1
|
Lindquist S, Kjær SK, Frederiksen K, Ørnskov D, Petersen LK, Munk C, Waldstrøm M. Clinical performance of human papillomavirus based cervical cancer screening algorithm: The result of a large Danish implementation study. Acta Obstet Gynecol Scand 2024. [PMID: 39012789 DOI: 10.1111/aogs.14915] [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: 12/19/2023] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION In Denmark, where human papillomavirus (HPV) -based cervical cancer screening is being implemented, the aim of this pilot implementation study was to test a specific screening algorithm, assess follow-up examination attendance, and measure the proportion of precancer lesions found in relation to the number of women referred for colposcopy. MATERIAL AND METHODS From May 2017 to December 2020, 36 417 women in the uptake area of the Department of Pathology, Vejle Hospital, Region of Southern Denmark, were included in the HPV group. Women positive for HPV16/18 irrespective of cytology and women positive for other high-risk HPV (hrHPV) types having concomitant abnormal cytology were referred directly to colposcopy. Women positive for other hrHPV types and normal cytology were referred to repeat screening after 12 months, and hrHPV negative to routine screening after three years. We obtained information on screening results and subsequent histological diagnosis from the Danish Pathology Databank through September 2022. RESULTS 3.6% of the women were referred to colposcopy after primary screening, 5% to repeat screening after 12 months, and 91.4% back to routine screening. High follow-up rates were observed: 96% attended colposcopy after primary screening, with 91% attending colposcopy after repeat screening. CIN3+ was detected at colposcopy following the primary screening in 28.1% of HPV16/18-positive women and 18.2% of those positive for other hrHPV types with concomitant abnormal cytology. Of the women with other hrHPV and simultaneous ASCUS/LSIL, 8% had CIN3+. At the repeat screening, 43% had become hrHPV negative, 55% were persistently positive for other hrHPV, and 2% had turned positive for HPV16/18. At the colposcopy following repeat screening, 10.1% of the women positive for other hrHPV were diagnosed with CIN3+, in comparison with 11.1% of the HPV16/18-positive women. CONCLUSIONS In this pilot implementation study, an algorithm for HPV-based screening was evaluated in a Danish setting. The results demonstrated high attendance at follow-up examinations and provided insights into the number of colposcopy referrals and the detection of CIN2 and CIN3+ cases. The results suggest that women testing positive for other hrHPV in combination with ASCUS/LSIL at primary screening could potentially be referred to repeat screening instead of an immediate colposcopy.
Collapse
Affiliation(s)
- Sofie Lindquist
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Institute, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics, Biostatistics, and Registry, Danish Cancer Institute, Copenhagen, Denmark
| | - Dorthe Ørnskov
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Institute, Copenhagen, Denmark
| | - Marianne Waldstrøm
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
2
|
Erasun D, Delcampo AV, DE Castro A, Munoz-Solano A, Schneider J. Colposcopically Directed Biopsy Before Ablative Treatment Versus Direct Ablative Treatment in Patients With Cervical Oncogenic HPV. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:430-433. [PMID: 38962553 PMCID: PMC11215457 DOI: 10.21873/cdp.10343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/25/2024] [Indexed: 07/05/2024]
Abstract
Background/Aim In the past, the standard of care for women with abnormal cervical cytology has been the performance of colposcopically guided biopsy, followed by conization or large loop excision of the transition zone (LLETZ) where biopsy revealed pre-cancerous or cancerous areas. More straightforward protocols are emerging which advocate performing LLETZ in all women with highly suspicious cytology, suspicious colposcopic impression, or the presence of high-risk oncogenic human papilloma virus (HPV) strains in their cervical swabs. This, theoretically, would reduce the rate of false-negative diagnoses, but at the price of overtreating a significant number of healthy women. Patients and Methods We retrospectively analyzed cervical cancer screening protocols in two large cohorts of women with high-risk HPV. The study compared outcomes between patients undergoing a colposcopically directed biopsy before LLETZ (n=683) and those proceeding directly to LLETZ without a biopsy (n=136). The primary focus was to assess whether intervening biopsies would reduce unnecessary ablative procedures without compromising the detection of high-grade lesions. Results The biopsy group had a high false-negative rate, with several high-grade lesions (CIN3) and a case of invasive cancer initially underdiagnosed. Conversely, the direct-to-LLETZ approach, while ensuring no high-grade lesions were missed, led to overtreatment of lower grade lesions. Conclusion These findings raise concern about the reliance on biopsy results for treatment decisions. Neither protocol was entirely satisfactory, although the more aggressive one avoided the potentially life-threatening consequence of false-negative results. Further research is mandatory to accurately diagnose all cases requiring aggressive treatment, without subjecting healthy women to ablative treatments they do not need.
Collapse
Affiliation(s)
- Diego Erasun
- Hospital Universitario Valdecilla, Santander, Spain
| | | | | | | | - José Schneider
- Universidad de Valladolid, Departamento de Ginecología, Valladolid, Spain
| |
Collapse
|
3
|
Bist R, Mohi MK, Garg R. Colposcopic findings to study cervical changes in reproductive age group women using various contraceptives. Arch Gynecol Obstet 2024; 309:2799-2809. [PMID: 38461428 DOI: 10.1007/s00404-024-07394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/19/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Colposcopy has a key role to play in see-and-treat programs for premalignant cervical lesions. The aim of the study/was to observe cervical changes with a colposcope using the Swede scoring system in fertile age group women using various contraceptives: conventional methods (barrier methods, coitus interruptus), oral contraceptives (OCPs), copper-T and bilateral tubectomy. The aim of the study was to observe and evaluate the colposcopic findings using the Swede scoring system for the diagnosis of premalignant/malignant lesions in reproductive age group women using various contraceptives. METHODS This was a prospective observational study, conducted among 200 women of reproductive age group using various contraceptives in a tertiary care institute in North India. PAP smear, direct visual examination, VIA (Visual Inspection with Acetic Acid) examination, colposcopic examination, and (biopsy if indicated) were done. The data were collected, and analysis was done using Microsoft Excel Office Software 2019 version 19.11 and epi info (CDC Atlanta) 7.23.1. Statistical analysis was done using percentages, mean, mode, median, standard deviation, Chi-square, Fisher's Test, and Anova Test. RESULTS We found positive PAP (Papanicolaou test) smears in 61.50%, positive VIA examination in 9%, and positive findings in colposcopic examination in 28.50%, Swede score of 0-3 in 100% (0-91%, 1-2%, 2-6%, and 3-1%) and positive biopsy in 9% subjects. Malignant findings were observed in 1.00% of PAP smears. Colposcopic findings were CIN 1 (cervical intraepithelial neoplasia 1) in 8.5% and CIN 2 in 0.5% subjects. Swede score was zero in 91%, 1 in 2%, 2 in 6%, and 3 in 1% of subjects. HPE (histopathological examination) was chronic cervicitis in 8.50% and mild dysplasia/CIN 1 in 0.5%. No significant statistical associations between contraceptive choice and false-positive test results or disease prevalence was found in any group except Cu-T users p = 0.0184 (especially for CIN 2; p = 0.0109 and CIN 1 more in all groups than Cu-T users). Colposcopy had sensitivity 100%, specificity 91.46% (0/0 = 0%) PPV = 5.56%, NPV = 100%, Accuracy = 91.5% for detecting mild dysplasia/CIN-non-significant (p = 0.055). Our study had mainly low-grade lesions with 100% NPV. With increase in Swede Score, sensitivity increases but at the expense of specificity but it was statistically non-significant (p = 0.055). CONCLUSIONS Our study may guide the rational use of colposcopy with Swede scoring for see-and-treat lesions, which is easy and with a low learning curve, as a tool for diagnosis but only in cases where indicated like unhealthy cervix because of the high rate of false-positive results. In low-grade lesions, it is highly useful to rule out the disease.
Collapse
Affiliation(s)
- Ritika Bist
- Department of Obstetrics and Gynecology, Government Medical College and Rajindra Hospital, Patiala, 147001, Punjab, India
| | - Manjit Kaur Mohi
- Department of Obstetrics and Gynecology, Government Medical College and Rajindra Hospital, Patiala, 147001, Punjab, India
| | - Rama Garg
- Department of Obstetrics and Gynecology, Government Medical College and Rajindra Hospital, Patiala, 147001, Punjab, India.
- Department of Obstetrics and Gynecology, Adesh Institute of Medical Sciences and Research, Adesh University, Bathinda, 151001, Punjab, India.
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Chu MMY, Cheung CSY, Ngu SF, Tse KY, Ip PPC, Cheung ANY, Ngan HYS, Chan KKL. The Value of Four-Quadrant Cervical Biopsy in Women with Different Colposcopic Impressions. Diagnostics (Basel) 2023; 13:2384. [PMID: 37510128 PMCID: PMC10378482 DOI: 10.3390/diagnostics13142384] [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: 05/10/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study was to compare the diagnostic efficacy of colposcopic-directed biopsy and four-quadrant biopsy in detecting high-grade cervical intra-epithelial neoplasia (CIN). Women attending three women's clinics for routine cervical screening were recruited. Colposcopy was arranged for women with any cytologic abnormalities greater than atypical squamous cells of undetermined significance (ASCUS), two consecutive ASCUS results or positive HPV testing. During colposcopy, a cervical biopsy was taken from the most suspicious area, but more than one biopsy was allowed. Four-quadrant biopsies at 3, 6, 9 and 12 o'clock and an endocervical curettage were also taken in all cases. A total of 1522 colposcopies were performed in 1311 subjects from June 2010 to August 2017, with 118 cases of high-grade CIN diagnosed. Colposcopic-directed biopsy detected 50.8% of the 118 high-grade CIN, while four-quadrant biopsy detected 86.4% (p < 0.0001). Twenty-seven cases (22.9%) of high-grade CIN were diagnosed in women with normal or unsatisfactory colposcopy. Among the 64 cases with low-grade colposcopic impression, four-quadrant biopsy detected significantly more high-grade CIN (53 cases, 82.8%) than colposcopic-directed biopsy (35 cases, 56.3%) (p = 0.0011). Four-quadrant cervical biopsies should be considered for all women with an abnormal smear or positive HPV testing, especially in patients with low-grade/normal/unsatisfactory colposcopy.
Collapse
Affiliation(s)
- Mandy Man-Yee Chu
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Charleen Sze-Yan Cheung
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Siew-Fei Ngu
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ka-Yu Tse
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Philip Pun-Ching Ip
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Annie Nga-Yin Cheung
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hextan Yuen-Sheung Ngan
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Karen Kar-Loen Chan
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| |
Collapse
|
6
|
Origoni M, Cantatore F, Sopracordevole F, Clemente N, Spinillo A, Gardella B, De Vincenzo R, Ricci C, Landoni F, Di Meo ML, Ciavattini A, Di Giuseppe J, Preti E, Iacobone AD, Carriero C, Dellino M, Capodanno M, Perino A, Miglioli C, Insolia L, Barbero M, Candiani M. Colposcopy Accuracy and Diagnostic Performance: A Quality Control and Quality Assurance Survey in Italian Tertiary-Level Teaching and Academic Institutions-The Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV). Diagnostics (Basel) 2023; 13:diagnostics13111906. [PMID: 37296757 DOI: 10.3390/diagnostics13111906] [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: 05/05/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Quality Control (QC) and Quality Assurance (QA) principles are essential for effective cervical cancer prevention. Being a crucial diagnostic step, colposcopy's sensitivity and specificity improvements are strongly advocated worldwide since inter- and intra-observer differences are the main limiting factors. The objective of the present study was the evaluation of colposcopy accuracy through the results of a QC/QA assessment from a survey in Italian tertiary-level academic and teaching hospitals. A web-based, user-friendly platform based on 100 colposcopic digital images was forwarded to colposcopists with different levels of experience. Seventy-three participants were asked to identify colposcopic patterns, provide personal impressions, and indicate the correct clinical practice. The data were correlated with a panel of experts' evaluation and with the clinical/pathological data of the cases. Overall sensitivity and specificity with the threshold of CIN2+ accounted for 73.7% and 87.7%, respectively, with minor differences between senior and junior candidates. Identification and interpretation of colposcopic patterns showed full agreement with the experts' panel, ranging from 50% to 82%, in some instances with better results from junior colposcopists. Colposcopic impressions correlated with a 20% underestimation of CIN2+ lesions, with no differences linked to level of experience. Our results demonstrate the good diagnostic performance of colposcopy and the need for improving accuracy through QC assessments and adhesion to standard requirements and recommendations.
Collapse
Affiliation(s)
- Massimo Origoni
- Department of Obstetrics & Gynecology, IRCCS Ospedale San Raffaele, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy
| | - Francesco Cantatore
- Department of Obstetrics & Gynecology, IRCCS Ospedale San Raffaele, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, IRCCS Oncological Referral Center (CRO), National Cancer Institute, 33081 Aviano, Italy
| | - Nicolò Clemente
- Gynecological Oncology Unit, IRCCS Oncological Referral Center (CRO), National Cancer Institute, 33081 Aviano, Italy
| | - Arsenio Spinillo
- Department of Obstetrics & Gynecology, IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Barbara Gardella
- Department of Obstetrics & Gynecology, IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Rosa De Vincenzo
- Gynecological Oncology Unit, Department of Woman and Child Health and Public Health, IRCCS Policlinico Universitario A. Gemelli, 00168 Rome, Italy
- Department of Health Sciences and Public Health, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Caterina Ricci
- Department of Health Sciences and Public Health, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano Bicocca, Clinic of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Maria Letizia Di Meo
- Department of Medicine and Surgery, University of Milano Bicocca, Clinic of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Marche Polytechnic University, 60123 Ancona, Italy
| | - Jacopo Di Giuseppe
- Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Marche Polytechnic University, 60123 Ancona, Italy
| | - Eleonora Preti
- Preventive Gynecology Unit, IRCCS European Institute of Oncology (IEO), 20141 Milan, Italy
| | - Anna Daniela Iacobone
- Preventive Gynecology Unit, IRCCS European Institute of Oncology (IEO), 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Carmine Carriero
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Miriam Dellino
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Massimo Capodanno
- Department of Obstetrics and Gynecology, University of Napoli, 80138 Naples, Italy
| | - Antonino Perino
- Department of Obstetrics and Gynecology, University of Palermo, 90146 Palermo, Italy
| | - Cesare Miglioli
- Research Center for Statistics, University of Geneva, 1201 Geneva, Switzerland
| | - Luca Insolia
- Research Center for Statistics, University of Geneva, 1201 Geneva, Switzerland
| | - Maggiorino Barbero
- Department of Obstetrics and Gynecology, Azienda Sanitaria Locale di Asti, 14100 Asti, Italy
| | - Massimo Candiani
- Department of Obstetrics & Gynecology, IRCCS Ospedale San Raffaele, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy
| |
Collapse
|