, 5 Cadogan Street, Glasgow, G2 6QE, UK
| | - Catriona Graham
- Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Edinburgh, Scotland, UK
| | - Ross Cameron
- Public Health Scotland, 5 Cadogan Street, Glasgow, G2 6QE, UK
| | - Kirsty Roy
- Public Health Scotland, 5 Cadogan Street, Glasgow, G2 6QE, UK
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Liu Y, Jin X, Gong Y, Ma Y, Du B, Yang L, Wang Y, Zhu W. Do women with high-risk HPV E6/E7 mRNA test positivity and NILM cytology need colposcopy? Infect Agent Cancer 2023; 18:54. [PMID: 37773080 PMCID: PMC10542237 DOI: 10.1186/s13027-023-00531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE This study aimed to assess the value of an HPV E6/E7 mRNA assay and HPV 16 18/45 genotype assay combined with age stratification for triaging women negative for intraepithelial lesions or malignancy (NILM) cytology. METHODS From January 2017 to December 2021, a total of 162,309 eligible women underwent cervical cancer screening at the Affiliated Hospital of Jining Medical University, China. Excluding those with negative HPV E6/E7 mRNA, abnormal and unsatisfactory cytology, and those who failed to undergo colposcopy, 6,845 women were ultimately included in our study. We analysed the triage guidance for different subtypes of HPV in the presence of NILM cytology. RESULTS Among 162,309 women, 19,834 (12.2%) were positive for HPV E6/E7 mRNA. Of the 6,845 women included in the study, 1,941 (28.4%), 561 (8.2%), 55 (0.8%) and 4,288 (62.6%) tested positive for HPV 16, HPV 18/45, HPV16/18/45 or other HR-HPV genotypes, respectively. The proportions of LSIL+ (including LSIL, HSIL and ICC) and HSIL+ (including HSIL and ICC) pathological results in the HPV 16/18/45 + group were 57% and 34.1%, respectively, higher than 36.3% and 11% in the other HR-HPV + group (χ2 = 653.214, P < 0.001). The percentages of LSIL + and HSIL + in the HPV16 + group (61.3% and 42.8%, respectively) and HPV16+/18/45 + group (76.3% and 41.9%, respectively) were much higher than those in the HPV18 + group (40.6% and 13.1%, respectively) (P < 0.001). However, there was no significant difference in the percentage of histopathological results between the HPV16 + group and HPV16+/18/45 + groups (P > 0.05). The above results were consistent after stratification according to age. CONCLUSION The rate of histopathological abnormalities was still high for the other HR-HPV subtypes with NILM cytology, although the rate of histopathological abnormalities was much higher for the HPV 16/18/45 positive subtypes. Therefore, colposcopy should be performed in women with HPV E6/E7 mRNA positivity and NILM cytology, regardless of age and HPV genotype.
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Grants
- M-2022242 Shandong Provincial Traditional Chinese Medicine Science and Technology Development Project
- M-2022242 Shandong Provincial Traditional Chinese Medicine Science and Technology Development Project
- 2020YXNS026,2021YXNS085,2022YXNS007 the Key R&D Program of Jining
- 2020YXNS026,2021YXNS085,2022YXNS007 the Key R&D Program of Jining
- 2020YXNS026,2021YXNS085,2022YXNS007 the Key R&D Program of Jining
- 2020YXNS026,2021YXNS085,2022YXNS007 the Key R&D Program of Jining
- JYHL2018FMS07,JYHL2022FMS01 Research Fund for Academician Lin He New Medicine
- JYHL2018FMS07,JYHL2022FMS01 Research Fund for Academician Lin He New Medicine
- 81502255 the National Natural Science Foundation of China
- the Key R&D Program of Jining
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Affiliation(s)
- Ying Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Xiu Jin
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Yingying Gong
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Yingying Ma
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Beibei Du
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Linqing Yang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Yunfei Wang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China.
| | - Weipei Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Taghavi K, Zhao F, Downham L, Baena A, Basu P. Molecular triaging options for women testing HPV positive with self-collected samples. Front Oncol 2023; 13:1243888. [PMID: 37810963 PMCID: PMC10560038 DOI: 10.3389/fonc.2023.1243888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
We review developments in molecular triaging options for women who test positive for high-risk human papillomavirus (hrHPV) on self-collected samples in the context of cervical cancer elimination. The World Health Organization (WHO) recommends hrHPV screening as the primary test for cervical screening due to its high sensitivity compared to other screening tests. However, when hrHPV testing is used alone for treatment decisions, a proportion of women of childbearing age receive unnecessary treatments. This provides the incentive to optimize screening regimes to minimize the risk of overtreatment in women of reproductive age. Molecular biomarkers can potentially enhance the accuracy and efficiency of screening and triage. HrHPV testing is currently the only screening test that allows triage with molecular methods using the same sample. Additionally, offering self-collected hrHPV tests to women has been reported to increase screening coverage. This creates an opportunity to focus health resources on linking screen-positive women to diagnosis and treatment. Adding an additional test to the screening algorithm (a triage test) may improve the test's positive predictive value (PPV) and offer a better balance of benefits and risks for women. Conventional triage methods like cytology and visual inspection with acetic acid (VIA) cannot be performed on self-collected samples and require additional clinic visits and subjective interpretations. Molecular triaging using methods like partial and extended genotyping, methylation tests, detection of E6/E7 proteins, and hrHPV viral load in the same sample as the hrHPV test may improve the prediction of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and invasive cancer, offering more precise, efficient, and cost-effective screening regimes. More research is needed to determine if self-collected samples are effective and cost-efficient for diverse populations and in comparison to other triage methods. The implementation of molecular triaging could improve screening accuracy and reduce the need for multiple clinical visits. These important factors play a crucial role in achieving the global goal of eliminating cervical cancer as a public health problem.
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Affiliation(s)
- Katayoun Taghavi
- Early Detection, Prevention and Infections Branch, International Agency For Research On Cancer (IARC), Lyon, France
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Laura Downham
- Early Detection, Prevention and Infections Branch, International Agency For Research On Cancer (IARC), Lyon, France
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency For Research On Cancer (IARC), Lyon, France
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency For Research On Cancer (IARC), Lyon, France
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Martinelli M, Giubbi C, Di Meo ML, Perdoni F, Musumeci R, Leone BE, Fruscio R, Landoni F, Cocuzza CE. Accuracy of Human Papillomavirus (HPV) Testing on Urine and Vaginal Self-Samples Compared to Clinician-Collected Cervical Sample in Women Referred to Colposcopy. Viruses 2023; 15:1889. [PMID: 37766295 PMCID: PMC10537107 DOI: 10.3390/v15091889] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
In the context of cervical cancer prevention, where human papillomavirus (HPV) infection is pivotal, HPV testing is replacing Pap Smear in primary screening. This transition offers an opportunity for integrating self-sampling to enhance coverage. We evaluated the accuracy of HPV testing using self-collected urine and vaginal samples, comparing them to physician-collected cervical swabs. From a cohort of 245 women with abnormal cytology, we collected self-sampled vaginal, urine, and clinician-administered cervical specimens. Employing Anyplex™II HPV28 assay, outcomes revealed HPV positivity rates of 75.1% (cervical), 78.4% (vaginal), and 77.1% (urine). Significant, hr-HPV detection concordance was observed between self-taken cervical samples and clinical counterparts (k = 0.898 for vaginal; k = 0.715 for urine). This study extends beyond accuracy, highlighting self-collected sample efficacy in detecting high-grade cervical lesions. The insight underscores self-sampling's role in bolstering participation and aligns with WHO's goal to eliminate cervical cancer by 2030.
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Affiliation(s)
- Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
| | - Chiara Giubbi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
| | | | - Federica Perdoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
| | - Rosario Musumeci
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
| | - Biagio Eugenio Leone
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
- IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
- IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
- IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Clementina Elvezia Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
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Dai Y, Chen T, Li X, Zhang C, Li T, Zhao Y, Wang Y, Chen S, Yu L, Jiang M, Wu Z, Yang J, Chen W. Evaluation of the clinical performance of p16/Ki-67 dual-staining cytology for cervical lesion detection in premenopausal and postmenopausal Chinese women. J Cancer Res Clin Oncol 2023; 149:10645-10658. [PMID: 37302113 DOI: 10.1007/s00432-023-04938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Studies on the clinical performance of p16/Ki-67 dual-staining in detecting cervical lesions by menopausal status were limited. METHODS 4364 eligible women were enrolled with valid p16/Ki-67, HR-HPV, and LBC test results, including 542 cancer and 217 CIN2/3 cases. The positivity rates of p16 and Ki-67 single staining and p16/ Ki-67 dual-staining were analyzed by different pathological grades and age groups. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV) of each test in different subgroups were calculated and compared. RESULTS P16/Ki-67 dual-staining positivity increased with histopathological severity in premenopausal and postmenopausal women (P < 0.05), while no increasing trends of individual expression of p16 single staining and Ki-67 single staining were observed in postmenopausal women. P16/Ki-67 showed higher SPE (88.09% vs. 81.91%, P < 0.001) and PPV (33.8% vs. 13.18%, P < 0.001) in detecting CIN2/3, and higher SEN (89.97% vs. 82.61%, P = 0.012) and SPE (83.22% vs. 79.89%, P = 0.011) in detecting cancer in premenopausal women than postmenopausal women. For triaging the HR-HPV+ population to identify CIN2/3, p16/Ki-67 performed comparably to LBC in the premenopausal women, and showed higher PPV (51.14% vs. 23.08%, P < 0.001) in premenopausal than postmenopausal women. For triaging ASC-US/LSIL population, p16/Ki-67 demonstrated higher SPE and lower colposcopy referral rate than HR-HPV in both premenopausal and postmenopausal women. CONCLUSIONS Expressions of p16/Ki-67 dual-staining between premenopausal and postmenopausal women are varied. P16/Ki-67 performs better in detecting cervical lesions in premenopausal women. For triaging, p16/Ki-67 is suitable for HR-HPV+ women, especially premenopausal women, to identify CIN2/3 and women with ASC-US/LSIL.
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Affiliation(s)
- Yu Dai
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tingting Chen
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, 518104, China
| | - Xinyue Li
- College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding, 071000, China
| | - Changning Zhang
- College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding, 071000, China
| | - Tingyuan Li
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yuqian Zhao
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yakun Wang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Simiao Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lulu Yu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Mingyue Jiang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zeni Wu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jinghong Yang
- Mianyang Maternity and Child Health Care Hospital, Mianyang, 621000, China.
| | - Wen Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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47
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Dhillon SK, Chung PYJ, Padalko E, Praet M, Pereira AR, Redzic N, Vanden Broeck D, Arbyn M. Intra- and interlaboratory reproducibility of the RIATOL qPCR HPV genotyping assay. J Med Virol 2023; 95:e29093. [PMID: 37702556 DOI: 10.1002/jmv.29093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
The implementation of cervical screening based on human papillomavirus (HPV) continues to progress rapidly across countries. Evidence has shown that assays detecting high-risk human papillomavirus (hrHPV) deoxyribonucleic acid (DNA) are more effective than cytology-based screening. Validation of new hrHPV DNA assays requires both noninferior clinical accuracy compared to a standard comparator for cervical precancer and good reproducibility. This study builds upon previous diagnostic accuracy assessments of the RIATOL HPV genotyping qPCR assay and aims to evaluate the international validation criteria for reproducibility. The intra- and interreproducibility of the RIATOL-qPCR assay were assessed using 550 remnant cervical cell material from the cytology archive of the National Reference Center for HPV in Belgium. Specimens were collected in the context of cervical cancer screening and tested in two different laboratories. The international reproducibility criteria include the lower bound of 95% confidence interval of the intra- and interlaboratory agreement regarding the detection of hrHPV DNA exceeding 87% with kappa ≥0.50. The RIATOL-qPCR assay demonstrated excellent intralaboratory reproducibility, achieving an overall agreement of 98.2 (95% CI 96.6-99.1%) and a kappa of 0.96. Interlaboratory testing showed an overall agreement of 98.5 (95% CI 97.1-99.4%) with a kappa of 0.97. The RIATOL-qPCR assay fulfills the third criterion for HPV test reproducibility requirement for use in cervical cancer screening.
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Affiliation(s)
- Sharonjit K Dhillon
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Pui Yan Jenny Chung
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Elizaveta Padalko
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostics Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marleen Praet
- Department of Pathological Anatomy, University of Ghent, Ghent, Belgium
| | - Ana Rita Pereira
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Antwerp, Belgium
| | - Nina Redzic
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Antwerp, Belgium
- AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
| | - Davy Vanden Broeck
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Antwerp, Belgium
- AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
- National Reference Centre for HPV, Brussels, Belgium
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
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Latsuzbaia A, Vanden Broeck D, Van Keer S, Weyers S, Donders G, Doyen J, Tjalma W, De Sutter P, Vorsters A, Arbyn M. Comparison of the Clinical Accuracy of Xpert HPV Assay on Vaginal Self-Samples and Cervical Clinician-Taken Samples within the VALHUDES Framework. J Mol Diagn 2023; 25:702-708. [PMID: 37354994 DOI: 10.1016/j.jmoldx.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023] Open
Abstract
The accuracy of high-risk human papillomavirus testing with the Xpert HPV assay on vaginal self-samples was compared with clinician-taken samples within the VALidation of HUman papillomavirus assays and collection DEvices for Self-samples and urine samples (VALHUDES) framework. Five-hundred and twenty-three women were recruited in five Belgian colposcopy clinics, of whom 483 (median age, 40 years; interquartile range, 31 to 49 years) were included in the main analysis (226 collected with Evalyn Brush and 257 collected with Qvintip). Cervical samples were collected with Cervex-Brush. Colposcopy and histology outcomes were considered as the reference standard. The Xpert HPV assay had similar accuracy for cervical intraepithelial neoplasia ≥2 on self-collected versus clinician-collected samples [relative sensitivity, 0.96 (95% CI, 0.91-1.02); and relative specificity, 0.96 (95% CI, 0.89-1.04)]. The relative accuracy slightly differed by vaginal collection device [sensitivity ratios of 0.98 (95% CI, 0.90-1.06) and 0.94 (95% CI, 0.87-1.02) for Evalyn and Qvintip, respectively; specificity ratios of 1.06 (95% CI, 0.95-1.19) and 0.88 (95% CI, 0.80-0.98) for Evalyn and Qvintip, respectively]. No difference in cycle threshold values was observed between vaginal and cervical samples. In conclusion, the sensitivity of Xpert HPV assay for cervical intraepithelial neoplasia ≥2 on vaginal self-samples was similar to that of cervical specimens. The clinical specificity was lower than on clinician-collected samples when self-samples were taken with Qvintip.
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Affiliation(s)
- Ardashel Latsuzbaia
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Davy Vanden Broeck
- Laboratory of Molecular Pathology, Algemeen Medisch Laboratorium Sonic Healthcare, Antwerp, Belgium; National Reference Centre for HPV, Brussels, Belgium; AMBIOR, Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium; International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Severien Van Keer
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Gilbert Donders
- Department of Obstetrics and Gynaecology of the General Regional Hospital Heilig Hart, Tienen, Belgium; Femicare vzw, Clinical Research for Women, Tienen, Belgium; Department of Obstetrics and Gynaecology, University Hospital Antwerp, Antwerp, Belgium
| | - Jean Doyen
- Department Gynaecology-Obstetrics, University Hospital Liège, Liège, Belgium
| | - Wiebren Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital, Edegem, Belgium; Molecular Imaging, Pathology, Radiotherapy, Oncology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Philippe De Sutter
- Department Gynaecology-Oncology, University Hospital Brussels, Brussels, Belgium
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Long ME, Lee YS, Vegunta S. Cervical cancer screening in menopause: when is it safe to exit? Menopause 2023; 30:972-979. [PMID: 37527477 DOI: 10.1097/gme.0000000000002222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
IMPORTANCE AND OBJECTIVE Despite a decreasing incidence of cervical cancer in North America overall, disparities in screening and cervical cancer rates persist, especially in the postmenopausal age group. METHODS We reviewed the literature regarding cervical cancer screening considerations for postmenopausal persons, with a focus on cervical cancer in postmenopausal persons, existing guidelines, screening methods, and gaps in care. DISCUSSION AND CONCLUSION Postmenopausal persons are an important population at risk because age 65 years in the United States and up to 70 years in some parts of Canada is a milestone for screening cessation if the criteria are met. Unfortunately, inadequate screening is common, with most women 65 years or older discontinuing ( exiting ) screening despite not meeting the criteria to do so. Screening cessation recommendations are nuanced, and if not all criteria are met, screening should be continued until they are. Cervical cancer screening should be stopped at the recommended age if adequate screening has occurred or at any age if life expectancy is limited or the patient has had a hysterectomy in the absence of high-grade preinvasive cervical lesions or cervical cancer. Human papillomavirus infection, which is causally linked to almost all cervical cancer cases, can persist or reactivate from a prior infection or can be newly acquired from sexual contact. With more persons aging with a cervix in place, the potential for cervical cancer has increased, and higher cancer rates may be observed if recommended screening is not adhered to. We propose an algorithm based on current cervical cancer screening guidelines to aid providers in identifying whether exit criteria have been met. Until adequate screening has been confirmed, cervical cancer screening should continue.
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Affiliation(s)
- Margaret E Long
- From the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Yeonsoo S Lee
- Student, Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Scottsdale, AZ
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
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50
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Han C, Huang W, Ye M, Zou R, Lan J, Chen J, Jiang J, Wang H, Xia L, Luo J, Li D, Geng J, Wang Z, Huang J. HPV prevalence and genotype distribution in 2,306 patients with cervical squamous cell carcinoma in central and eastern China. Front Public Health 2023; 11:1225652. [PMID: 37701907 PMCID: PMC10493278 DOI: 10.3389/fpubh.2023.1225652] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/09/2023] [Indexed: 09/14/2023] Open
Abstract
Background To explore the positivity rate and genotype distribution of human papillomavirus (HPV) in cervical squamous cell carcinoma (CSCC) tissues in central and eastern China and to provide theoretical basis for cervical cancer screening and prophylactic HPV vaccine development in China. Methods DNA was extracted from paraffin-embedded tissues of CSCC samples and exfoliated cervical cells of cervical cancer screening populations. 23 HPV genotypes were detected by combining polymerase chain reaction (PCR) and reverse dot hybridized gene chip detection technology in 2,306 CSCC tissues and 10,245 cervical cancer screening populations. The genotype distribution of HPV infection was analyzed. Results The overall infection rate of HPVs in 2,306 CSCC patients was 92.71%. The frequency of single-type HPV infection and multiple-type HPV infection were 86.48% and 13.51%, respectively. The most common HPV genotypes detected in Chinese CSCC tissues were HPV-16, HPV-18, HPV-31, HPV-33, HPV-45, HPV-52, HPV-58, and HPV-59. The overall positivity rate of these eight high-risk HPV (HR-HPV) genotypes in HPV-positive CSCC was as high as 96.91%. Of which the positivity rate of seven HR-HPV genotypes related to nine-valent HPV vaccines in HPV-positive CSCC was 95.09%. Meanwhile, the overall infection rates of HR-HPV and low-risk HPV (LR-HPV) in female aged 35-64 years who underwent cervical cancer screening were 13.16% and 1.32%, respectively. The high-frequency HR-HPV genotypes in cervical cancer screening women were HPV-52, HPV-58, HPV-16, HPV-53, HPV-68, HPV-39, HPV-51, and HPV-56, with positivity rates of 2.25%, 1.60%, 1.31%, 1.22%, 0.93%, 0.92%, 0.78%, and 0.74%, respectively. Conclusion Among women screened for cervical cancer in China, detecting the 8 high-frequency HR-HPV genotypes can reduce technical difficulty and reagent costs, while also improving the efficiency and effectiveness of cervical cancer screening. HPV genotyping assists gynecologists in assessing the risk of HR-HPV-positive cervical intraepithelial neoplasia and guiding them in implementing appropriate interventions. Furthermore, HPV genotyping is helpful for doctors to follow up HR-HPV-positive women and to evaluate the protective effect of HPV vaccine.
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Affiliation(s)
- Chunrong Han
- Department of Pathology, Nanjing Lishui People’s Hospital (Zhongda Hospital Lishui Branch), Southeast University, Nanjing, China
| | - Wanqiu Huang
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Centre for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mei Ye
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Centre for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Zou
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Centre for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianyun Lan
- Department of Pathology, Yancheng No.1 People’s Hospital, Yancheng, China
| | - Jing Chen
- Department of Pathology, Jingjiang People’s Hospital, Taizhou, China
| | - Jingui Jiang
- Department of Pathology, Jinhu County People’s Hospital, Huai’an, China
| | - Hongjing Wang
- Department of Pathology, Dantu District People’s Hospital of Zhenjiang, Zhenjiang, China
| | - Lin Xia
- Department of Pathology, People’s Hospital of Yangzhong City, Yangzhong, China
| | - Jun Luo
- Department of Central Laboratory, Jiangsu Health Vocational College, Nanjing, China
| | - Dongbin Li
- Department of Pathology, Nanjing Meishan Hospital, Nanjing, China
| | - Jianxiang Geng
- Department of Pathology, Nanjing Hospital of Traditional Chinese Medicine, Nanjing, China
- The Cross-Strait Precision Medicine Association HPV Infection Disease Professional Committee, Nanjing, China
| | - Zhihui Wang
- Department of Pathology, Linyi Cancer Hospital, Linyi, China
- The Cross-Strait Precision Medicine Association HPV Infection Disease Professional Committee, Nanjing, China
| | - Jian Huang
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Centre for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
- The Cross-Strait Precision Medicine Association HPV Infection Disease Professional Committee, Nanjing, China
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