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Dombrowski C, Bourgain C, Ma Y, Meiwald A, Pinsent A, Weynand B, Turner KME, Huntington S, Adams EJ, Bogers J, Croes R, Sahebali S. An economic evaluation of two cervical screening algorithms in Belgium: HR-HPV primary compared to HR-HPV and liquid-based cytology co-testing. Eur J Cancer Prev 2024; 33:262-270. [PMID: 37933867 DOI: 10.1097/cej.0000000000000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To assess the costs and benefits of two algorithms for cervical cancer screening in Belgium (1) high-risk human papillomavirus (HR-HPV) primary screening and (2) HR-HPV and liquid-based cytology (LBC) co-testing. METHODS A decision tree was adapted from published work and parameterised using HORIZON study data and Belgian cost and population data. The theoretical model represents two different screening algorithms for a cohort of 577 846 women aged 25-64 attending routine cervical screening. Scenario analyses were used to explore the impact of including vaccinated women and alternative pricing approaches. Uncertainty analyses were conducted. RESULTS The cost per woman screened was €113.50 for HR-HPV primary screening and €101.70 for co-testing, representing a total cost of €65 588 573 and €58 775 083, respectively, for the cohort; a 10% difference. For one screening cycle, compared to HR-HPV primary, co-testing resulted in 13 173 more colposcopies, 67 731 more HR-HPV tests and 477 020 more LBC tests. Co-testing identified 2351 more CIN2+ cases per year (27% more than HR-HPV primary) and 1602 more CIN3+ cases (24% more than HR-HPV primary) than HR-HPV primary. CONCLUSION In Belgium, a co-testing algorithm could increase cervical pre-cancer detection rates compared to HR-HPV primary. Co-testing would cost less than HR-HPV primary if the cost of the HPV test and LBC were cost-neutral compared to the current cost of LBC screening but would cost more if the cost per HPV test and LBC were the same in both co-testing and HR-HPV primary strategies.
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Affiliation(s)
| | - Claire Bourgain
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
| | - Yixuan Ma
- Aquarius Population Health, London, UK
| | | | | | - Birgit Weynand
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
| | | | | | | | - Johannes Bogers
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
- University of Antwerp, Laboratory for Cell Biology and Histology, Antwerp
| | | | - Shaira Sahebali
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
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Ouh YT, Kim TJ, Ju W, Kim SW, Jeon S, Kim SN, Kim KG, Lee JK. Development and validation of artificial intelligence-based analysis software to support screening system of cervical intraepithelial neoplasia. Sci Rep 2024; 14:1957. [PMID: 38263154 PMCID: PMC10806233 DOI: 10.1038/s41598-024-51880-4] [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: 09/13/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
Cervical cancer, the fourth most common cancer among women worldwide, often proves fatal and stems from precursor lesions caused by high-risk human papillomavirus (HR-HPV) infection. Accurate and early diagnosis is crucial for effective treatment. Current screening methods, such as the Pap test, liquid-based cytology (LBC), visual inspection with acetic acid (VIA), and HPV DNA testing, have limitations, requiring confirmation through colposcopy. This study introduces CerviCARE AI, an artificial intelligence (AI) analysis software, to address colposcopy challenges. It automatically analyzes Tele-cervicography images, distinguishing between low-grade and high-grade lesions. In a multicenter retrospective study, CerviCARE AI achieved a remarkable sensitivity of 98% for high-risk groups (P2, P3, HSIL or higher, CIN2 or higher) and a specificity of 95.5%. These findings underscore CerviCARE AI's potential as a valuable diagnostic tool for highly accurate identification of cervical precancerous lesions. While further prospective research is needed to validate its clinical utility, this AI system holds promise for improving cervical cancer screening and lessening the burden of this deadly disease.
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Tae Jin Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, Republic of Korea
| | - Woong Ju
- Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Seob Jeon
- Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Soo-Nyung Kim
- R&D Center, NTL Medical Institute, Yongin, Republic of Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Gil Medical Center, 24, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jae-Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
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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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Dombrowski CA, Weston GMF, Descamps PP, Izopet PJ, Adams EJ, Adams E. Health economic evaluation of an mRNA high-risk human papillomavirus (HR-HPV) assay versus a DNA HR-HPV assay for the proposed French cervical screening programme. Medicine (Baltimore) 2022; 101:e29530. [PMID: 35866838 PMCID: PMC9302372 DOI: 10.1097/md.0000000000029530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Population screening programmes must make good use of resources for the health system and users. To evaluate impacts of the type of diagnostic test in the new French cervical screening programme, an messenger ribonucleic acid (mRNA) high-risk human papillomavirus assay was compared to a deoxyribonucleic acid (DNA) high-risk human papillomavirus assay for a hypothetical cohort of women aged 25 to 65 years. PERSPECTIVE This evaluation takes the perspective of the French healthcare system. SETTING France. METHODS A decision tree model reflecting the French cervical screening algorithms was parametrised using French cost and population data and the Danish Horizon study. The outcomes were total costs, and number of colposcopies, HPV tests and cytology tests for the cohort. One-way and probabilistic sensitivity analyses and scenarios analyses were conducted to test the robustness of results to parameter and structural uncertainty. RESULTS Adopting an mRNA versus DNA assay as part of national cervical screening in France is estimated to save €6.5 million (95% credibility intervals €-1.3 - €13.5 million) and prevent 47,795 (95% credibility intervals 35,309 - 60,139) unnecessary colposcopies, 38,666 unnecessary HPV tests and 121,670 cytology tests over two years for a cohort of 2,168,806 million women aged 25 to 65 years. Sensitivity analyses indicated robust results across a range of inputs. CONCLUSION The choice of high-risk human papillomavirus assay makes a significant difference to resource use and costs and is important to consider when implementing cervical screening in France. Using an mRNA versus DNA assay can result in cost savings and reductions in unnecessary testing and procedures, which in turn benefits women and the health care system.
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Affiliation(s)
| | - Georgie MF Weston
- Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK
| | | | - Pr Jacques Izopet
- U1043; UMR CNRS, U5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), CHU Toulouse, Hôpital Purpan, Virology Laboratory, France
| | | | - Elisabeth Adams
- Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK
- *Correspondence: Elisabeth Adams, Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK (e-mail: )
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Piyathilake CJ, Badiga S, Simons JL, Bell WC, Jolly PE. HPV E1 qPCR, a Low-Cost Alternative Assay to Roche Diagnostic Linear Array is Effective in Identifying Women at Risk for Developing Cervical Cancer. Int J Womens Health 2022; 14:257-266. [PMID: 35221728 PMCID: PMC8865867 DOI: 10.2147/ijwh.s347546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Since a quantitative polymerase chain reaction (qPCR) assay targeting the E1 region of HPV genome is cost-effective/simple to perform, we evaluated the agreement between the Roche Diagnostics Linear Array (RDLA) genotyping test and qPCR-based E1 assay to detect HR-HPV genotypes that are included or not included in HPV vaccines and compared their accuracy to detect CIN 2+. METHODS Study population included 257 African American (AA) and 266 Caucasian American (CA) diagnosed with intraepithelial neoplasia (CIN) grades ≤CIN 1 or ≥CIN 2 (CIN 2+) and tested for HPV by the RDLA and E1 assay. The concordance was determined using Gwet's AC1. The calculated positive predictive value (PPV) and negative predictive value (NPV) of the two assays were used to determine their suitability to detect CIN lesions. RESULTS Overall, the E1 assay showed substantial agreement with the RDLA assay to detect any HR-HPV genotype and the agreement was higher in women diagnosed with CIN 2+ than ≤CIN 1. The concordance was largely higher in Cas than in Aas. The NPV and PPV values to detect CIN lesions were similar between the two assays. CONCLUSION Utilization of the HPV E1 assay as a tool for CC screening could be a cost-effective approach that applies to both vaccinated and unvaccinated populations.
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Affiliation(s)
- Chandrika J Piyathilake
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Suguna Badiga
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Janice L Simons
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Walter C Bell
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Pauline E Jolly
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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Schroll JB, Serizawa RR, Rebolj M. Human Papillomavirus Testing in the Last Cervical Screening Round at Age 60-64 Years. Obstet Gynecol 2021; 138:389-397. [PMID: 34352844 PMCID: PMC8366760 DOI: 10.1097/aog.0000000000004522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the real-life screening outcomes after cytology was replaced by human papillomavirus (HPV) testing for women aged 60-64 years. METHODS Using the Danish national pathology register, we compared screening outcomes during two consecutive calendar periods, one where women were screened with cytology and one where most women were screened with HPV testing. Our primary outcomes were the proportions of women with positive test results, high-grade cervical intraepithelial neoplasia (CIN 2 or worse), and cervical cancer. RESULTS Women screened during the HPV testing period were more likely to have a positive screening test result than were women screened during the cytology period (relative proportion 2.80, 95% CI 2.65-2.96). The detection of CIN 2 or worse was also increased (relative proportion 1.54, 95% CI 1.31-1.80), whereas there was no increase in screen-detected cervical cancer diagnoses (relative proportion 1.27, 95% CI 0.76-2.12). Within the first 4 years after a negative screening test result, including 168,477 woman-years at risk after a negative screen result in the HPV period and 451,421 woman-years after a negative screen result in the cytology period, the risk of a cervical cancer diagnosis was approximately 4 per 100,000 woman-years and was similar for both screening tests (relative risk 0.99, 95% CI 0.41-2.35). CONCLUSION Human papillomavirus testing led to more positive screening test results and diagnoses of high-grade CIN lesions. Few women were diagnosed with cervical cancer after a negative screening test result.
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Affiliation(s)
- Jeppe Bennekou Schroll
- Department of Gynaecology and Obstetrics and the Department of Pathology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; and the Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Guy's Cancer Centre, Great Maze Pond, London, United Kingdom
| | - Reza Rafiolsadat Serizawa
- Department of Gynaecology and Obstetrics and the Department of Pathology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; and the Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Guy's Cancer Centre, Great Maze Pond, London, United Kingdom
| | - Matejka Rebolj
- Department of Gynaecology and Obstetrics and the Department of Pathology, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, and the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; and the Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Guy's Cancer Centre, Great Maze Pond, London, United Kingdom
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Pesola F, Rebolj M, Leeson S, Dunk L, Pickford L, Gjini A, Sasieni P. Introducing human papillomavirus (HPV) primary testing in the age of HPV vaccination: projected impact on colposcopy services in Wales. BJOG 2021; 128:1226-1235. [PMID: 33247993 PMCID: PMC8246959 DOI: 10.1111/1471-0528.16610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the demand for colposcopy in the Cervical Screening Wales programme after the introduction of human papillomavirus (HPV) cervical screening, which coincided with the start of screening of women vaccinated against HPV types 16/18. DESIGN The study used a computational model that assigns screening and screening-related colposcopy events to birth cohorts in individual calendar years. SETTING Cervical Screening Wales. POPULATION Women aged 25-64 years from birth cohorts 1953-2007. METHODS AND MAIN OUTCOME MEASURES We estimated the numbers of colposcopies and high-grade cervical intraepithelial lesions (CIN2+) within Cervical Screening Wales in 2018-32, using official population projections for Wales and published estimates of the effects of HPV screening and vaccination. RESULTS Vaccination will reduce the number of colposcopies by 10% within the first 3-4 years after the national roll-out of HPV screening, and by about 20% thereafter. The number of screening colposcopies is estimated to increase from 6100 in 2018 and peak at 8000 (+31%) in 2021, assuming current screening intervals are maintained. The numbers of CIN2+ lesions follow similar patterns, stabilising at around 1000 diagnoses per year by 2026, approximately 60% lower than at present. Extending the screening intervals to 5 years for all women shows similar trends but introduces peaks and troughs over the years. CONCLUSIONS Vaccination will not fully prevent an increase in colposcopies and detected CIN2+ lesions during the first 2-3 years of HPV-based screening but the numbers are expected to decrease substantially after 5-6 years. TWEETABLE ABSTRACT HPV-based cervical screening will initially increase colposcopy referral. In 6 years, this increase will be reversed, partly by HPV vaccination.
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Affiliation(s)
- F Pesola
- Cancer Prevention GroupSchool of Cancer & Pharmaceutical SciencesFaculty of Medicine and Life SciencesKing’s College LondonLondonUK
| | - M Rebolj
- Cancer Prevention GroupSchool of Cancer & Pharmaceutical SciencesFaculty of Medicine and Life SciencesKing’s College LondonLondonUK
| | - S Leeson
- Department of Obstetrics and GynaecologyBetsi Cadwaladr University Health BoardBangorUK
| | - L Dunk
- Public Health WalesCardiffUK
| | | | - A Gjini
- Public Health WalesCardiffUK
| | - P Sasieni
- Cancer Prevention GroupSchool of Cancer & Pharmaceutical SciencesFaculty of Medicine and Life SciencesKing’s College LondonLondonUK
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Arezzo F, Cormio G, Loizzi V, Cazzato G, Cataldo V, Lombardi C, Ingravallo G, Resta L, Cicinelli E. HPV-Negative Cervical Cancer: A Narrative Review. Diagnostics (Basel) 2021; 11:diagnostics11060952. [PMID: 34073478 PMCID: PMC8229781 DOI: 10.3390/diagnostics11060952] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer (CC) is the fourth most frequent cancer in women worldwide. HPV infection is associated with the majority of CC cases, but a small proportion of CCs actually test negative for HPV. The prevalence of HPV among CC histotypes is very different. It has been suggested that HPV-negative CC may represent a biologically distinct subset of tumors, relying on a distinct pathogenetic pathway and carrying a poorer prognosis, than HPV-positive CCs. Although, the discordance in terms of sensitivity and specificity between different HPV tests as well as the potential errors in sampling and storing tissues may be considered as causes of false-negative results. The identification of HPV-negative CCs is essential for their correct management. The aim of this narrative review is to summarize the clinical and pathological features of this variant. We also discuss the pitfalls of different HPV tests possibly leading to classification errors.
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Affiliation(s)
- Francesca Arezzo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
- Correspondence: (F.A.); (G.I.); Tel.: +39-3274961788 (F.A.); +39-3388536505 (G.I.)
| | - Gennaro Cormio
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
| | - Vera Loizzi
- Obstetrics and Gynecology Unit, Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (L.R.)
| | - Viviana Cataldo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
| | - Claudio Lombardi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
| | - Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (L.R.)
- Correspondence: (F.A.); (G.I.); Tel.: +39-3274961788 (F.A.); +39-3388536505 (G.I.)
| | - Leonardo Resta
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (L.R.)
| | - Ettore Cicinelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (G.C.); (V.C.); (C.L.); (E.C.)
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St-Martin G, Thamsborg LH, Andersen B, Christensen J, Ejersbo D, Jochumsen K, Johansen T, Larsen LG, Waldstrøm M, Lynge E. Management of low-grade cervical cytology in young women. Cohort study from Denmark. Acta Oncol 2021; 60:444-451. [PMID: 33030976 DOI: 10.1080/0284186x.2020.1831061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Cytology findings of atypical squamous cells of unknown significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) are common among women under 30, but evidence on best management strategy is insufficient. We therefore investigated how different management strategies used in Denmark influenced biopsy rates and detection of cervical intraepithelial neoplasia (CIN). METHODS Register-based cohort study including Danish women aged less than 30 years and born 1980-95, with ASCUS/LSIL as their first abnormal cervical cytology in 2008-16. Rates and relative risks (RR) of biopsy and detection of CIN3+, CIN2 and < CIN2 during two years follow-up were compared between women referred directly to colposcopy after ASCUS/LSIL or undergoing additional testing, including mRNA or DNA test for high risk HPV or repeat cytology. RESULTS 19,946 women with ASCUS and 19,825 with LSIL were included in the study of whom 92% had adequate information about follow-up. Among women referred directly to biopsy, CIN3+ was detected among 21%, CIN2 in 17%, while 62% had < CIN2. Repeating cytology after 6 months reduced the biopsy rate to 44% of which 53% had < CIN2. Biopsy rates with HPV test were 67% for DNA test, 77% with 14-type mRNA test and 58% with 5-type mRNA test. The detection of CIN3+ was somewhat higher, between 13% and 14% for the three HPV tests vs. 11% with repeat cytology. However, the detection of < CIN2 (not indicating treatment) also increased with RR 2.11 (95% CI 2.01-2.21) for 14-type mRNA test, 1.35 (95% CI 1.29-1.41) for 5-type mRNA test, and 1.86 (95% CI 1.76-1.97) with HPV DNA test. CONCLUSIONS The choice of management strategy influences both the detection rate for severe lesions (CIN3+) and the proportion of women followed up for potentially insignificant findings.
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Affiliation(s)
- Gry St-Martin
- Center for Epidemiological research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Randers, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jette Christensen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Kirsten Jochumsen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense C, Denmark
| | - Tonje Johansen
- Department of Pathology, Randers Regional Hospital, Central Denmark Region, Randers, Denmark
| | - Lise Grupe Larsen
- Department of Pathology, Zealand University Hospital, Naestved, Denmark
| | - Marianne Waldstrøm
- Department of Pathology, Vejle Sygehus, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Lynge
- Center for Epidemiological research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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10
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Costa AF, Pogere A, Pasinato APBF, Bello EJM, Onofre ASC, Onofre FBDM. DNA ploidy measurement and human papillomavirus in abnormal cervical cytology. Cytopathology 2020; 32:180-186. [PMID: 33217061 DOI: 10.1111/cyt.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the efficacy of high-risk human papillomavirus (HR-HPV) and DNA image cytometry (DNA-ICM) status for identifying high-grade cervical intraepithelial neoplasia or worse (≥CIN2). METHODS This cross-sectional study was performed in women undergoing follow-up procedure after a previous abnormal cervical cytology. Cervical cells were collected for HPV detection and DNA ploidy measurement. Biopsy samples were taken for histological confirmation. Sensitivity and specificity values for ≥CIN2 detection with HR-HPV and DNA-ICM were determined. RESULTS HR-HPV was present in 74.5% of the women. The most frequent HPV infection was HPV 16, followed by HPV 31, 33 and 58. Aneuploidy was observed in 60.6% of all cases. Referral cytology revealed 78.0% sensitivity and 68.6% specificity for detecting a ≥CIN2 lesion. The HR-HPV test alone showed 92.7% sensitivity, albeit it was not statistically different from DNA-ICM (88.1%, P > .05). Positivity for HPV or DNA-ICM resulted in 100% sensitivity. Higher specificity was observed for the combination of HR-HPV and DNA-ICM (88.6%), with no difference from DNA-ICM alone (85.7%, P > .05). CONCLUSION DNA-ICM or HR-HPV positivity identified all cases of ≥CIN2 in women undergoing follow-up procedure after a previous abnormal cervical cytology. Routine cervical cancer screening could be improved by the incorporation of DNA-ICM as a complementary method to primary screening to identify which women need closer follow-up.
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Affiliation(s)
- Ane Francyne Costa
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Adriane Pogere
- Department of Obstetrics and Gynecology, Polydoro Ernani of Sao Thiago University Hospital of the Federal University of Santa Catarina, Florianópolis, Brazil
| | - Ana Paula Beltrame Farina Pasinato
- Department of Pathology, Polydoro Ernani of Sao Thiago University Hospital of the Federal University of Santa Catarina, Florianópolis, Brazil
| | - Edson Jose Monteiro Bello
- Department of Virology, Central Laboratory of Public Health of Distrito Federal (LACEN-DF), Brasília, Brazil
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Weston G, Dombrowski C, Harvey MJ, Iftner T, Kyrgiou M, Founta C, Adams EJ. Use of the Aptima mRNA high-risk human papillomavirus (HR-HPV) assay compared to a DNA HR-HPV assay in the English cervical screening programme: a decision tree model based economic evaluation. BMJ Open 2020; 10:e031303. [PMID: 32152154 PMCID: PMC7064071 DOI: 10.1136/bmjopen-2019-031303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the impact of using the Aptima messenger RNA (mRNA) high-risk human papilloma virus (HR-HPV) assay versus a DNA HR-HPV assay in a primary HPV cervical screening programme. DESIGN One hypothetical cohort followed for 3 years through HPV primary cervical screening. SETTING England. PARTICIPANTS A hypothetical cohort of women aged 25-65 years tested in the National Health Service (NHS) Cervical Screening Programme (CSP) for first call or routine recall testing. METHODS A decision tree parameterised with data from the CSP (2017/18) and the HORIZON study. Uncertainty analyses were conducted using data from the FOCAL and GAST studies, other DNA HPV tests in addition to one-way and probabilistic sensitivity and scenarios analyses, to test the robustness of results. INTERVENTIONS Aptima mRNA HR-HPV assay and a DNA HR-HPV assay (cobas 4800 HPV assay). MAIN OUTCOME MEASURES Primary: total colposcopies and total costs for the cohort. Secondary: total HPV and cytology tests, number lost to follow-up. RESULTS At baseline for a population of 2.25 million women, an estimated £15.4 million (95% credibility intervals (CI) £6.5 to 24.1 million) could be saved and 28 009 (95% CI 27 499 to 28 527) unnecessary colposcopies averted if Aptima mRNA assays are used instead of a DNA assay, with 90 605 fewer unnecessary HR-HPV and 253 477 cytology tests performed. These savings are due to a lower number of HPV positive samples in the mRNA arm. When data from other primary HPV screening trials were compared, results indicated that using the Aptima mRNA assay generated cost savings and reduced testing in every scenario. CONCLUSION Using the Aptima mRNA assay versus a DNA assay would almost certainly yield cost savings and reduce unnecessary testing and procedures, benefiting the NHS and women in the CSP.
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Affiliation(s)
| | | | | | - Thomas Iftner
- Department of Medical Virology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Kyrgiou
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Imperial College London, London, UK
- Queen Charlotte's and Chelsea, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Christina Founta
- Department of Gynaecological Oncology, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, Somerset, UK
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12
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Westre B, Giske A, Guttormsen H, Wergeland Sørbye S, Skjeldestad FE. Quality control of cervical cytology using a 3-type HPV mRNA test increases screening program sensitivity of cervical intraepithelial neoplasia grade 2+ in young Norwegian women-A cohort study. PLoS One 2019; 14:e0221546. [PMID: 31689301 PMCID: PMC6830931 DOI: 10.1371/journal.pone.0221546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/11/2019] [Indexed: 12/02/2022] Open
Abstract
Within 2021, Norway intends to complete implementation of HPV DNA-based primary screening for cervical cancer for women 34–69 years, while continue cytology-based screening for women 25–33 years. Over the recent years, the incidence of cervical cancer has increased by 30% among women younger than 40 years. In this subset of women, nearly 30% were diagnosed with a normal smear, as most recent smear, prior the cancer diagnosis. This observation demands quality control of normal smears. The aim of this study was to assess increase in program sensitivity of CIN2+ after follow-up of women with false negative Pap-smears testing positive for a 3-type (-16, -18, -45) HPV mRNA test in a cohort design over one screening interval. 521 women, aged 23–39 years, and no prior history of CIN1+ or HSIL, with an ASC-US or worse smear (ASC-US+) and 1444 women with normal screening cytology comprised the study cohorts. The positivity rate for the 3-type HPV mRNA was 1.9% (28/1444). Rescreening revealed 23 women with ASC-US, two women with LSIL, two women with ASC-H, and one woman with AGUS. If the HPV mRNA-positivity rate and histology findings from samples rescreened were applied to all women with normal cytology, an estimated increase in screening sensitivity of 16.4% (95% CI:15.3–17.5) for CIN2+ and 17.3% (95% CI:16.2–18.4) for CIN3+ were achieved. By rescreening less than 2% of women with normal cytology positive for a 3-type HPV mRNA test, we achieved a significant increase in screening program sensitivity.
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Affiliation(s)
- Bjørn Westre
- Department of Pathology, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Anita Giske
- Department of Pathology, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Hilde Guttormsen
- Department of Pathology, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | | | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- * E-mail:
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Salazar KL, Duhon DJ, Olsen R, Thrall M. A review of the FDA-approved molecular testing platforms for human papillomavirus. J Am Soc Cytopathol 2019; 8:284-292. [PMID: 31320315 DOI: 10.1016/j.jasc.2019.06.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The advent of US Food and Drug Administration (FDA)-approved molecular testing for human papillomavirus (HPV) has resulted in a dramatic shift from cytological testing alone to a combination of cytology and molecular testing for primary HPV screening. HPV testing has quickly become an essential component of daily practice in most laboratories and clinical practices. Although the principle of HPV testing is now familiar, it is important to understand the mechanisms behind these platforms in order to properly interpret the results and understand the limits of each method. HPV tests are more automated and reproducible than cytology, but are by no means perfect. None of these platforms will identify every HSIL/CIN2+ or cancer. This fact must be kept in mind when correlating the results of HPV testing with cytology or biopsy findings. The goal of this paper is to review the FDA- approved molecular testing platforms for HPV, including methodology, limitations, and specifications. The concordance between the platforms will also be discussed. Package inserts of the 5 FDA- approved molecular testing platforms for HPV, as well as a literature review of the platforms, were reviewed and assimilated into the article. Due to the multiple modalities available for detection of hrHPV, the concordance between these assays becomes important. Prior publications have compared HC2, Cervista, cobas, and Aptima, with most studies comparing to HC2 because it is considered the reference standard. With the newly approved BD platform, concordance studies were reviewed as well.
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Affiliation(s)
- Katrina L Salazar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Daniel J Duhon
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
| | - Randall Olsen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Michael Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
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Nakalembe M, Makanga P, Mubiru F, Swanson M, Martin J, Huchko M. Prevalence, correlates, and predictive value of high-risk human papillomavirus mRNA detection in a community-based cervical cancer screening program in western Uganda. Infect Agent Cancer 2019; 14:14. [PMID: 31114629 PMCID: PMC6515623 DOI: 10.1186/s13027-019-0230-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 12/26/2022] Open
Abstract
Background New strategies are needed to combat the high incidence of cervical cancer in resource-limited settings such as sub-Saharan Africa. Screening for high-risk human papillomavirus (hrHPV) DNA is sensitive for pre-cancer, but its lack of specificity results in substantial overtreatment in low resource settings where additional testing (e.g., colposcopy) is rarely available. Testing for hrHPV E6/E7 mRNA may enhance specificity, but little is known about its performance characteristics in resource-limited settings. Methods In a series of community health fairs in rural Uganda, women aged 25 to 49 years provided self-collected vaginal samples, which were tested for hrHPV (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) E6/E7 mRNA with the Aptima® assay. Positive specimens underwent testing for HPV-16 and 18/45. After excluding pregnant women, all women testing positive for any hrHPV subsequently were offered cervical biopsy to determine pathology. Results A total of 1892 women provided a vaginal sample for hrHPV testing during 24 health fairs. The median age was 34 years, HIV prevalence was 10, and 95% had not been previously screened. Prevalence of any hrHPV E6/E7 mRNA was 21% (95% confidence interval (CI): 19 to 23%); the prevalence of HPV-16 was 2.6%, HPV-18/45 1.9%, and HPV 16 and 18/45 were jointly found in 0.1% of the study population. Younger age, pregnancy and HIV-positivity were independently associated with any hrHPV infection. Of the 255 evaluable cervical biopsies, the positive predictive value of detecting any hrHPV E6/E7 mRNA for presence of cervical intraepithelial neoplasia grade 2 or higher ("CIN 2+") was 8.2% (95% CI: 5.1 to 12%). The positive predictive value associated with detection of HPV-16 mRNA (15%) or HPV-18/45 mRNA (15%) was only slightly higher. Conclusion Among community-based women in Uganda, the prevalence of any hrHPV E6/E7 mRNA in vaginal samples was high, but the prevalence of the most oncogenic HPV types (16, 18, or 45) was substantially lower. Positive predictive value of hrHPV mRNA-positivity for CIN 2+ was also low, including when restricting to HPV 16/18/45-positivity. The findings emphasize the need to identify more specific screening approaches for cervical cancer.
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Affiliation(s)
- Miriam Nakalembe
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Philippa Makanga
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Frank Mubiru
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Megan Swanson
- Department of Obstetrics and Gynecology, University of California, San Francisco, Uganda
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, Uganda
| | - Megan Huchko
- 4Department of Obstetrics and Gynecology, Global Health Institute, Duke University, Durham, North Carolina USA
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15
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Song T, Seong SJ, Lee SK, Kim BR, Ju W, Kim KH, Nam K, Sim JC, Kim TJ. Screening capacity and cost-effectiveness of the human papillomavirus test versus cervicography as an adjunctive test to Pap cytology to detect high-grade cervical dysplasia. Eur J Obstet Gynecol Reprod Biol 2019; 234:112-116. [PMID: 30682600 DOI: 10.1016/j.ejogrb.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/26/2018] [Accepted: 01/05/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study compared the screening capacities and cost-effectiveness of the human papillomavirus (HPV) test versus cervicography as an adjunctive test to Papanicolaou (Pap) cytology to detect high-grade cervical neoplasia in Korea, a country with a high prevalence of cervical cancer. STUDY DESIGN Of 33,531 Korean women who underwent cervicography as a screening test for cervical cancer between January 2015 and December 2016, we retrospectively analyzed the records of 4117 women who simultaneously or subsequently underwent Pap cytology, an HPV test, cervicography, and colposcopically directed biopsy. At a threshold of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), based on colposcopic biopsy, we compared the diagnostic capacities and cost-effectiveness of these screening tools. RESULTS The CIN2+ prevalence was 10.8% (446 of 4117 women) and the positive rate of high-risk HPV was 61.0% (2511 of 4117 women). Cervicography as an adjunctive to Pap cytology was a more sensitive test (97.5% vs 93.7%) with a higher odds ratio (15.65 vs 5.86) than the HPV test for detection of CIN2+ (P-value = 0.003). Moreover, the cost of cervicography co-testing was 23% less than that of HPV co-testing, decreasing the cost per patient with CIN2+ lesions from $1474 to $1135. CONCLUSION Cervicography and Pap co-testing had superior screening capacity and cost-effectiveness for detection of preinvasive cervical lesions than HPV and Pap co-testing and may be an effective and cost-saving screening strategy in clinical practice in country with a high prevalence of cervical cancer.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea.
| | - Seon-Kyung Lee
- Department of Obstetrics & Gynecology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Byoung-Ryun Kim
- Department of Obstetrics & Gynecology, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Woong Ju
- Department of Obstetrics & Gynecology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Ki Hyung Kim
- Department of Obstetrics & Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Kyehyun Nam
- Department of Obstetrics & Gynecology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jae Chul Sim
- Department of Obstetrics & Gynecology, Dongguk University Gyeongju Hospital, Graduate School of Medicine of Dongguk University, Gyeongju, Republic of Korea
| | - Tae Jin Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea
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16
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Rebolj M, Njor S, Lynge E, Preisler S, Ejegod D, Rygaard C, Bonde J. Referral population studies underestimate differences between human papillomavirus assays in primary cervical screening. Cytopathology 2018; 28:419-428. [PMID: 28901682 DOI: 10.1111/cyt.12451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We studied how representative cytologically abnormal women ("referral populations") are with respect to uncovering differences between human papillomavirus (HPV) assays in the primary screening where most women are cytologically normal. METHODS A total of 4997 women were tested with SurePath® cytology, and Hybrid Capture 2 (HC2), cobas, CLART and APTIMA HPV assays. Women with positive test results were offered a follow-up. For all detected HPV infections and HPV-positive high-grade cervical intraepithelial neoplasia (≥CIN2), we studied the distributions of assay-specific signal strengths in the baseline samples as documented by the assays' automatically generated reports. We calculated the likelihood of test result discordance as the proportion of HPV-positive samples that were not confirmed by all four assays. RESULTS Median signal strengths for HPV infections were weaker in normal than abnormal cytology (P<.001, adjusted for women's age, multiple infections and the reason for taking the sample). For HC2, they were RLU/CO 11.0 (interquartile range, IQR: 3.3-52.8) vs 124.2 (IQR: 22.8-506.9), respectively; for cobas, Ct 33.5 (IQR: 29.6-37.5) vs 26.9 (IQR: 23.7-31.3), respectively; for APTIMA, S/CO 10.2 (IQR: 5.8-11.3) vs 11.1 (IQR: 9.4-15.5), respectively. Similar patterns were observed for HPV-positive ≥CIN2. The four HPV assays more frequently returned discordant test results in normal than in abnormal cytology. Relative frequency of discordance in detecting HPV infections was 0.39 (95% confidence interval: 0.33-0.48) for abnormal vs normal cytology. CONCLUSIONS These data suggest that referral population studies, by not including sufficient numbers of cytology normal women, underestimate the differences between HPV assays that would become apparent in primary screening.
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Affiliation(s)
- M Rebolj
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - S Njor
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E Lynge
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S Preisler
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - D Ejegod
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - C Rygaard
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - J Bonde
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
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Fuller MY, Mody RR, Luna E, Armylagos D, Schwartz MR, Mody DR, Ge Y. Performance of Roche cobas high-risk human papillomavirus (hrHPV) testing in the two most common liquid-based Papanicolaou test platforms. J Am Soc Cytopathol 2018; 7:142-148. [PMID: 31043309 DOI: 10.1016/j.jasc.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION High-risk human papillomavirus (hrHPV) testing is important in cervical cancer screening and management algorithms. Roche (Pleasanton, Calif.) cobas hrHPV testing is commonly performed on both ThinPrep (TP) and SurePath (SP) samples, but performance of these platforms has not been fully investigated in the literature. MATERIALS AND METHODS Roche hrHPV testing was performed on 47,885 (TP = 18,295; SP = 29,590) out of 130,648 consecutive Papanicolaou tests, over 16 months; 1895 of those had interpretable biopsies. RESULTS The overall hrHPV detection rates were similar in TP (13.5%) and SP (13.1%). The hrHPV positive rate was higher in SP (8.5%) than TP (7.3%, P < 0.0001) in women with negative cytology; the difference in other cytologic diagnosis categories was insignificant. TP samples had significantly fewer negative cytology diagnoses (7.3% versus 8.5%, P < 0.0001), more low-grade abnormalities in cytology and biopsies, and higher colposcopy referral rate (4.8% versus 2.7%, P < 0.0001) than SP. There were no differences between TP and SP in detecting ≥HSIL by hrHPV testing, cytology or biopsy. SP samples had a significantly higher rate of HPV 16/18 but a lower rate of non-16/18 hrHPV genotypes than TP. CONCLUSIONS Roche cobas hrHPV testing was similar in both TP and SP platforms. The significantly lower hrHPV detection rate in cytological negative TP samples is likely related to higher cytology reporting rates for indeterminate and low-grade diagnoses in TP than SP samples. Significant differences were also observed in hrHPV genotyping results between TP and SP. Clinical risk stratification based on hrHPV testing may need to take testing platforms into consideration.
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Affiliation(s)
- Maren Y Fuller
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - Eric Luna
- BioReference Laboratories, Houston, Texas
| | | | - Mary R Schwartz
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Dina R Mody
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Weill Medical College of Cornell University, New York, New York
| | - Yimin Ge
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Weill Medical College of Cornell University, New York, New York.
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18
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Lam JUH, Elfström KM, Ejegod DM, Pedersen H, Rygaard C, Rebolj M, Lynge E, Juul KE, Kjær SK, Dillner J, Bonde J. High-grade cervical intraepithelial neoplasia in human papillomavirus self-sampling of screening non-attenders. Br J Cancer 2018; 118:138-144. [PMID: 29136403 PMCID: PMC5765223 DOI: 10.1038/bjc.2017.371] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Self-sampling for human papillomavirus (HPV) offered to women who do not participate in cervical cancer screening is an increasingly popular method to increase screening coverage. The rationale behind self-sampling is that unscreened women harbour a high proportion of undetected precancer lesions. Here, we compare the cervical intraepithelial neoplasia grade 2 or worse (⩾CIN2) detection rate between non-attenders who participated in self-sampling and women attending routine screening. METHODS A total of 23 632 women who were qualified as non-attenders in the Copenhagen Region were invited for HPV-based self-sampling. Of these, 4824 women returned a self-sample, and HPV-positive women were referred for cytology and HPV co-testing as follow-up. The entire cohort and a reference cohort (3347 routinely screened women) were followed for histopathology confirmed ⩾CIN2. Odds ratio (OR) and the relative positive predictive value of ⩾CIN2 detection between the two populations were estimated. RESULTS Women participating in self-sampling had a higher ⩾CIN2 detection than women undergoing routine cytology-based screening (OR=1.83, 95% CI: 1.21-2.77) and a similar detection as routinely screened women tested with cytology and HPV testing (OR=1.03, 95% CI: 0.75-1.40). The positive predictive value for ⩾CIN2 was higher in screening non-attenders than in routinely HPV- and cytology-screened screened women (36.5% vs 25.6%, respectively). CONCLUSIONS Self-sampling offered to non-attenders showed higher detection rates for ⩾CIN2 than routine cytology-based screening, and similar detection rates as HPV and cytology co-testing. This reinforces the importance of self-sampling for screening non-attenders in organised cervical cancer screening.
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Affiliation(s)
- J U H Lam
- Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - K M Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm 14186, Sweden
| | - D M Ejegod
- Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - H Pedersen
- Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - C Rygaard
- Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - M Rebolj
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - E Lynge
- Department of Public Health, University of Copenhagen, Copenhagen 1014, Denmark
| | - K E Juul
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen 2100, Denmark
| | - S K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen 2100, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - J Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm 14186, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 14186, Sweden
| | - J Bonde
- Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
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Prevalence of Human Papillomavirus in Self-Taken Samples from Screening Nonattenders. J Clin Microbiol 2017; 55:2913-2923. [PMID: 28724554 PMCID: PMC5625377 DOI: 10.1128/jcm.00550-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/13/2017] [Indexed: 11/20/2022] Open
Abstract
The Copenhagen Self-Sampling Initiative (CSi) has shown how human papillomavirus (HPV)-based self-sampling can be used to increase screening participation among 23,632 nonattenders in the Capital Region of Denmark. In this study, we describe HPV prevalence and genotype frequency in 4,824 self-samples as determined by three HPV assays (the CLART, Onclarity, and Hybrid Capture 2 [HC2] assays) and compare the results with those for physician-taken follow-up samples. The HPV self-sample findings were also compared to the findings for a reference population of 3,347 routinely screened women from the Horizon study, which had been undertaken in the same screening laboratory. Nonattenders had an HPV prevalence of 11.3% as determined by the CLART assay, which was lower than that for women from the Horizon study (18.5%). One-third of the CSi women who tested HPV positive by self-sampling tested HPV negative on the physician-taken follow-up sample. The CLART and Onclarity assays agreed on 64% (95% confidence interval [CI], 60 to 68%) of the HPV-positive self-taken samples. When the HC2 assay results were added into a three-way comparison, the level of agreement decreased to 27% (95% CI, 24 to 29%). Our findings suggest that further validation of HPV assays on self-taken samples is needed for optimal HPV detection and correct clinical management of HPV-positive women.
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Ogilvie GS, Krajden M, van Niekerk D, Smith LW, Cook D, Ceballos K, Lee M, Gentile L, Gondara L, Elwood-Martin R, Peacock S, Stuart G, Franco EL, Coldman AJ. HPV for cervical cancer screening (HPV FOCAL): Complete Round 1 results of a randomized trial comparing HPV-based primary screening to liquid-based cytology for cervical cancer. Int J Cancer 2016; 140:440-448. [DOI: 10.1002/ijc.30454] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/16/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Gina S. Ogilvie
- Faculty of Medicine, University of British Columbia; Vancouver BC Canada
- British Columbia Centre for Disease Control; Vancouver BC Canada
| | - Mel Krajden
- Faculty of Medicine, University of British Columbia; Vancouver BC Canada
- British Columbia Centre for Disease Control; Vancouver BC Canada
| | - Dirk van Niekerk
- Lower Mainland Laboratories; Vancouver BC Canada
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
| | - Laurie W. Smith
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control; Vancouver BC Canada
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
| | - Kathy Ceballos
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
| | - Marette Lee
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
| | - Laura Gentile
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
| | - Lovedeep Gondara
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
| | - Ruth Elwood-Martin
- Faculty of Medicine, University of British Columbia; Vancouver BC Canada
| | - Stuart Peacock
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
| | - Gavin Stuart
- Faculty of Medicine, University of British Columbia; Vancouver BC Canada
| | - Eduardo L. Franco
- Departments of Oncology and Epidemiology & Biostatistics, McGill University; Montreal Quebec Canada
| | - Andrew J. Coldman
- Cervical cancer screening program, British Columbia Cancer Agency; Vancouver BC Canada
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Differential Detection of Human Papillomavirus Genotypes and Cervical Intraepithelial Neoplasia by Four Commercial Assays. J Clin Microbiol 2016; 54:2669-2675. [PMID: 27535689 PMCID: PMC5078541 DOI: 10.1128/jcm.01321-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/10/2016] [Indexed: 11/20/2022] Open
Abstract
Laboratories now can choose from >100 human papillomavirus (HPV) assays for cervical screening. Our previous analysis based on the data from the Danish Horizon study, however, showed that four widely used assays, Hybrid Capture 2 (HC2), cobas, CLART, and Aptima, frequently do not detect the same HPV infections. Here, we determined the characteristics of the concordant samples (all four assays returning a positive HPV test result) and discordant samples (all other HPV-positive samples) in primary cervical screening at 30 to 65 years of age (n = 2,859) and in a concurrent referral population from the same catchment area (n = 885). HPV testing followed the manufacturers' protocols. Women with abnormal cytology were managed according to the routine recommendations. Cytology-normal/HPV-positive women were invited for repeated testing in 18 months. Screening history and histologically confirmed cervical intraepithelial neoplasia (CIN) in 2.5 years after the baseline testing were determined from the national pathology register. HPV-positive women undergoing primary screening having concordant samples were more likely to harbor high-risk infections and less likely to harbor only low-risk infections than women with discordant samples. Additionally, assay signal strengths were substantially higher in concordant samples. More than 80% of ≥CIN2 results were found for women with concordant samples, and no ≥CIN2 results were found when the infection was detected by only one assay. These patterns were similar in the referral population despite the younger age and higher number of HPV infections. HPV test result discordance identified a cluster of low-risk HPV infections that were hardly ever associated with high-grade CIN and, almost exclusively, represented false-positive screening findings.
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The BD Onclarity HPV Assay on Samples Collected in SurePath Medium Meets the International Guidelines for Human Papillomavirus Test Requirements for Cervical Screening. J Clin Microbiol 2016; 54:2267-72. [PMID: 27307461 PMCID: PMC5005508 DOI: 10.1128/jcm.00508-16] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/08/2016] [Indexed: 12/21/2022] Open
Abstract
This study describes a validation of the BD Onclarity HPV (Onclarity) assay using the international guidelines for HPV test requirements for cervical cancer screening of women 30 years old and older using Danish SurePath screening samples. The clinical specificity (0.90, 95% confidence interval [CI] = 0.88 to 0.91) and sensitivity (0.97, 95% CI = 0.87 to 1.0) of the Onclarity assay were shown to be not inferior to the reference assay (specificity, 0.90 [95% CI = 0.88 to 0.92]; sensitivity, 0.98 [95% CI = 0.91 to 1.0]). The intralaboratory reproducibility of Onclarity was 97%, with a lower confidence bound of 96% (kappa value, 0.93). The interlaboratory agreement was 97%, with a lower confidence bound of 95% (kappa value, 0.92). The BD Onclarity HPV assay fulfills all the international guidelines for a new HPV test to be used in primarily screening. This is the first clinical validation of a new HPV assay using SurePath screening samples, and thus the Onclarity HPV assay is the first HPV assay to hold an international validation for both SurePath and ThinPrep.
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Haedicke J, Iftner T. A review of the clinical performance of the Aptima HPV assay. J Clin Virol 2015; 76 Suppl 1:S40-S48. [PMID: 26614686 DOI: 10.1016/j.jcv.2015.10.027] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/19/2015] [Accepted: 10/31/2015] [Indexed: 11/20/2022]
Abstract
This comprehensive review compiles published data from 62 original articles comparing different HPV tests and one meta-analysis on the clinical performance of the Aptima HR HPV (AHPV) assay in either screening or referral populations as well as for the purpose of test of cure. A number of publications with technical issues were also considered. Besides a brief introduction in the development of E6/E7 mRNA testing, the review summarizes data on analytical sensitivies and specificities, as well as on clinical sensitivity, specificity, NPV and PPV with histological endpoints CIN2+ and CIN3+, where available. Although most studies were of cross-sectional design, five studies with a longitudinal prospective design or component were identified. In addition to the study design, sample size, age and CIN2/3+ prevalence of the respective cohort are listed. This allows direct comparison of the published data in the respective groups. One major outcome of this review is the remarkably stable similar sensitivities of AHPV and HC2 independent from study design for detection of CIN2/3+ combined with a higher specificity of the AHPV. The second outcome was the longitudinal predictive value derived from registry linkage and other prospective studies that would support the applicability of the AHPV test in primary screening with at least a three year screening interval.
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Affiliation(s)
- Juliane Haedicke
- Division of Experimental Virology, Medical Virology, University Hospital Tübingen, Germany
| | - Thomas Iftner
- Division of Experimental Virology, Medical Virology, University Hospital Tübingen, Germany.
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