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Feltri G, Valenti G, Isidoro E, Kaur J, Treleani M, Bartelloni A, Mauro C, Spiga F, Ticich G, Di Napoli M, Biagi C, Pachetti M, Centonze S, Castriciano S, Zanchiello S, Giudici F, Gerin D, Zanconati F. Evaluation of self-sampling-based cervical cancer screening strategy using HPV Selfy CE-IVD test coupled with home-collection kit: a clinical study in Italy. Eur J Med Res 2023; 28:582. [PMID: 38072937 PMCID: PMC10712215 DOI: 10.1186/s40001-023-01263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 08/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Primary human papillomaviruses (HPV) cervical cancer screening can be strengthened by offering home-collection of biological specimen as a valuable option to increase screening coverage. As recommended by World Health Organization (WHO), screening programs should consider whether the inclusion of HPV self-sampling as a complementary option within their existing screening algorithms could address the gaps in current coverage. However, few HPV screening tests are validated for self-sampling according to international guidelines. This study aimed to test a self-sampling-based screening strategy, complementary to the main screening program based on clinician-collected cervical samples. The study took place in Trieste, Italy, and it aimed to evaluate the feasibility of self-testing at home under an opt-in system during COVID-19 pandemic in order to exploit self-sampling to reduce the screening delay generated by the lockdown. METHODS 500 women, who should have received the screening call in 2020, were asked, via phone call, to participate in the study. To whom agreed, a home-collection kit, including a vaginal dry swab for specimen collection, was sent. The recipients performed the sample self-collection and sent back the swab through traditional mail using a prepaid envelope. Once received by the hospital, the samples were analyzed with HPV Selfy (Ulisse BioMed, Italy), a CE-IVD HPV screening test specifically validated for self-collection. Results were further compared using cobas® 4800 HPV (Roche, Switzerland). RESULTS 80% women sent back their swab, showing one of the highest return rate obtained in comparable studies. 34 HPV-positive women were followed up and underwent the Pap test, that revealed 8 low squamous intraepithelial lesions (LSIL) cases, later triaged to colposcopy. HPV Selfy was confirmed to be an adequate test for self-sampling-based screening. CONCLUSIONS This study further confirmed the feasibility of self-test at home screening strategy based on self-sampling with an opt-in system as a support method to enhance cervical cancer screening coverage in Italy. Enrolled women showed a high appreciation for this approach. HPV Selfy test demonstrated to be a valuable assay for cervical cancer screening based on home self-collection. TRIAL REGISTRATION ASUGI Trieste n. 16008/2018 and amendment 02-11/09/2020.
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Affiliation(s)
- Giulia Feltri
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | | | - Erica Isidoro
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | - Jaspreett Kaur
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marianna Treleani
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Aurora Bartelloni
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Claudia Mauro
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Federica Spiga
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giulia Ticich
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | - Michela Di Napoli
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | - Claudia Biagi
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | | | - Sandro Centonze
- Clinical Research Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | | | - Fabiola Giudici
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Équipe Labellisée Ligue Contre le Cancer, Oncostat, U1018, Inserm, Université Paris-Saclay, Villejuif, France
| | - Daniela Gerin
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Fabrizio Zanconati
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy.
- Department of Medical Science, University of Trieste, Trieste, Italy.
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Rongthongaram W, Plumworasawat S, Charakorn C, Lertkhachonsuk A, Satitniramai S. Overtreatment in the see-and-treat approach for high-grade squamous cervical cytology. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100205. [PMID: 37753518 PMCID: PMC10518508 DOI: 10.1016/j.eurox.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 09/28/2023] Open
Abstract
Objectives To evaluate overtreatment with the 'see-and-treat' approach in patients with high-grade squamous cervical cytology, and identify the clinical factors associated with overtreatment. Study design Patients with high-grade squamous intra-epithelial lesion (HSIL) cytology undergoing colposcopy and loop electrosurgical excision procedure (LEEP) in a single visit or the 'see-and-treat' approach from January 2005 to December 2019 were reviewed retrospectively. The overtreatment rate and complications following LEEP were explored. Results In total, 220 cases were identified. The overtreatment rate was 11.4%, and surgical complications were haemorrhage (n = 3, 1.36%) and infection (n = 9, 4.09%). On univariable analysis, factors associated with overtreatment were current cytological result and colposcopic impression. On multi-variable analysis, current cytological result of non-HSIL compared with HSIL/cancer, and colposcopic diagnosis of low-grade lesion or normal compared with high-grade lesion or cancer had adjusted odds ratios of 13.81 [95% confidence interval (CI) 1.23-155.20; p = 0.033] and 3.58 (95% CI 1.32-9.74; p = 0.013), respectively. Conclusions The overtreatment rate with the 'see-and-treat' approach was 11.4%. Independent factors associated with overtreatment were current cervical cytological result of non-HSIL, and low-grade or normal colposcopic diagnosis.
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Affiliation(s)
- W. Rongthongaram
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S. Plumworasawat
- Department of Pathology, Division of Anatomical Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - C. Charakorn
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - A.A. Lertkhachonsuk
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S. Satitniramai
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Yoneda JY, Teixeira JC, Derchain S, Bragança JF, Zeferino LC, Vale DB. Screen-and-treat approach in managing cervical cancer precursor lesions: An observational study with 524 women. Eur J Obstet Gynecol Reprod Biol 2023; 280:78-82. [PMID: 36434824 DOI: 10.1016/j.ejogrb.2022.11.016] [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: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To detect factors related to overtreatment with the "Screen-and-treat" approach (S&T) in women with suspicious cervical precancerous lesions. STUDY DESIGN A retrospective observational study of 524 women with high-grade squamous intraepithelial lesions (HSIL) or more severe (HSIL+) in cytology, treated by the Large Loop Excision of the Transformation Zone (LLETZ): 161 without a previous biopsy (S&T group) and 363 with a previous biopsy (biopsy group) from January 2017 to July 2020. The main outcome was a diagnosis of LLETZ: negative (negative or low-grade squamous intraepithlelial lesion LSIL) or HSIL+. A negative diagnosis was interpreted as "overtreatment." Results were analyzed as a function of the S&T approach (whether previous biopsy or not). Variables were obtained from medical records, and were compared with Chi-square or Fisher's exact test (p, p-value), to estimate the chances of a logistic regression analysis (Odds Ratio, OR, or admitting a Confidence Interval (CI) of 95 %). RESULTS No differences were observed in groups regarding menopausal status, smoking, hormonal contraceptive use, colposcopy findings, LLETZ diagnosis, and recurrence. Comparing biopsy vs S&T groups, the frequency of women over 40 years was 28.4 % vs 39.7 % (p = 0.011), and transformation zone type 3 was 12.2 vs 26.8 % (p < 0.001), respectively. In women managed by S&T, when compared to a LLETZ diagnosis, an HSIL+ result was more frequent in women presenting with TZ 1 (93.1 % TZ1 vs 78.5 % TZ2 vs 73.8 % TZ3, p = 0.008) and in women with abnormal colposcopy (92.9 % abnormal vs 38.1 % negative, p < 0.001). Multiple regression analysis found that women with negative colposcopic findings presented a higher risk for negative LLETZ diagnosis (LSIL/Negative final histology) (18.6; 6.18-56.02). CONCLUSIONS No difference was observed in the LLETZ diagnosis in women who did or did not use the S&T approach: it was adequate for women referred by cytological HSIL along with high-grade colposcopic findings.
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Affiliation(s)
- Juliana Y Yoneda
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Julio C Teixeira
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Joana F Bragança
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Luiz C Zeferino
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil.
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Kiviharju M, Heinonen A, Jakobsson M, Virtanen S, Auvinen E, Kotaniemi-Talonen L, Dillner J, Kyrgiou M, Nieminen P, Aro K, Kalliala I. Overtreatment rate after immediate local excision of suspected cervical intraepithelial neoplasia: A prospective cohort study. Gynecol Oncol 2022; 167:167-173. [PMID: 36153296 DOI: 10.1016/j.ygyno.2022.09.016] [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: 07/07/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The gold standard of cervical intraepithelial neoplasia (CIN) treatment is large loop excision of the transformation zone (LLETZ) after histopathological diagnosis from punch biopsies. In addition, treatment may be appropriate at initial colposcopy. Our objective was to study the applicability of immediate treatment strategy according to clinical parameters. METHODS We conducted a prospective cohort study among patients referred to colposcopy at Helsinki University Hospital, Finland, between January 2014, and September 2018 (ISRCTN10933736). Patients treated with LLETZ, either after biopsies or immediately at initial colposcopy, were included. The main outcome measure was overtreatment (OT) rate defined as normal or low-grade histopathological findings in LLETZ specimen within both treatment groups. RESULTS A total of 572 patients treated with LLETZ were included: 360 treated after biopsies and 212 treated immediately at initial colposcopy. When LLETZ was performed immediately after high-grade referral cytology and with colposcopic impression of high-grade disease, the overtreatment (OT) rate was 10.0% (95% CI 9.10 to 17.2), whereas when LLETZ was done after biopsy-confirmed high-grade lesions, the OT rate was 18.9% (95% CI 14.7 to 23.7), resulting in risk difference (RD) -8.91% (95% CI -16.0 to -1.82). Among HPV16/18 positive patients the OT rate was 8.22% (95% CI 3.08 to 17.0) for immediate treatment, resulting in RD of -10.7% (95% CI -18.3 to -3.04) compared to LLETZ after biopsies. CONCLUSIONS Immediate LLETZ does not result in overtreatment when applied on selected cases, especially after high-grade referral cytology and when high-grade lesion is also colposcopically suspected.
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Affiliation(s)
- Mari Kiviharju
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Annu Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Hyvinkää Hospital, HUCH and University of Helsinki, 05850 Hyvinkää, Finland
| | - Seppo Virtanen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Eeva Auvinen
- Department of Virology, University of Helsinki, Helsinki University Hospital, 00014 Helsinki, Finland
| | - Laura Kotaniemi-Talonen
- Department of Obstetrics and Gynecology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Finland
| | | | - Maria Kyrgiou
- Department of Metabolism, Digestion and Reproduction - Surgery & Cancer, Faculty of Medicine, Imperial College London, W120NN, London, UK
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Karoliina Aro
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, 00029 Helsinki, Finland.
| | - Ilkka Kalliala
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, 00029 Helsinki, Finland; Department of Metabolism, Digestion and Reproduction - Surgery & Cancer, Faculty of Medicine, Imperial College London, W120NN, London, UK
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Liu SS, Chan KKL, Wei TN, Tse KY, Ngu SF, Chu MMY, Lau LSK, Cheung ANY, Ngan HYS. Clinical performance of the Roche Cobas 4800 HPV test for primary cervical cancer screening in a Chinese population. PLoS One 2022; 17:e0272721. [PMID: 35930575 PMCID: PMC9355206 DOI: 10.1371/journal.pone.0272721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
High-risk human papillomavirus (HR-HPV) testing has become an increasing important strategy in primary cervical cancer screening in recent years. It warrants the evaluation of molecular-based HPV tests for accuracy and efficacy of screening. The performance of Roche Cobas 4800 HPV test was validated and compared with Digene Hybrid Capture 2 (HC2) high-risk HPV DNA test for primary screening in a large Chinese screening cohort. Of 6345 women screened, overall agreement between Cobas and HC2 was 92.23% (95% CI: 91.57–92.89). The inter-assay agreement was correlated with the severity of underlying biology, with an increasing concordance found in samples with more severe abnormalities. Most of the discordant samples had the test signal strength closer to the test limits of the detection than concordant samples, reflecting a low viral load and infection of a cluster of low-risk HPV in these samples. The Cobas test demonstrated significantly higher specificity in identifying CIN2+/CIN3+ cases than HC2 test (66.46% vs 43.67% and 65.42% vs 42.86%, p<0.001), with comparable sensitivity in clinical evaluation. Increased specificity of Cobas test would accent women having the highest risk of developing CIN2+, with the potential to reduce unnecessary colposcopy referral in a screening population.
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Affiliation(s)
- Stephanie S. Liu
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Karen K. L. Chan
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tina N. Wei
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ka Yu Tse
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Siew F. Ngu
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mandy M. Y. Chu
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lesley S. K. Lau
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Annie N. Y. Cheung
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hextan Y. S. Ngan
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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Loop Electrosurgical Excision Procedure in a Low-Resource Setting: Feasibility of Selective See-and-Treat Approach. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00497-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sachan R, Shukla A, Patel M, Sachan P, Verma M, Singh U. Single step “See and Treat” strategy might be replacing the “conventional three step strategy” in management of preinvasive cervical lesions at tertiary center: A North Indian study. J Cancer Res Ther 2021; 18:1541-1547. [DOI: 10.4103/jcrt.jcrt_799_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Loopik DL, Siebers AG, Melchers WJG, Massuger LFAG, Bekkers RLM. Clinical practice variation and overtreatment risk in women with abnormal cervical cytology in the Netherlands: two-step versus see-and-treat approach. Am J Obstet Gynecol 2020; 222:354.e1-354.e10. [PMID: 31647895 DOI: 10.1016/j.ajog.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Only a few small studies have compared the 2-step method (biopsy followed by treatment) with a see-and-treat (immediate treatment) approach in women both low-grade or high-grade referral cytology. The clinical practice variation in the Netherlands has not been reviewed before. OBJECTIVES To determine overtreatment rates in the 2-step versus see-and-treat approach in women referred for colposcopy because of abnormal cytology results, and to evaluate clinical practice variation in the Netherlands. MATERIALS AND METHODS This was a population-based retrospective cohort study including 36,581 women with a histologic result of the cervix identified from the Dutch Pathology Registry (PALGA) between 2016 and 2017. Odds ratios for overtreatment, defined primarily as cervical intraepithelial neoplasia grade 1 or less, were determined for the 2-step and see-and-treat approach in relation to age, high-risk human papillomavirus status, and referral cytology. RESULTS Of the included women 10,713 women (29.3%) received the 2-step method; 6,851 women (18.7%) underwent see-and-treat; and 19,017 women (52.0%) received conservative management after colposcopy with histologic assessment with cytologic follow-up or another type of treatment. Despite the existence of a national guideline advising see-and-treat only in case of suspected high-grade disease in women who have completed their childbearing, there is a wide practice variation between the 2 strategies in the Netherlands, with 7.0-88.3% of the women receiving see-and-treat per laboratory. The median time between cytology and treatment was 1-2 months (range, 0-12 months) in women receiving see-and-treat and the 2-step method, respectively. A total of 4119 women (23.5%) were overtreated, with older women, high-risk human papillomavirus-negative women, and women with low-grade cytology results being more likely to be overtreated. Women with low-grade cytology results and see-and-treat were associated with a higher overtreatment rate than women receiving the 2-step method (65.0% [1414 of 2174] versus 32.1% [1161 of 3613], respectively; odds ratio, 3.34; 95% confidence interval, 2.92-3.82). However, in women with high-grade cytology results, see-and-treat was inversely associated with overtreatment (11.3% [529 of 4677] versus 14.3% [1015 of 7100], respectively; odds ratio, 0.68; 95% confidence interval, 0.58-0.81). CONCLUSION A see-and-treat approach is justified only in women with high-grade cytology results who have completed their childbearing. There is a wide practice variation between the 2 strategies in the Netherlands, and gynecologists should adhere to the guideline to prevent overtreatment.
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Affiliation(s)
- Diede L Loopik
- Department of Obstetrics and Gynaecology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, Netherlands.
| | - Albert G Siebers
- Department of Pathology, Radboudumc, Nijmegen, Netherlands; PALGA, Houten, Netherlands
| | | | | | - Ruud L M Bekkers
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, Netherlands
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Risk of Cervical Intraepithelial Neoplasia 2 or Worse by Cytology, Human Papillomavirus 16/18, and Colposcopy Impression: A Systematic Review and Meta-analysis. Obstet Gynecol 2019; 132:725-735. [PMID: 30095780 DOI: 10.1097/aog.0000000000002812] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To calculate pooled risk estimates for combinations of cytology result, human papillomavirus (HPV) 16/18 genotype and colposcopy impression to provide a basis for risk-stratified colposcopy and biopsy practice. DATA SOURCE A PubMed search was conducted on June 1, 2016, and a ClinicalTrials.gov search was conducted on June 9, 2018, using key words such as "uterine cervical neoplasms," "cervical cancer," "mass screening," "early detection of cancer," and "colposcopy." METHODS OF STUDY SELECTION Eligible studies must have included colposcopic impression and either cytology results or HPV 16/18 partial genotype results as well as a histologic biopsy diagnosis from adult women. Manuscripts were reviewed for the following: cytology, HPV status, and colposcopy impression as well as age, number of women, and number of cervical intraepithelial neoplasia (CIN) 2, CIN 3, and cancer cases. Strata were defined by the various combinations of cytology, genotype, and colposcopic impression. TABULATION, INTEGRATION, AND RESULTS Of 340 abstracts identified, nine were eligible for inclusion. Data were also obtained from three unpublished studies, two of which have since been published. We calculated the risk of CIN 2 or worse and CIN 3 or worse based on cytology, colposcopy, and HPV 16/18 test results. We found similar risk patterns across studies in the lowest risk groups such that risk estimates were similar despite different referral populations and study designs. Women with a normal colposcopy impression (no acetowhitening), less than high-grade squamous intraepithelial lesion cytology, and HPV 16/18-negative were at low risk of prevalent precancer. Women with at least two of the following: high-grade squamous intraepithelial lesion cytology, HPV16- or HPV18-positive, and high-grade colposcopic impression were at highest risk of prevalent precancer. CONCLUSION Our results support a risk-based approach to colposcopy and biopsy with modifications of practice at the lowest and highest risk levels.
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Should We Always Look Before We LEEP? A Discussion of the Pros and Cons of Colposcopic Biopsy Prior to Treatment. J Low Genit Tract Dis 2019; 23:147-150. [PMID: 30817690 DOI: 10.1097/lgt.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aitken CA, Siebers AG, Matthijsse SM, Jansen EEL, Bekkers RLM, Becker JH, Ter Harmsel B, Roovers JPWR, van Kemenade FJ, de Kok IMCM. Management and treatment of cervical intraepithelial neoplasia in the Netherlands after referral for colposcopy. Acta Obstet Gynecol Scand 2019; 98:737-746. [PMID: 30687935 PMCID: PMC6593855 DOI: 10.1111/aogs.13547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/17/2018] [Accepted: 01/07/2019] [Indexed: 01/09/2023]
Abstract
Introduction The aim of this study was to describe trends in the diagnosis and treatment of women referred from the national screening program with cervical intraepithelial neoplasia (CIN) in the Netherlands, and to compare these trends with national guidelines and identify potential areas for improvement for the new primary high‐risk HPV screening program. Material and methods We conducted a population‐based cohort study using data from the Dutch pathology archive. Women aged 29‐63 years who took part in the Dutch cervical screening program between 1 January 2005 and 31 December 2014 were selected. Three referral groups were identified: direct referrals and those referred after either one (first indirect referrals) or two (second indirect referrals) repeat cytology tests, totaling 85 239 referrals for colposcopy. The most invasive management technique and the most severe diagnosis of each screening episode was identified. Rates of management techniques were calculated separately by referral type, highest CIN diagnosis and age group. Results In all, 85.1% of CIN 3 lesions were treated with excision (either large excision or hysterectomy) and 26.4% of CIN 1 lesions were treated with large excision. Rates of overtreatment (CIN 1 or less) in see‐and‐treat management were higher for indirect referrals than for direct referrals and increased with age. Large excision rates increased with CIN diagnosis severity. Conclusions Despite guideline recommendations not to treat, CIN 1 lesions were treated in just over 25% of cases and approximately 15% of CIN 3 lesions were possibly undertreated. Given the expected increase in CIN detection in the new primary high‐risk HPV screening program, reduction in CIN 1 treatment and CIN 2 treatment in younger women is needed to avoid an increase in potential harm.
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Affiliation(s)
- Clare A Aitken
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Albert G Siebers
- PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, Houton, the Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,BresMed Health Solutions, Utrecht, the Netherlands
| | - Erik E L Jansen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ruud L M Bekkers
- Department of Gynecology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.,Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeroen H Becker
- Department of Obstetrics and Gynecology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands
| | - Bram Ter Harmsel
- Department of Gynecology, Roosevelt Kliniek, Leiden, the Netherlands
| | - Jan-Paul W R Roovers
- Bergman Clinics (Gynecology), Amsterdam, Amsterdam, the Netherlands.,Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Factors Related to Overtreatment in the See-and-Treat Approach: A Retrospective Multicentric Observational Study. J Low Genit Tract Dis 2019; 23:129-132. [PMID: 30707116 DOI: 10.1097/lgt.0000000000000455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the association between colposcopic features, age, menopausal status, and overtreatment in women subjected to "see-and-treat" approach, to identify subgroups of patients in which this approach could be more appropriate. MATERIALS AND METHODS Retrospective multicentric cohort study conducted on women older than 25 years, with a high-grade squamous cytological report and a visible squamocolumnar junction, in which colposcopy and the excisional procedure were performed at the same time without a previous cervical biopsy (see and treat). Overtreatment was defined as histopathological finding of cervical intraepithelial lesion grade 1 or normal tissue. RESULTS Among the 254 included patients, the overall overtreatment rate was 12.6%, whereas in women with a grade 2 colposcopy, it was 3.2% and, in women with grade 1 colposcopy, it was 22.0%. Among the considered factors (age, menopause, and grade 1 colposcopy), only a positive association with overtreatment and grade 1 colposcopy emerged (odds ratio = 8.70, 95% CI = 2.95-25.62, p < .001). CONCLUSIONS See and treat may be appropriate in women older than 25 years with a visible squamocolumnar junction and a high-grade squamous cervical cytology. Patients need to be informed about the higher risk of overtreatment in case of a grade 1 colposcopic impression, which however may still be considered acceptable. Patient's age and menopausal status should not influence the decision to propose a see-and-treat approach.
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13
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Colposcopy Evaluation at the Time of Loop Electrosurgical Excision Procedure May Avoid Unnecessary Treatment. J Low Genit Tract Dis 2018; 22:367-374. [PMID: 29957657 DOI: 10.1097/lgt.0000000000000410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the accuracy of colposcopy evaluation at the time of the loop electrosurgical excision procedure (LEEP) to identify women with a previous confirmatory diagnosis of squamous intraepithelial lesion/cervical intraepithelial neoplasia (SIL/CIN) with low probability of dysplasia in the LEEP specimen. MATERIALS AND METHODS We prospectively recruited a cohort of 162 women undergoing LEEP for histological high-grade SIL/CIN 2-3 or low-grade SIL/CIN 1 with high-grade SIL cytology showing a fully visible squamocolumnar junction in the colposcopy evaluation at the time of LEEP. At the referral visit cervical cytology, human papillomavirus and genotype detection, digital colposcopy, colposcopical lesion measurement, and 1 or more biopsies of the transformation zone were obtained. The uterine cervix was colposcopically evaluated intraoperatively. RESULTS Thirty-four women (21.0%) had a normal colposcopy evaluation at the time of the LEEP, whereas the remaining 128 women showed abnormal findings. Absence of SIL/CIN in the LEEP specimen was confirmed in 28 (82.3%) of the 34 women with a normal colposcopy at the time of LEEP group and 8 (3.1%) of the 128 women showing abnormal colposcopy at the time of LEEP group (p < .001). A normal colposcopic evaluation at the time of LEEP was associated with an increase in the risk of absence of lesion in the cone specimen compared with cases presenting an abnormal colposcopy (95% CI = 33.8-1,555.1, p < .001). The colposcopy evaluation at the time of LEEP had a positive predictive value of 82.3% (95% CI = 66.5-91.5) and a negative predictive value of 96.9% (95% CI = 92.2-98.8) to predict low probability of SIL/CIN in the specimen. CONCLUSIONS Colposcopic evaluation at the time of LEEP seems to be accurate to identify SIL/CIN postbiopsy regression; thus, its performance would be considered at the time of the treatment.
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15
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Multimodal Hyperspectroscopic Imaging for Detection of High-Grade Cervical Intraepithelial Neoplasia. J Low Genit Tract Dis 2017; 21:166-170. [PMID: 28403024 DOI: 10.1097/lgt.0000000000000309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Numerous new alternative digital colposcopy techniques have been developed, of which multimodal hyperspectroscopy (MHS) showed a high sensitivity in previous studies. The objective of this prospective single-center cohort study was to evaluate the clinical value of MHS for detecting high-grade cervical intraepithelial neoplasia in a colposcopy referral population and colposcopy follow-up population, to assess whether MHS could be safely used to improve care for women at risk for high-grade cervical intraepithelial neoplasia. MATERIALS AND METHODS A total of 125 women from a colposcopy referral population and colposcopy follow-up population were evaluated with MHS and tested for the presence of high-risk human papillomavirus (HPV) with HPV-16/18 genotyping. Spectroscopic measurements of the cervix were taken and compared with an end point based on histology, high-risk HPV, and cytology. Evaluable data for analysis were collected from 102 of the subjects. Sensitivity, specificity, and predictive values were calculated for MHS and colposcopic impression based on conventional colposcopic examination. RESULTS From the total study population of the 102 patients, 47 were enrolled in the colposcopy referral group and 55 in the colposcopy follow-up group. The MHS yielded a sensitivity of 93.6% (95% CI = 78.6-99.2), with a corresponding specificity of 42.3% (95% CI = 30.6-54.6) in the group with a composite end point. No adverse effects occurred, and patient acceptability was high. CONCLUSIONS Multimodal hyperspectroscopy is a digital colposcopy technique that offers an easy, rapid, well-tolerated point-of-care assessment with a high sensitivity for the presence of high-grade cervical intraepithelial lesions, however, with a low specificity, resulting in limited clinical value.
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16
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See-and-Treat for High-Grade Cytology: Do Young Women Have Different Rates of High-Grade Histology? J Low Genit Tract Dis 2017; 20:243-6. [PMID: 27243140 DOI: 10.1097/lgt.0000000000000229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare rates of cervical intraepithelial neoplasia grade 3 or greater (CIN3+) between women aged 21 to 24 and women aged 25 or older undergoing a see-and-treat strategy for high-grade squamous intraepithelial lesion (HSIL) cytology. METHODS In this retrospective cohort study, women treated with a see-and-treat loop electrosurgical excisional procedure (LEEP) for HSIL cytology at our university-based colposcopy clinic between 2008 and 2013 were identified. Data collected included age, race, parity, smoking status, method of contraception, history of abnormal cytology, HIV status, and LEEP histology. Cohorts were compared using Pearson chi-squared test of association and Fisher exact test. RESULTS Three hundred sixty-nine women were included in this analysis. The mean age was 30 (SD, 7.2; range, 21-56). Ninety-seven women (26.3%) were 21 to 24 years old. The rate of CIN3 in all women undergoing a see-and-treat LEEP for HSIL cytology was 65.9% (95% CI, 60.8-70.5). The rate of CIN 2 was 15.2% (95% CI, 11.9-19.2). Three women (1.1%) had invasive carcinoma. There was no difference in risk of CIN3+ in the young women compared with women aged 25 years or older (RR, 1.37; 95% CI, 0.92-2.02). Within this see-and-treat population, there was no correlation between presence of CIN3+ and race, smoking, contraception, or HIV status. CONCLUSIONS Most women undergoing see-and-treat for HSIL cytology will have CIN3 on final histology. In this large cohort, women aged 21 to 24 did not have lower rates of CIN3 compared with women aged 25 and older, suggesting that see-and-treat is still a valid treatment option for the prevention of invasive disease in young women.
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17
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Ebisch RM, Siebers AG, Bosgraaf RP, Massuger LF, Bekkers RL, Melchers WJ. Triage of high-risk HPV positive women in cervical cancer screening. Expert Rev Anticancer Ther 2016; 16:1073-85. [PMID: 27598683 DOI: 10.1080/14737140.2016.1232166] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION High-risk human papillomavirus (hrHPV) testing is expected to replace cytology as primary screening method for cervical cancer screening in an increasing number of countries. The high sensitivity of hrHPV testing is combined with a limited specificity which makes triaging of hrHPV positive women necessary. As an ideal triage method does not yet exist, an optimal triage strategy for hrHPV positive women based on current knowledge should be obtained. The aim of this article is to present an overview of available options for triage of hrHPV positive women, with their strengths and limitations and possible future opportunities. AREAS COVERED Current knowledge on morphological biomarkers, molecular biomarkers and combined triage strategies will be discussed to give an overview of the state-of-the-art on triaging hrHPV positive women. The literature search was limited to studies on triage strategies for hrHPV positive women. Expert commentary: Experience with morphology-based biomarkers makes these a valuable triage method. However, they lack the ability of differentiating productive from transforming infections. Molecular biomarkers are objective, highly reproducible, can be used in high throughput testing, and show promising results. With more extensive knowledge on these molecular markers, cervical cancer screening may transform to a full molecular screening in the future.
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Affiliation(s)
- Renée Mf Ebisch
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
| | - Albert G Siebers
- b Department of Pathology , Radboud university medical center , Nijmegen , The Netherlands
| | - Remko P Bosgraaf
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
| | - Leon Fag Massuger
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
| | - Ruud Lm Bekkers
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
| | - Willem Jg Melchers
- c Department of Medical Microbiology , Radboud university medical center , Nijmegen , The Netherlands
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18
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Ebisch RMF, de Kuyper-de Ridder GM, Bosgraaf RP, Massuger LFAG, IntHout J, Verhoef VMJ, Heideman DAM, Snijders PJF, Meijer CJLM, van Kemenade FJ, Bulten J, Siebers AG, Bekkers RLM, Melchers WJG. The clinical value of HPV genotyping in triage of women with high-risk-HPV-positive self-samples. Int J Cancer 2016; 139:691-9. [PMID: 26991464 DOI: 10.1002/ijc.30090] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/09/2016] [Accepted: 02/19/2016] [Indexed: 02/02/2023]
Abstract
Cytology alone, or combined with HPV16/18 genotyping, might be an acceptable method for triage in hrHPV-cervical cancer screening. Previously studied HPV-genotype based triage algorithms are based on cytology performed without knowledge of hrHPV status. The aim of this study was to explore the value of hrHPV genotyping combined with cytology as triage tool for hrHPV-positive women. 520 hrHPV-positive women were included from a randomised controlled self-sampling trial on screening non-attendees (PROHTECT-3B). Eighteen baseline triage strategies were evaluated for cytology and hrHPV genotyping (Roche Cobas 4800) on physician-sampled triage material. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), referral rate, and number of referrals needed to diagnose (NRND) were calculated for CIN2+ and CIN3+. A triage strategy was considered acceptable if the NPV for CIN3+ was ≥98%, combined with maintenance or improvement of sensitivity and an increase in specificity in reference to the comparator, being cytology with a threshold of atypical cells of undetermined significance (ASC-US). Three triage strategies met the criteria: HPV16+ and/or ≥LSIL; HPV16+ and/or ≥HSIL; (HPV16+ and/or HPV18+) and/or ≥HSIL. Combining HPV16+ and/or ≥HSIL yielded the highest specificity (74.9%, 95% CI 70.5-78.9), with a sensitivity (94.4%, 95% CI 89.0-97.7) similar to the comparator (93.5%, 95% CI 87.7-97.1), and a decrease in referral rate from 52.2% to 39.5%. In case of prior knowledge of hrHPV presence, triage by cytology testing can be improved by adjusting its threshold, and combining it with HPV16/18 genotyping. These strategies improve the referral rate and specificity for detecting CIN3+ lesions, while maintaining adequate sensitivity.
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Affiliation(s)
- Renée M F Ebisch
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, HB, 6500, The Netherlands
| | | | - Remko P Bosgraaf
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, HB, 6500, The Netherlands.,Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, ME, 5200, The Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, HB, 6500, The Netherlands
| | - Joanna IntHout
- Institute for Health Sciences, Radboud University Medical Center, Nijmegen, HB, 6500, The Netherlands
| | - Viola M J Verhoef
- Department of Pathology, VU University Medical Center, Amsterdam, MB, 1007, The Netherlands
| | - Daniëlle A M Heideman
- Department of Pathology, VU University Medical Center, Amsterdam, MB, 1007, The Netherlands
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, MB, 1007, The Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, MB, 1007, The Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, CA, 3000, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, HB, 6500, The Netherlands
| | - Albert G Siebers
- Department of Pathology, Radboud University Medical Center, Nijmegen, HB, 6500, The Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, HB, 6500, The Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, HB, 6500, The Netherlands
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19
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Nghiem VT, Davies KR, Beck JR, Follen M, Cantor SB. Overtreatment and Cost-Effectiveness of the See-and-Treat Strategy for Managing Cervical Precancer. Cancer Epidemiol Biomarkers Prev 2016; 25:807-14. [PMID: 26929242 DOI: 10.1158/1055-9965.epi-15-1044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/15/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND See-and-treat using loop electrosurgical excision procedure (LEEP) has been recommended as an alternative in managing high-grade cervical squamous intraepithelial lesions, but existing literature lacks evidence of the strategy's cost-effectiveness. We evaluated the overtreatment and cost-effectiveness of the see-and-treat strategy compared with usual care. METHODS We modeled a hypothetical cohort of 40-year-old females who had not been screened for cervical cancer and followed them through their lifetimes using a Markov model. From a U.S. health-system perspective, the analysis was conducted in 2012 dollars and measured effectiveness in quality-adjusted life-years (QALY). We estimated incremental cost-effectiveness ratios (ICER) using a willingness-to-pay threshold of $50,000/QALY. The robustness of the see-and-treat strategy's cost-effectiveness and its overtreatment rates were further examined in various sensitivity analyses. RESULTS In the base-case, the see-and-treat strategy yielded an ICER of $70,774/QALY compared with usual care. For most scenarios in the deterministic sensitivity analysis, this strategy had ICERs larger than $50,000/QALY, and its cost-effectiveness was sensitive to the disutility of LEEP treatment and biopsy-directed treatment adherence under usual care. Probabilistic sensitivity analysis showed that the see-and-treat strategy had a 50.1% chance to be cost-effective. It had an average overtreatment rate of 7.1% and a 78.8% chance to have its overtreatment rate lower than the 10% threshold. CONCLUSION The see-and-treat strategy induced an acceptable overtreatment rate. Its cost-effectiveness, compared with usual care, was indiscriminating at the chosen willingness-to-pay threshold but much improved when the threshold increased. IMPACT The see-and-treat strategy was reasonable for particular settings, that is, those with low treatment adherence. Cancer Epidemiol Biomarkers Prev; 25(5); 807-14. ©2016 AACR.
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Affiliation(s)
- Van T Nghiem
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, Texas. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kalatu R Davies
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Robert Beck
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Michele Follen
- Department of Obstetrics & Gynecology, Brookdale University Hospital & Medical Center, Brooklyn, New York
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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20
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Ebisch RMF, Rovers MM, Bosgraaf RP, van der Pluijm-Schouten HW, Melchers WJG, van den Akker PAJ, Massuger LFAG, Bekkers RLM. Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis. BJOG 2015; 123:59-66. [DOI: 10.1111/1471-0528.13530] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- RMF Ebisch
- Department of Obstetrics and Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
| | - MM Rovers
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Operating Rooms; Radboud University Medical Center; Nijmegen the Netherlands
| | - RP Bosgraaf
- Department of Obstetrics and Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Obstetrics and Gynaecology; Jeroen Bosch Hospital; 's-Hertogenbosch the Netherlands
| | | | - WJG Melchers
- Department of Medical Microbiology; Radboud University Medical Center; Nijmegen the Netherlands
| | - PAJ van den Akker
- Department of Obstetrics and Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
| | - LFAG Massuger
- Department of Obstetrics and Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
| | - RLM Bekkers
- Department of Obstetrics and Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
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21
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Vansevičiūtė R, Venius J, Žukovskaja O, Kanopienė D, Letautienė S, Rotomskis R. 5-aminolevulinic-acid-based fluorescence spectroscopy and conventional colposcopy for in vivo detection of cervical pre-malignancy. BMC WOMENS HEALTH 2015; 15:35. [PMID: 25887444 PMCID: PMC4405835 DOI: 10.1186/s12905-015-0191-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/27/2015] [Indexed: 11/10/2022]
Abstract
Background Sensitized fluorescence diagnostics are based on selective accumulation of photosensitizer in the tissue where carcinogenesis has started. The present study compared topical 5-aminolevulinic acid (5-ALA)-based fluorescence spectroscopy (FS) in vivo with conventional colposcopy for cervical intraepithelial neoplasia (CIN) detection. Methods We enrolled 48 patients who were referred for colposcopy because of high-grade changes in cervical cytology. Every inspected cervix was divided in to quadrants, and there were 174 quadrants included in the study. Each patient had a cytological smear, colposcopy, FS and histopathological analysis. For FS, 3% 5-ALA cream was used topically and after an average 135 min incubation, fluorescence spectra were recorded from the cervix in vivo. FS and colposcopy results were correlated with histopathology. Results All spectra were evaluated by a ratio of the protoporphyrin IX fluorescence intensity at 634 nm and autofluorescence intensity at 510 nm. For proper grouping of low-risk and high-risk cases, a threshold of 3.87 was calculated. Data per quadrant showed that FS had higher sensitivity than colposcopy (71.7% vs 67.4%) but specificity was greater for colposcopy (86.6% vs 75.6%). Combination of the methods showed higher sensitivity (88.0% vs 67.4%) but reduced specificity (88.0% and 69.5%), but it had the highest number of correctly identified high-risk changes and the highest (79.3%) accuracy. Data for each patient showed FS sensitivity of 91.2%, which was greater than for colposcopy (88.2%). Higher overdiagnosis resulted in decreased specificity for fluorescence methodology—71.4% versus 78.6% for colposcopy. In both cases, accuracy was 85.4% and effectiveness was >80%, which means that both methods can be used to determine high-risk cervical intraepithelial neoplasia. The diagnostic sensitivity of 97.1% for this complementary diagnosis indicates that it could be the best choice for detection of high-risk changes. Conclusions 5-ALA-based FS is an objective method, requiring short-term administration for appropriate fluorescence measurements. FS is a promising diagnostic tool with similar accuracy as colposcopy but with the potential advantage of providing objective results.
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Affiliation(s)
| | - Jonas Venius
- National Cancer Institute, Vilnius, Lithuania. .,Laboratory of Biomedical Physics, National Cancer Institute, Vilnius, Lithuania.
| | - Olga Žukovskaja
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | | | - Simona Letautienė
- National Cancer Institute, Vilnius, Lithuania. .,Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Ričardas Rotomskis
- Laboratory of Biomedical Physics, National Cancer Institute, Vilnius, Lithuania. .,Biophotonics Group, Laser Research Center, Vilnius University, Vilnius, Lithuania.
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22
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Verhoef VMJ, van Kemenade FJ, Rozendaal L, Heideman DAM, Bosgraaf RP, Hesselink AT, Melchers WJG, Massuger LFAG, Bekkers RLM, Steenbergen RDM, Berkhof J, Snijders PJF, Meijer CJLM. Follow-up of high-risk HPV positive women by combined cytology and bi-marker CADM1/MAL methylation analysis on cervical scrapes. Gynecol Oncol 2015; 137:55-9. [PMID: 25667975 DOI: 10.1016/j.ygyno.2015.01.550] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/31/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Triage of HPV screen-positive women is needed to identify those with underlying cervical intraepithelial neoplasia grade 2/3 or worse (CIN2/3+). Presently, cytology on a physician-taken cervical scrape is mostly accepted as triage test, but needs follow-up testing in order not to miss severe disease. Here, we evaluated the performance of combined cytology and bi-marker CADM1/MAL-methylation analysis as triage test on physician-taken cervical scrapes of HPV positive women. METHODS In this post-hoc analysis, we used 364 left-over HPV positive cytology triage samples of participants of a randomized controlled trial (PROHTECT-3: n=46,001) performed in population-based cervical screening. Study endpoints were CIN2+ and CIN3+ detection. Cytology testing with and without methylation marker analysis was evaluated with regard to sensitivity, specificity, positive and negative predictive value, and referral rate. RESULTS Bi-marker CADM1/MAL-methylation positivity increased proportionally with severity of underlying lesions. Overall, cytology and bi-marker CADM1/MAL-methylation analysis yielded similar performances with regard to CIN3+ detection, yet in combination a significantly higher sensitivity for CIN3+ (88.7%) was obtained at a specificity of 53.6% and a colposcopy referral rate of 53.6%. The combined strategy detected all six cervical cancers, whereas triage by cytology alone failed to detect two of them. CONCLUSIONS Cytology and bi-marker CADM1/MAL-methylation analysis perform complementary for CIN2+/CIN3+ detection when used as triage tool on cervical scrapes of HPV positive women. This approach not only results in a higher CIN3+ sensitivity than cytology triage with an acceptable referral rate, but also seems to reduce the risk of missing cervical cancers and advanced high-grade lesions.
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Affiliation(s)
- Viola M J Verhoef
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lawrence Rozendaal
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Remko P Bosgraaf
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Albertus T Hesselink
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
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DNA methylation analysis in self-sampled brush material as a triage test in hrHPV-positive women. Br J Cancer 2014; 111:1095-101. [PMID: 25032730 PMCID: PMC4453842 DOI: 10.1038/bjc.2014.392] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Primary high-risk human papillomavirus (hrHPV) testing in cervical cancer screening shows relatively low specificity, which makes triage testing necessary. In this study, DNA methylation analysis was compared with cytology for triage testing in hrHPV-positive women. Moreover, feasibility of DNA methylation analysis directly on brush-based self-sampled specimens was assessed. METHODS Non-responding women from population-based screening were invited to self-collect a cervico-vaginal specimen for hrHPV testing; hrHPV-positive women were referred to a physician for triage liquid-based cytology. DNA methylation analysis was performed on 128 hrHPV-positive physician-collected triage samples and 50 matched brush self-samples with QMSP for C13ORF18, EPB41L3, JAM3 and TERT. RESULTS In physician-taken triage material, DNA methylation analysis of JAM3 showed the highest combined specificity (88%) and sensitivity (82%) for detection of CIN3+, whereas cytology showed a specificity of 48% and a sensitivity of 91%. Out of 39 women with abnormal cytology and normal histology (false-positive by cytology), 87% were negative for JAM3 and 90% for C13ORF18 methylation. Agreement between DNA methylation analysis performed directly on the matched self-sampled material and physician-taken samples was 88% for JAM3 (κ=0.75, P<0.001) and 90% for C13ORF18 (κ=0.77; P<0.001). CONCLUSIONS DNA methylation analysis as a triage test in hrHPV-positive women is an attractive alternative to cytology. Furthermore, DNA methylation is feasible directly on brush-based self-samplers and showed good correlation with matched physician-taken samples. Direct molecular triage on self-collected specimens could optimise the screening program, especially for non-responders, as this would eliminate the need for an additional physician-taken scraping for triage testing.
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Reasons for non-attendance to cervical screening and preferences for HPV self-sampling in Dutch women. Prev Med 2014; 64:108-13. [PMID: 24736093 DOI: 10.1016/j.ypmed.2014.04.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 03/10/2014] [Accepted: 04/04/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES High attendance rates in cervical screening are essential for effective cancer prevention. Offering HPV self-sampling to non-responders increases participation rates. The objectives of this study were to determine why non-responders do not attend regular screening, and why they do or do not participate when offered a self-sampling device. METHODS A questionnaire study was conducted in the Netherlands from October 2011 to December 2012. A total of 35,477 non-responders were invited to participate in an HPV self-sampling study; 5347 women did opt out. Finally, 30,130 women received a questionnaire and self-sampling device. RESULTS The analysis was based on 9484 returned questionnaires (31.5%) with a self-sample specimen, and 682 (2.3%) without. Among women who returned both, the main reason for non-attendance to cervical screening was that they forgot to schedule an appointment (3068; 32.3%). The most important reason to use the self-sampling device was the opportunity to take a sample in their own time-setting (4763; 50.2%). A total of 30.9% of the women who did not use the self-sampling device preferred after all to have a cervical smear taken instead. CONCLUSIONS Organisational barriers are the main reason for non-attendance in regular cervical screening. Important reasons for non-responders to the regular screening to use a self-sampling device are convenience and self-control.
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Bosgraaf RP, Verhoef VMJ, Massuger LFAG, Siebers AG, Bulten J, de Kuyper-de Ridder GM, Meijer CJM, Snijders PJF, Heideman DAM, IntHout J, van Kemenade FJ, Melchers WJG, Bekkers RLM. Comparative performance of novel self-sampling methods in detecting high-risk human papillomavirus in 30,130 women not attending cervical screening. Int J Cancer 2014; 136:646-55. [PMID: 24923998 DOI: 10.1002/ijc.29026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 05/27/2014] [Indexed: 01/22/2023]
Abstract
We determined whether the participation rate for a brush-based cervicovaginal self-sampling device is noninferior to the participation rate for a lavage-based one for testing for hrHPV (high-risk human papillomavirus). Additionally, positivity rates for hrHPV, the detection rates for cervical intraepithelial neoplasia grades 2 and 3 or worse (CIN2+/3+), and user comfort were compared. A total of 35,477 non-responders of the regular cervical screening program aged 33-63 years were invited to participate. Eligible women (n = 30,130) were randomly assigned to receive either a brush-based or a lavage-based device, and a questionnaire for reporting user convenience. Self-sampling responders testing hrHPV-positive were invited for a physician-taken sample for cytology; triage-positive women were referred for colposcopy. A total of 5,218 women participated in the brush-based sampling group (34.6%) and 4809 women in the lavage-based group (31.9%), i.e. an absolute difference of 2.7% (95%CI 1.8-4.2). The hrHPV-positivity rates in the two groups were identical (8.3%, relative risk (RR) 0.99, 95%CI 0.87-1.13). The detection of CIN2+ and CIN3+ in the brush group (2.0% for CIN2+; 1.3% for CIN3+) was similar to that in the lavage group (1.9% for CIN2+; 1.0% for CIN3+) with a cumulative RR of 1.01, 95%CI 0.83-1.24 for CIN2+ and 1.25, 95%CI 0.92-1.70 for CIN3+. The two self-sampling devices performed similarly in user comfort. In conclusion, offering a brush-based device to non-responders is noninferior to offering a lavage-based device in terms of participation. The two self-sampling methods are equally effective in detecting hrHPV, CIN2+/CIN3+ and are both well accepted.
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Affiliation(s)
- Remko P Bosgraaf
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
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Liu H, Lv C, Ding B, Wang J, Li S, Zhang Y. Antitumor activity of G-quadruplex-interactive agent TMPyP4 with photodynamic therapy in ovarian carcinoma cells. Oncol Lett 2014; 8:409-413. [PMID: 24959286 PMCID: PMC4063630 DOI: 10.3892/ol.2014.2125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 03/20/2014] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the potential effects of photodynamic therapy (PDT) mediated by the cationic porphyrin, 5,10,15,20-tetra-(N-methyl-4-pyridyl)porphine (TMPyP4), on an ovarian carcinoma cell line and the underlying mechanisms by which TMPyP4-PDT exerts its actions. The analysis of cell viability, hematoxylin and eosin staining and flow cytometric apoptosis assays revealed that TMPyP4-PDT potently suppressed the growth of the A2780 cells in a laser energy- and dose-dependent manner. Mechanically, it was observed that TMPyP4-PDT suppressed the proliferation and motility of the A2780 cells. In addition, the expression levels of minichromosome maintenance protein-2 (MCM2) and carbonic anhydrase IX (CA-IX) were detected by western blot analysis. The results indicated that the TMPyP4-PDT-induced apoptosis and antimetastatic activity in the A2780 cells was accompanied by the inhibition of the expression of MCM2 and CA-IX. Therefore, TMPyP4-PDT may represent a potential therapeutic method for the treatment of ovarian carcinoma.
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Affiliation(s)
- Hongli Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Changshuai Lv
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Baijuan Ding
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jie Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Shan Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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