Screening for Cervical Cancer in High-Risk Populations: DNA Pap Test or Hybrid Capture II Test Alone?

The diagnostic value of serum hybrid capture 2 (CH2) HPV DNA in cervical cancer: a systematic review and meta-analysis

The diagnostic accuracy of cervical cancer remains a clinical challenge, and a number of studies have used the serum hybrid capture 2 (HC2) human papillomavirus (HPV) DNA in the diagnosis of cervical cancer. The aim of the present meta-analysis was to determine the overall accuracy of HC2 HPV DNA in the diagnosis of cervical cancer. A systematic review of studies from PubMed, Embase, the Cochrane Library, Web of Science, Ovid, Chinese Biomedical Literature Database-disc, Chinese National Knowledge Infrastructure (CNKI), Technology of Chongqing (VIP), and Wan Fang database was conducted, and the data concerning the accuracy of HC2 HPV DNA in the diagnosis of cervical cancer were pooled. The methodological quality of each study was assessed by quality assessment for studies of diagnostic accuracy (QUADAS). Statistical analysis was performed by employing Meta-DiSc (version 1.4) and Stata (version 12.0) software. The overall test performance was summarized using receiver operating characteristic curves. Finally, 12 studies, including 12,492 subjects, met the inclusion criteria and then included in this present meta-analysis. The summary estimates for serum HC2 HPV DNA in the diagnosis of cervical cancer were as follows: sensitivity 0.83 (95 % confidence interval (CI) 0.81-0.85), specificity 0.71 (95 % CI 0.69-0.72), positive likelihood ratio 3.65 (95 % CI 1.77-7.54), negative likelihood ratio 0.32 (95 % CI 0.21-0.48), and diagnostic odds ratio 10.54 (95 % CI 4.95-22.46), and the area under the curve was 0.8922. Our findings suggest that HC2 HPV DNA may improve the accuracy of cervical cancer diagnosis, while the results of HC2 HPV DNA assays should be interpreted in parallel with conventional test results and other clinical findings.

A notable accessory screening program for detection of cervical intraepithelial neoplasia

OBJECTIVE

Papanicolaou (Pap) smear test is implemented to detect cervical intraepithelial neoplasia (CIN) in Taiwan. However, the utility of that has limitations. High-risk human papillomavirus (HR-HPV) is an important risk factor in development of cervical cancer. In this study, we estimate the utility of HR-HPV testing in the screening of CIN.

METHODS

Firstly, 726 subjects were recruited and willing to prove cervical exfoliated epithelial cells for Pap smear screening and HR-HPV DNA testing. Subsequently, 205 of the eligible subjects with greater than or equal to CIN1 of Pap smear results were asked to perform histologic diagnosis that served as a gold standard for the estimation of the effects of both Pap smear and HR-HPV testing.

RESULTS

The histology is significantly associated with HR-HPV infection, as well as significantly highly correlated with the individuals who have both Pap smear greater than or equal to CIN1 and positive HR-HPV infection but not significantly correlated with the individuals who only have Pap smear greater than or equal to CIN1 but without HR-HPV infection.

CONCLUSIONS

Combinative surveillance of HR-HPV infection and Pap smear is a useful tool to detect and monitor precancerous lesions in the screening program. HR-HPV testing is a notable accessory screening program for detection of CIN in Taiwanese women.

Cervical screening by visual inspection, HPV testing, liquid-based and conventional cytology in Amazonian Peru

Cervical cancer is an important public health problem in many developing countries, where cytology screening has been ineffective. We compared four tests to identify the most appropriate for screening in countries with limited resources. Nineteen midwives screened 5,435 women with visual inspection (VIA) and collected cervical samples for HPV testing, liquid-based cytology (LBC) and conventional cytology (CC). If VIA was positive, a doctor performed magnified VIA. CC was read locally, LBC was read in Lima and HPV testing was done in London. Women with a positive screening test were offered colposcopy or cryotherapy (with biopsy). Inadequacy rates were 5% and 11% for LBC and CC respectively, and less than 0.1% for VIA and HPV. One thousand eight hundred eighty-one women (84% of 2,236) accepted colposcopy/cryotherapy: 79 had carcinoma in situ or cancer (CIS+), 27 had severe- and 42 moderate-dysplasia on histology. We estimated a further 6.5 cases of CIS+ in women without a biopsy. Sensitivity for CIS+ (specificity for less than moderate dysplasia) was 41.2% (76.7%) for VIA, 95.8% (89.3%) for HPV, 80.3% (83.7%) for LBC, and 42.5% (98.7%) for CC. Sensitivities for moderate dysplasia or worse were better for VIA (54.9%) and less favourable for HPV and cytology. In this setting, VIA and CC missed the majority of high-grade disease. Overall, HPV testing performed best. VIA gives immediate results, but will require investment in regular training and supervision. Further work is needed to determine whether screened-positive women should all be treated or triaged with a more specific test.