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Wang S, Dang L, Liu S, Rezhake R, Yan H, Duan X, Zhang L, Zhang L, Zhang L, Su M, Guo F, Yan C, Liu M, Cao X, Sun M, Qiao Y, Zhao F. Cervical Cancer Screening via Visual Inspection With Acetic Acid and Lugol Iodine for Triage of HPV-Positive Women. JAMA Netw Open 2024; 7:e244090. [PMID: 38551562 PMCID: PMC10980959 DOI: 10.1001/jamanetworkopen.2024.4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
Importance Limited evidence supports the performance of human papillomavirus (HPV) DNA testing as a primary screening method, followed by triage with visual inspection with acetic acid, in areas with limited health care resources, as suggested by the 2021 World Health Organization guidelines. Objective To evaluate the performance of visual inspection with acetic acid and Lugol iodine as a triage method for detecting cervical precancerous lesions among HPV-positive women in 1 visit. Design, Setting, and Participants This cohort study examined the implementation of a government-led cervical cancer screening program conducted from January 1, 2016, to December 31, 2020, in Ordos City, China. Female residents, aged 35 to 64 years, who understood the screening procedures and voluntarily participated were included in the study. Women were excluded if they reported never having had sexual intercourse, were pregnant, had a hysterectomy, or had ever undergone treatment for cervical lesions. Statistical analysis was conducted from December 2022 to December 2023. Exposures The program used the careHPV DNA assay as the primary screening method, and immediate triage was performed by visual inspection if HPV screening results were positive, with a 5-year screening interval. A colposcopy was performed for the women who had suspected cancer on visual inspection results or who were HPV positive and had abnormal visual inspection results, all in 1 visit. Main Outcomes and Measures The rate of compliance with colposcopy and the detection rate of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). Results The study included 187 863 women (median age, 46 years [IQR, 40-52 years]) who participated in the program and had valid HPV test results. The overall prevalence of HPV positivity was 12.8% (24 070 of 187 863), and the adherence to triage with visual inspection among HPV-positive women was 93.9% (22 592 of 24 070). Among HPV-positive women, the rate of compliance with colposcopy was 65.6% (2714 of 4137), and the CIN2+ detection rate was 2.8% (643 of 22 592). Conclusions and Relevance The findings of this cohort study suggest that the implementation of HPV testing, visual inspection, and colposcopy within 1 visit may mitigate losses to follow-up, detect precancerous lesions, and hold significant implications for screening in comparable areas with limited health care resources.
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Affiliation(s)
- Sumeng Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Dang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujun Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Remila Rezhake
- Cancer Research Institute, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China
| | - Huijiao Yan
- Department of Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianzhi Duan
- Department of Obstetrics and Gynecology, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China
| | - Le Zhang
- Dean’s Office, Ordos Maternal and Child Health Care Hospital, Inner Mongolia Autonomous Region, Ordos, China
| | - Linlin Zhang
- Women’s Health Department, Ikinholo Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Lifeng Zhang
- Women’s Health Department, Otog Front Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Meili Su
- Dean’s Office, Dalad Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Fumei Guo
- Women’s Health Department, Jungar Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Cailing Yan
- Women’s Health Department, Otog Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Meili Liu
- Department of Obstetrics and Gynecology, Hangjin Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Xiaoyan Cao
- Women’s Health Department, Uxin Banner Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Min Sun
- Department of Obstetrics and Gynecology, Dongsheng District Maternal and Child Care Center, Ordos City, Inner Mongolia Autonomous Region, Ordos, China
| | - Youlin Qiao
- Department of Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fanghui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ardhaoui M, Rhouma RBH, Tounsi Guettiti H, Fehri E, Ouerhani K, Jemia ZB, Laassili T, Guizani I, Boubaker MS, Ennaifer E. Distribution of high-risk human papillomavirus in women with ASC-US or LSIL in Tunisian women: Place of HPV testing for women triage in Tunisia. Diagn Microbiol Infect Dis 2023; 105:115859. [PMID: 36543027 DOI: 10.1016/j.diagmicrobio.2022.115859] [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: 05/31/2022] [Revised: 09/29/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
The present study aimed to evaluate the distribution of oncogenic HPVs in Tunisian women diagnosed with ASC-US or LSIL in order to highlight the importance of HPV testing in the management of women with minor cytological lesions. The study involved 213 cervical samples from women aged from 18 to 82 years and diagnosed with ASC-US or LSIL. HPV detection and genotyping was performed by nested PCR followed by reverse Line Blotting. HPV DNA was identified in 161 cases (76.3%). Oncogenic HPV genotypes were detected in 53.1% of cases. The most frequent high-risk genotypes in this study were HPV16 (28.8%) followed by: HPV51 (9.6%), HPV18, HPV31 HPV56 (7.1%) and HPV45 (5.1%). Thus, 24 % of studied women were not infected by HPV and about 47% of infections are without oncogenic HPV. These results highlight the value of HPV testing in the decision algorithm of management of minor abnormalities lesions.
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Affiliation(s)
- Monia Ardhaoui
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia; Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia.
| | - Rahima B H Rhouma
- Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia; High Institute of Sciences and Technology of Environments of Borj-Cedria, University of Carthage, Tunis, Tunisia
| | - Haifa Tounsi Guettiti
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Emna Fehri
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia; Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Kaouther Ouerhani
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia; Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Zeineb B Jemia
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia; Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Thalja Laassili
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia; Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Ikram Guizani
- Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Med S Boubaker
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Emna Ennaifer
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia; Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
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Uusküla A, Oja M, Tamm S, Tisler A, Laanpere M, Padrik L, Nygard M, Reisberg S, Vilo J, Kolde R. Prevaccination Prevalence of Type-Specific Human Papillomavirus Infection by Grade of Cervical Cytology in Estonia. JAMA Netw Open 2023; 6:e2254075. [PMID: 36745455 DOI: 10.1001/jamanetworkopen.2022.54075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
IMPORTANCE Large-scale data on type-specific human papillomavirus (HPV) prevalence and disease burden worldwide are needed to guide cervical cancer prevention efforts. Promoting the research and application of health care big data has become a key factor in modern medical research. OBJECTIVE To examine the prevaccination prevalence of high-risk HPV (hrHPV) and type distribution by cervical cytology grade in Estonia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used text mining and the linking of data from electronic health records and health care claims to examine type-specific hrHPV positivity in Estonia from 2012 to 2019. Participants were women aged at least 18 years. Statistical analysis was performed from September 2021 to August 2022. MAIN OUTCOMES AND MEASURES Type-specific hrHPV positivity rate by cervical cytological grade. RESULTS A total of 11 017 cases of cervical cytology complemented with data on hrHPV testing results between 2012 and 2019 from 66 451 women aged at least 18 years (mean [SD] age, 48.1 [21.0] years) were included. The most common hrHPV types were HPV16, 18, 31, 33, 51 and 52, which accounted for 73.8% of all hrHPV types detected. There was a marked decline in the positivity rate of hrHPV infection with increasing age, but the proportion did not vary significantly based on HPV type. Implementation of nonavalent prophylactic vaccination was estimated to reduce the number of women with high-grade cytology by 50.5% (95% CI, 47.4%-53.6%) and the number with low-grade cytology by 27.8% (95% CI, 26.3%-29.3%), giving an overall estimated reduction of 33.1% (95% CI, 31.7%-34.5%) in the number of women with precancerous cervical cytology findings. CONCLUSIONS AND RELEVANCE In this cross-sectional study, text mining and natural language processing techniques allowed the detection of precursors to cervical cancer based on data stored by the nationwide health system. These findings contribute to the literature on type-specific HPV distribution by cervical cytology grade and document that α-9 phylogenetic group HPV types 16, 31, 33, 52 and α-7 phylogenetic group HPV 18 are the most frequently detected in normal-to-high-grade precancerous lesions in Estonia.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Marek Oja
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- STACC, Tartu, Estonia
| | - Sirli Tamm
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- STACC, Tartu, Estonia
| | - Anna Tisler
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Made Laanpere
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu; Tartu University Hospital Women's Clinic, Tartu, Estonia
| | - Lee Padrik
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu; Tartu University Hospital Women's Clinic, Tartu, Estonia
| | - Mari Nygard
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Sulev Reisberg
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- STACC, Tartu, Estonia
- Quretec, Tartu, Estonia
| | - Jaak Vilo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- STACC, Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu, Estonia
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Koc S, Yuksel D, Kinay T, Burkankulu D, Kayikcioglu F. Histologıcal results of HPV genotyping from a colposcopy center. Arch Gynecol Obstet 2022; 308:193-200. [PMID: 36543966 DOI: 10.1007/s00404-022-06879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the role of partial human papillomavirus (HPV) genotyping tests in predicting the diagnosis of high-grade cervical intraepithelial lesion and cancer (HSIL +) as a result of colposcopic histopathology. MATERIALS AND METHODS The study included 2872 patients who presented at our colposcopy unit between January 1, 2015 and December 31, 2019 and underwent colposcopy for the first time. The patients were compared in terms of HSIL + results as HPV 16/18 and HPV other type positive groups. RESULTS HSIL + was determined at the rate of 22.3% in the HPV 16/18 group and at 7.0% in the HPV Other group, and the difference was statistically significant (p = 0.000). HPV 16/18 types were found to be responsible for 84.8% of cervical cancers and 83.5% of HSIL and worse cases. CONCLUSION Partial HPV 16/18 genotyping is an effective strategy in the triage of HPV-positive women. HPV type identification consistent with the epidemiology of HPV types in HSIL + cases in the screened population, and the age-appropriate use of primary HPV tests will determine the sensitivity and cost effectiveness of screening.
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Inturrisi F, Lissenberg‐Witte BI, Veldhuijzen NJ, Bogaards JA, Ronco G, Meijer CJLM, Berkhof J. Estimating the direct effect of human papillomavirus vaccination on the lifetime risk of screen-detected cervical precancer. Int J Cancer 2021; 148:320-328. [PMID: 32663316 PMCID: PMC7754437 DOI: 10.1002/ijc.33207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 01/26/2023]
Abstract
Birth cohorts vaccinated against human papillomavirus (HPV) are now entering cervical cancer screening. Assessment of (pre)cancer (CIN3+) risk is needed to assess the residual screening need in vaccinated women. We estimated the lifetime (screen-detected) CIN3+ risk under five-yearly primary HPV screening between age 30 and 60, using HPV genotyping and histology data of 21,287 women participating in a screening trial with two HPV-based screening rounds, 5 years apart. The maximum follow-up after an HPV-positive test was 9 years. We re-estimated the CIN3+ risk after projecting direct vaccine efficacy for the bivalent and the nonavalent HPV vaccines, assuming life-long protection. The lifetime CIN3+ risk was 4.1% (95% confidence interval 3.5-4.9) and declined by 53.5% and 70.5% after bivalent vaccination without and with cross-protection, respectively, translating into a residual lifetime CIN3+ risk of 1.9% (1.4-2.4) and 1.2% (0.9-1.5). The CIN3+ risk declined by 88.5% after nonavalent vaccination, translating into a residual lifetime CIN3+ risk of 0.5% (0.2-0.7). The latter risk increased to 1.6% when vaccine protection only lasted until the first screening round at age 30. Among HPV-positive women with abnormal adjunct cytology, the nine-year CIN3+ risk was 16.9% (8.7-32.4) after nonavalent vaccination. In conclusion, HPV vaccination will lead to a strong decline in the lifetime CIN3+ risk and the remaining absolute CIN3+ risk will be very low. Primary HPV testing combined with adjunct cytology at five-year intervals still seems feasible even after nonavalent vaccination, although unlikely to be cost-effective. Our results support a de-intensification of screening programs in settings with high vaccination coverage.
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Affiliation(s)
- Federica Inturrisi
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
| | - Birgit I. Lissenberg‐Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
| | - Nienke J. Veldhuijzen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
- The Leprosy Research InitiativeAmsterdamThe Netherlands
| | - Johannes A. Bogaards
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
- Centre for Infectious Disease ControlNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | | | - Chris J. L. M. Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
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Gilham C, Sargent A, Kitchener HC, Peto J. HPV testing compared with routine cytology in cervical screening: long-term follow-up of ARTISTIC RCT. Health Technol Assess 2020; 23:1-44. [PMID: 31219027 DOI: 10.3310/hta23280] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The National Screening Committee (NSC) based its recommendation that human papillomavirus (HPV) testing should replace cytology in primary cervical screening largely on the 2009 follow-up results of the ARTISTIC trial (A Randomised Trial In Screening To Improve Cytology). The NSC must now decide on screening intervals and triage policy. Options include extending the screening interval up to 10 years for human papillomavirus-negative (HPV-) women, delaying recall for human papillomavirus-positive (HPV+) women with normal cytology (as their infections are usually transient), and basing triage on full HPV typing. METHODS In ARTISTIC, 24,510 women were recruited who were attending routine cervical cytology in Greater Manchester in 2001-3. The women were randomly allocated between revealing and concealing their HPV test results and were recalled every 3 years. After 2009, the women returned to routine cytological screening with recall every 3 years for those aged < 50 years, and every 5 years for those aged 50-64 years. We have followed the cohort to 2015 through national cancer registration for CIN3 (cervical intraepithelial neoplasia grade 3) and cancer, and through linkage to the cervical screening call-recall system to obtain lifetime cytology records. RESULTS The analysis comprised 24,496 women at round 1 and 13,591 women at round 2 (which was 30-48 months later). Follow-up via local histology laboratories and national cancer registration identified 505 cases of cervical intraepithelial neoplasia grade 3 or cervical cancer (CIN3+) (including 22 invasive cervical cancers). The cumulative CIN3+ risk 10 years after a negative HPV test [0.31%, 95% confidence interval (CI) 0.18% to 0.49%, in the revealed arm] was similar to that 3 years after negative cytology (0.30%, 95% CI 0.23% to 0.41%, in the concealed arm) and fell sharply with age, from 1.1% (95% CI 0.7% to 1.8%) in those women aged < 25 years to 0.08% (95% CI 0.03% to 0.20%) in those women aged > 50 years. The 10-year cumulative CIN3+ risk following a new HPV infection at round 2 was 3.4% (95% CI 2.1% to 5.4%). The highest risks were associated with type-specific persistent infections that, overall, resulted in a 10-year cumulative CIN3+ risk of 20.4% (95% CI 15.6% to 26.4%). CONCLUSIONS We found a similar level of protection 10 years after a negative HPV test and 3 years after negative cytology. These data support a considerably longer screening interval after a negative HPV test than after a negative cytology test. About three-quarters of women with HPV infection and normal cytology clear their infections within about 3 years. Their risk of CIN3+ within this time frame is low (1.5%), suggesting that the current policy of annual repeat testing and referral after 2 years may be unnecessarily cautious. Approximately 40% of women who remained HPV+ had cleared their initial infection and acquired a new HPV type. The cumulative CIN3+ risks in women with type-specific persistent infections are about six times higher than in women with new infections. Triage strategies based on HPV persistence would, therefore, reduce unnecessary referral of women with new (and largely transient) infections. HPV assays that identify HPV types 31, 33, 45, 52 and 58 in addition to 16 and 18 could be useful in triage as well as in primary HPV testing. Similar results in recent routine HPV screening suggest that our results are generalisable despite changes in cytology and HPV assay methods. We are continuing to follow the ARTISTIC cohort into the new era of primary HPV screening. Future work will focus on the implications of more sensitive HPV testing for primary HPV screening policy and triage of HPV-positive women. Our results suggest that a more sensitive test is needed to detect occult CIN3 at high risk of progression to cancer, but this would substantially increase the overall HPV detection rate. Tests such as DNA (deoxyribonucleic acid) methylation for distinguishing HPV infection from neoplasia will be evaluated on stored samples and on further samples now being collected from women in the cohort who are still being screened. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 28. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clare Gilham
- Non-Communicable Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexandra Sargent
- Department of Virology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Henry C Kitchener
- School of Cancer and Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Julian Peto
- Non-Communicable Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK
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Cao X, Liu S, Jia M, Chen H, Zhao D, Dong B, Guo Z, Ren L, Zhang S, Sun X. Performance of HPV16/18 in Triage of Cytological Atypical Squamous Cells of Undetermined Significance. Anal Cell Pathol (Amst) 2019; 2019:4324710. [PMID: 31934532 PMCID: PMC6942702 DOI: 10.1155/2019/4324710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022] Open
Abstract
CONTEXT Human papillomavirus (HPV) testing is widely used in cervical cancer screening in women; however, its efficiency in triaging women with atypical squamous cells of undetermined significance (ASC-US) needs to be validated. OBJECTIVE To evaluate the performance of HPV16/18 in the triage of women with ASC-US. METHODS Women presenting for routine cervical cancer screening had cervical specimens collected, with which both liquid-based cytology (LBC) and hrHPVs were examined; those with ASC-US cytology underwent colposcopy. HPV16/18 and 12 other types were tested with domestic hybridization capture and chemiluminescence signal amplification (DH3). Performance characteristics of HPV test (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for identification of cervical intraepithelium neoplasma (CIN) grade 2 or worse (CIN2+), and CIN grade 3 or worse (CIN3+)) were determined using standard statistical tests. RESULTS 317 women with ASC-US were eligible for the study. HrHPV prevalence was 15.77% (50/317); HPV16/18 prevalence was 3.61% (20/317). Sensitivity and specificity of HPV16/18 for detection of CIN 2+ were 64.71% and 97% and 64.29% and 96.37% for detection of CIN 3+, respectively. The positive predictive values (PPVs) and negative predictive values (NPVs) of HPV16/18 were 55.00% and 97.98% for CIN2+ and 45.00% and 98.32% for CIN3+, respectively. CONCLUSION HPV16/18 can be considered as an effective method to triage women with ASC-US as its good clinical performance. TRIAL REGISTRATION This trial is registered with Henan Cancer Hospital Medical Ethics Committee on July 5, 2016 (http://www.anti-cancer.com.cn), with registry no.: 2016037.
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Affiliation(s)
- Xiaoqin Cao
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Shuzheng Liu
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Manman Jia
- Gynecologic Oncology Department, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan 450008, China
| | - Hongmin Chen
- Gynecologic Oncology Department, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan 450008, China
| | - Dongmei Zhao
- Pathology Department, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan 450008, China
| | - Bing Dong
- Molecular Pathology Department, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan 450008, China
| | - Zhen Guo
- Central Laboratory, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan 450008, China
| | - Lingyan Ren
- Pathology Department, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan 450008, China
| | - Shaokai Zhang
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Xibin Sun
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
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Rizzuto I, Nalam M, Jiang J, Linder A, Rufford B. Risk factors for HPV persistence and cytology anomalies at follow-up after treatment for cervical dysplasia. Int J Gynaecol Obstet 2018; 141:240-244. [DOI: 10.1002/ijgo.12431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/13/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ivana Rizzuto
- Department of Gynaecological Oncology; Ipswich Hospital; Ipswich UK
| | - Mythili Nalam
- Department of Gynaecological Oncology; Ipswich Hospital; Ipswich UK
| | - Jason Jiang
- Department of Gynaecological Oncology; Ipswich Hospital; Ipswich UK
| | - Anders Linder
- Department of Gynaecological Oncology; Ipswich Hospital; Ipswich UK
| | - Barnaby Rufford
- Department of Gynaecological Oncology; Ipswich Hospital; Ipswich UK
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Perez S, Iñarrea A, Pérez-Tanoira R, Gil M, López-Díez E, Valenzuela O, Porto M, Alberte-Lista L, Peteiro-Cancelo MA, Treinta A, Carballo R, Reboredo MC, Alvarez-Argüelles ME, Purriños MJ. Fraction of high-grade cervical intraepithelial lesions attributable to genotypes targeted by a nonavalent HPV vaccine in Galicia, Spain. Virol J 2017; 14:214. [PMID: 29110680 PMCID: PMC5674742 DOI: 10.1186/s12985-017-0879-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022] Open
Abstract
Background Human papillomavirus (HPV) bivalent and quadrivalent vaccines have been widely implemented in worldwide organized immunization programs. A nonavalent HPV vaccine is now available in several countries. The objective was to describe the fraction of squamous non-invasive high-grade cervical intraepithelial lesions attributable to genotypes targeted by bi-quadrivalent vaccines and by nonavalent vaccine according to age and diagnosis in women living in the city of Vigo (Galicia, Spain). Methods Cervical scrapings (2009–2014) of women with histological diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2, n = 145) and grade 3-carcinoma in situ (CIN3-CIS, n = 244) were tested with Linear Array HPV Genotyping test (Roche diagnostics, Mannheim, Germany). Hierarchical estimation of the fraction attributable to HPV 16/18 or HPV 31/33/45/52/58 detected alone or in combination was calculated. Absolute additional fraction attributable to genotypes targeted by nonavalent vaccine compared to genotypes targeted by bi-quadrivalent vaccines was calculated as the increment of attributable cases with respect to all studied cases. Age group 1, 2 and 3 included women 18 to 34, 35–44 and ≥45 years old, respectively. EPIDAT 3.1 was used. Results Fraction attributable to genotypes targeted by bi-quadrivalent vaccines was 59% CIN2 vs. 69% CIN3-CIS (p < 0.001). It was 63/51/50% of CIN2 and 78/66/45% of CIN3-CIS in age group 1, 2, 3, respectively. Fraction attributable to genotypes targeted by nonavalent vaccine was 86% CIN2 and 86% CIN3-CIS. It was 87/91/75% of CIN2 and 90/86/76% of CIN3-CIS in age group 1, 2, 3, respectively. Fraction attributable to genotypes targeted by these vaccines tended to decrease as age increased (p-trend <0.05). Globally, absolute additional attributable fraction was 16%, 26% and 29% in age group 1, 2 and 3, respectively (p < 0.005). Conclusions Absolute additional fraction of CIN2 and CIN3-CIS attributable to genotypes targeted by nonavalent vaccine was observed in women of any age, especially in those over 35 years old.
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Affiliation(s)
- S Perez
- Microbiology Department, Institute of Biomedical Research of Vigo, University Hospital of Vigo, Vigo, Spain.
| | - A Iñarrea
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - R Pérez-Tanoira
- Internal Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - M Gil
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - E López-Díez
- Urology Department, University Hospital of Vigo, Vigo, Spain
| | - O Valenzuela
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - M Porto
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - L Alberte-Lista
- Pathology Department, University Hospital of Vigo, Vigo, Spain
| | | | - A Treinta
- Microbiology Department, Institute of Biomedical Research of Vigo, University Hospital of Vigo, Vigo, Spain
| | - R Carballo
- Microbiology Department, Institute of Biomedical Research of Vigo, University Hospital of Vigo, Vigo, Spain
| | - M C Reboredo
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | | | - M J Purriños
- Health and Epidemiology Department. Innovation and management of public health. Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, A Coruña, Spain
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Galati L, Peronace C, Fiorillo MT, Masciari R, Giraldi C, Nisticò S, Minchella P, Maiolo V, Barreca GS, Marascio N, Lamberti AG, Giancotti A, Lepore MG, Greco F, Mauro MV, Borelli A, Bocchiaro GL, Surace G, Liberto MC, Focà A. Six years genotype distribution of Human Papillomavirus in Calabria Region, Southern Italy: a retrospective study. Infect Agent Cancer 2017; 12:43. [PMID: 28770002 PMCID: PMC5531005 DOI: 10.1186/s13027-017-0154-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although analysis of the Human papillomavirus (HPV) genotype spread in a particular area has a crucial impact on public health and prevention programmes, there is a lack of epidemiological data regarding HPV in the Calabria region of Italy. We therefore update information on HPV age/genotype distribution by retrospectively analysing a cohort of women, with and without cervical lesions, living in Calabria, who underwent HPV DNA testing; moreover, we also evaluated HPV age/genotype distribution in a subset of patients with cervical lesions. METHODS Cervical scrape specimens obtained from 9590 women (age range 20-75 years) from January 2010 to December 2015 were tested for HPV DNA. Viral types were genotyped by Linear Array HPV Genotyping® test (Roche, USA) at the Clinical Microbiology Operative Unit of six hospitals located in four provinces of the Calabria region. Cervical scrape specimens were also used to perform Pap smears for cytological analysis in a subset of 405 women; cytological classification of the samples was performed according to the Bethesda classification system. RESULTS A total of 2974 women (31%) (C.I. 95% 30.09-31.94) were found to be HPV DNA positive for at least one (57.3%) or several (42.7%) HPV genotypes. Of single genotype HPV infections, 46.5% and 36.4 % were classed as high-risk (HR, Group 1) and low-risk (LR, Group 3) respectively, while 16.9% were classed as probably/possibly carcinogenic and 0.2% undetermined risk. Stratified by age, total HPV distribution, showed the highest prevalence within the range 30-39 years (37.2%), while single genotype infection distribution displayed a peak in women from the age range 20-29 years (37.5%). The most common high-risk HPV type was HPV 16 (19.1%), followed by HPV 31 (9.1%). CONCLUSIONS We provide epidemiological data on HPV age/genotype distribution in women living in the Calabria region with or without cytological abnormalities, further to the enhancement of HPV screening/prevention programmes for the local population.
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Affiliation(s)
- Luisa Galati
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Cinzia Peronace
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Teresa Fiorillo
- Unit of Microbiology and Virology, Polo Sanitario Nord ASP 5, Reggio Calabria, Italy
| | - Rosanna Masciari
- Unit of Mirobiology and Virology, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | - Cristina Giraldi
- Unit of Microbiology and Virology, "Annunziata" Hospital, Cosenza, Italy
| | - Salvatore Nisticò
- Unit of Microbiology and Virology, General Hospital, Lamezia Terme, Italy
| | - Pasquale Minchella
- Unit of Mirobiology and Virology, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | - Vincenzo Maiolo
- Unit of Microbiology and Virology, "G. Jazzolino" Hospital, Vibo Valentia, Italy
| | - Giorgio Settimo Barreca
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Nadia Marascio
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Angelo Giuseppe Lamberti
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Aida Giancotti
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | | | - Francesca Greco
- Unit of Microbiology and Virology, "Annunziata" Hospital, Cosenza, Italy
| | | | - Annelisa Borelli
- Unit of Microbiology and Virology, General Hospital, Lamezia Terme, Italy
| | - Giuseppa Lo Bocchiaro
- Unit of Microbiology and Virology, Polo Sanitario Nord ASP 5, Reggio Calabria, Italy
| | - Giovanni Surace
- Unit of Microbiology and Virology, Polo Sanitario Nord ASP 5, Reggio Calabria, Italy
| | - Maria Carla Liberto
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
| | - Alfredo Focà
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Viale Europa, 88100 Catanzaro, Italy
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11
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Ronco G, Zappa M, Franceschi S, Tunesi S, Caprioglio A, Confortini M, Del Mistro A, Carozzi F, Segnan N, Zorzi M, Giorgi-Rossi P. Impact of variations in triage cytology interpretation on human papillomavirus-based cervical screening and implications for screening algorithms. Eur J Cancer 2016; 68:148-155. [PMID: 27755998 DOI: 10.1016/j.ejca.2016.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/24/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women positive to human papillomavirus (HPV+) testing at cervical screening need triage, typically cytology and immediate colposcopy in case of atypical squamous cells of undetermined significance (ASCUS) or worse (ASCUS+) or, in cytology-normal HPV+ women, HPV test repeat after 1 year and colposcopy referral if still HPV+. Our hypothesis was that substantial variations in triage positivity and sensitivity may produce little variation in overall referral to colposcopy and on sensitivity of the entire screening process. METHODS Centre- and age-aggregated data from 72,869 women aged 35-64 years were derived from 10 organised screening programmes which have piloted HPV screening in Italy since 2012. Overall colposcopy referral was evaluated as a function of immediate colposcopy referral and overall CIN2+ detection as a function of the proportion of all CIN2+ detected by immediate referral (a proxy of cytology's sensitivity). We fitted additive regression models, adjusted for centre, age, compliance to HPV retesting and to colposcopy, by generalised estimation equations. RESULTS The proportion of HPV+ women directly referred to colposcopy varied across programmes (20-57%; average 37%) and so did CIN2+ detection (49-94%; average 77%). Overall, 63% (range 41-75%) of HPV+ were referred to colposcopy either immediately or at HPV repeat. An absolute 10% increase in immediate colposcopy referral resulted in 4.2% (95% CI: 3.3-5.1%) increase in overall referral. An absolute 10% increase in cytology's sensitivity resulted in a 1.1% (95% CI: 0.1-2.0%) increase in overall CIN2+ detection. CONCLUSIONS Repeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged.
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Affiliation(s)
- Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy.
| | - Marco Zappa
- Institute for Cancer Study and Prevention (ISPO), Florence, Italy
| | | | - Sara Tunesi
- Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy; Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Piemonte Orientale, Novara, Italy
| | - Adele Caprioglio
- Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | | | | | | | - Nereo Segnan
- Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Manuel Zorzi
- Registro Tumori del Veneto, Regione Veneto, Padova, Italy
| | - Paolo Giorgi-Rossi
- Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Italy; Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
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