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Dull PM, Achilles SL, Ahmed R, Barnabas RV, Campos NG, Chirgwin K, Cohen JA, de Sanjosé S, Doorbar J, Einstein MH, Emerson CI, Gottlieb SL, Hildesheim A, Qiao Y, Ruff P, Sampson JN, Sasieni P, Schiffman M, Shin H, Stanley MA, Trimble CL, Wentzensen N, Riemer AB, Schiller JT, Kreimer AR. Meeting report: Considerations for trial design and endpoints in licensing therapeutic HPV16/18 vaccines to prevent cervical cancer. Vaccine 2024; 42:126100. [PMID: 39004526 DOI: 10.1016/j.vaccine.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
Cervical cancer is a major cause of morbidity and mortality globally with a disproportionate impact on women in low- and middle-income countries. In 2021, the World Health Organization (WHO) called for increased vaccination, screening, and treatment to eliminate cervical cancer. However, even with widespread rollout of human papillomavirus (HPV) prophylactic vaccines, millions of women who previously acquired HPV infections will remain at risk for progression to cancer for decades to come. The development and licensing of an affordable, accessible therapeutic HPV vaccine, designed to clear or control carcinogenic HPV and/or to induce regression precancer could significantly contribute to the elimination efforts, particularly benefiting those who missed out on the prophylactic vaccine. One barrier to development of such vaccines is clarity around the regulatory pathway for licensure. In Washington, D.C. on September 12-13, 2023, a meeting was convened to provide input and guidance on trial design with associated ethical and regulatory considerations. This report summarizes the discussion and conclusions from the meeting. Expert presentation topics included the current state of research, potential regulatory challenges, WHO preferred product characteristics, modeling results of impact of vaccine implementation, epidemiology and natural history of HPV infection, immune responses related to viral clearance and/or precancer regression including potential biomarkers, and ethical considerations. Panel discussions were held to explore specific trial design recommendations to support the licensure process for two vaccine indications: (1) treatment of prevalent HPV infection or (2) treatment of cervical precancers. Discussion covered inclusion/exclusion criteria, study endpoints, sample size and power, safety, study length, and additional data needed, which are reported here. Further research of HPV natural history is needed to address identified gaps in regulatory guidance, especially for therapeutic vaccines intended to treat existing HPV infections.
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Affiliation(s)
- Peter M Dull
- Bill & Melinda Gates Foundation, Seattle, WA, USA.
| | | | | | - Ruanne V Barnabas
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; School of Medicine, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Silvia de Sanjosé
- ISGlobal, Barcelona, Spain; National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | - Youlin Qiao
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Paul Ruff
- University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | | | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Haina Shin
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | | | - Nicholas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Angelika B Riemer
- German Cancer Research Center (DKFZ), Heidelberg, Germany; German Center for Infection Research (DZIF), Partner Site Heidelberg, Germany
| | - John T Schiller
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Teng X, Chen H, Yang H, Liu H, Wang Y, Su Z, Tang C. Pre-clinical study of IR808 dye for cervical cancer in vitro and in vivo imaging. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03508-7. [PMID: 39367983 DOI: 10.1007/s00210-024-03508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 10/01/2024] [Indexed: 10/07/2024]
Abstract
There is an urgent need for improved methods for early screening and rapid diagnosis of cervical cancer since current conventional screening methods are plagued by operator subjectivity and unnecessary biopsies. IR808 is a tumour-targeting near-infrared (NIR) fluorescent dye that permits NIR imaging without the requirement of chemical conjugation. Our study investigates an IR808-based strategy for real-time monitoring of the cervix in vivo and rapid assessment of cervical specimens in vitro. We investigated the uptake of IR808 in vitro using normal cervical epithelial cells and three cervical cancer cell lines. The biodistribution of IR808 was examined in vivo via intravenous injection into tumour-bearing mice. Additionally, in vitro tissues were stained with IR808 to simulate the identification of cervical tumors in the clinical setting. Biocompatibility of the dye in both cellular and animal models was also examined. IR808 exhibited significant tumour-to-background ratios in fluorescence molecular imaging of in vivo tumors in nude mice. The application of NIR fluorescent dye IR808 in specific imaging screening, safe and non-invasive real-time monitoring, and rapid identification of cervical tumors from tissue specimens is expected to improve current screening methods for cervical cancer.
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Affiliation(s)
- Xiaohui Teng
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, China
| | - Hongbiao Chen
- School of Medicine, Chenggong Hospital, Xiamen University, Xiamen, 361000, China
| | - Han Yang
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, China
| | - Hongli Liu
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, China
| | - Yanlong Wang
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, China
| | - Zhiying Su
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, China
| | - Chu Tang
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China.
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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; 103:1781-1788. [PMID: 39012789 PMCID: PMC11324913 DOI: 10.1111/aogs.14915] [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: 12/19/2023] [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.
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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
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Cui N, Li X, Wen X, Xu J, Chen L. Pathological Changes and Pregnancy Outcomes in Cervical Intraepithelial Neoplasia Patients After Cold Knife Conization. Int J Gen Med 2024; 17:3641-3648. [PMID: 39189006 PMCID: PMC11346493 DOI: 10.2147/ijgm.s457614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/19/2024] [Indexed: 08/28/2024] Open
Abstract
Objective Analyze women treated with underwent cold knife conization (CKC) to remove advanced squamous intraepithelial lesions (CIN) of the cervix. The histopathological upgrading of the lesions previously detected on vaginal biopsy and postoperative pregnancy outcomes of were investigated, to identify high-risk subgroups in women. Methods A retrospective study was conducted at the First Central Hospital of Baoding City from June 2019 to December 2022 to analyze confirmed cases of Cervical Intraepithelial Neoplasia CIN-II and CIN-III. Investigation of pathological changes in postoperative pathological tissues, and to perform binary logistic analysis to identify risk factors for histopathological escalation in postoperative lesions. We analyze the effects of CKC surgery on pregnancy outcomes in patients by comparing against a control group of healthy pregnant women. Results Out of the 176 patients diagnosed with CIN-II who underwent cervical biopsy, 39 (22.16%) were found to have a final specimen diagnosis of CIN-III, while 7 (3.98%) were downgraded to CIN-I. Among the 108 patients diagnosed with CIN-III who underwent cervical biopsy, 7 cases (6.48%) were ultimately confirmed to have CIN-III. Ki67-positive, p16-positive (OR = 1.13, 95% CI 1.01-1.15), and colposcopy biopsy for CIN-II (OR = 1.59, 95% CI 1.33-3.6) were independent risk factors for pathological upgrade after CKC. Compared with healthy pregnant women, CIN patients had higher rates of premature birth (14.4%), premature rupture of the fetal membrane (13.6%), and cesarean section (37.5%) (P < 0.05). The mode of conception, abortion rate, ectopic pregnancy rate, and postpartum hemorrhage were not different between healthy pregnant women and CIN patients (P > 0.05). Conclusion Following cervical multi-point biopsy or CKC, along with pathological examination, the accurate diagnosis of cervical lesions is crucial as it allows for more precise identification of such lesions. Additionally, CKC increases the risk of premature birth, premature rupture of membranes, and the need for cesarean section.
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Affiliation(s)
- Na Cui
- Department of Obstetrics and Gynecology, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of China
| | - Xue Li
- Department of Obstetrics and Gynecology, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of China
| | - Xin Wen
- Department of Obstetrics and Gynecology, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of China
| | - JingJing Xu
- Department of Ultrasound, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of China
| | - Li Chen
- Department of Obstetrics and Gynecology, Baoding No.1 Central Hospital, Baoding City, Hebei Province, 071000, People’s Republic of China
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Sahasrabuddhe VV. Cervical Cancer: Precursors and Prevention. Hematol Oncol Clin North Am 2024; 38:771-781. [PMID: 38760198 DOI: 10.1016/j.hoc.2024.03.005] [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] [Indexed: 05/19/2024]
Abstract
Cervical cancer, caused due to oncogenic types of human papillomavirus (HPV), is a leading preventable cause of cancer morbidity and mortality globally. Chronic, persistent HPV infection-induced cervical precursor lesions, if left undetected and untreated, can progress to invasive cancer. Cervical cancer screening approaches have evolved from cytology (Papanicolaou test) to highly sensitive HPV-based molecular methods and personalized, risk-stratified, management guidelines. Innovations like self-collection of samples to increase screening access, innovative triage methods to optimize management of screen positives, and scalable and efficacious precancer treatment approaches will be key to further enhance the utility of prevention interventions.
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Affiliation(s)
- Vikrant V Sahasrabuddhe
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 5E-338, Rockville, MD, USA.
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Tan JHJ, Neesham D, Szabo RA, Khomko N, Yap D, Wrede CDH. Colposcopy performance in the new primary HPV screening in Australia: How to determine colposcopy competency? Aust N Z J Obstet Gynaecol 2024; 64:375-382. [PMID: 38425311 DOI: 10.1111/ajo.13807] [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: 07/31/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
AIMS To assess colposcopic performance and determine indicators for competency within the new Australian primary human papillomavirus (HPV) cervical screening program. MATERIALS AND METHODS A retrospective observational study of 4542 women seen at The Royal Women's Hospital Colposcopy Clinic in Melbourne, from 1 December 2017 to 31 July 2020 after a higher-risk cervical screening test (CST) result. RESULTS Histological CIN2+ was detected in 25.1% up to two years from first colposcopy visit (FCV). The majority (86.7%) of CIN2+ was detected early within the first six months of presentation. Biopsy rate overall was 96.1% with abnormal colposcopic impression. Of four colposcopists with a lower biopsy rate, only one was able to achieve this early detection rate. Biopsy was also taken in over 30% of cases with negative reflex cytology and normal colposcopy, with CIN2+ detected in 5.0% among positive HPV16/18 and 3.8% with non-16/18 HPV. Positive predictive value of high-grade colposcopic impression at FCV averaged 66.4% (range: 54.9-81.6% among our colposcopists) and is poorly correlated with early detection rate of CIN2+. Overall accuracy of colposcopy is 84.5% (range: 78.7-90.3%), buoyed by high true negative colposcopic predictions secondary to high rates of negative reflex cytology referral with the new screening algorithm and is also unlikely to be a useful colposcopy indicator. CONCLUSIONS Early detection rate of CIN2+ within the first six months of presentation is a useful measure of colposcopy competency and we would encourage our National Cancer Screening Register to explore this with the participating colposcopists.
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Affiliation(s)
- Jeffrey H J Tan
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Neesham
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Rebecca A Szabo
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalia Khomko
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Desiree Yap
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - C David H Wrede
- Department of Oncology & Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Aquilina A, Papagiannakis E. Deep Learning Diagnostic Classification of Cervical Images to Augment Colposcopic Impression. J Low Genit Tract Dis 2024; 28:224-230. [PMID: 38713522 DOI: 10.1097/lgt.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVE A deep learning classifier that improves the accuracy of colposcopic impression. METHODS Colposcopy images taken 56 seconds after acetic acid application were processed by a cervix detection algorithm to identify the cervical region. We optimized models based on the SegFormer architecture to classify each cervix as high-grade or negative/low-grade. The data were split into histologically stratified, random training, validation, and test subsets (80%-10%-10%). We replicated a 10-fold experiment to align with a prior study utilizing expert reviewer analysis of the same images. To evaluate the model's robustness across different cameras, we retrained it after dividing the dataset by camera type. Subsequently, we retrained the model on a new, histologically stratified random data split and integrated the results with patients' age and referral data to train a Gradient Boosted Tree model for final classification. Model accuracy was assessed by the receiver operating characteristic area under the curve (AUC), Youden's index (YI), sensitivity, and specificity compared to the histology. RESULTS Out of 5,485 colposcopy images, 4,946 with histology and a visible cervix were used. The model's average performance in the 10-fold experiment was AUC = 0.75, YI = 0.37 (sensitivity = 63%, specificity = 74%), outperforming the experts' average YI of 0.16. Transferability across camera types was effective, with AUC = 0.70, YI = 0.33. Integrating image-based predictions with referral data improved outcomes to AUC = 0.81 and YI = 0.46. The use of model predictions alongside the original colposcopic impression boosted overall performance. CONCLUSIONS Deep learning cervical image classification demonstrated robustness and outperformed experts. Further improved by including additional patient information, it shows potential for clinical utility complementing colposcopy.
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Tsampazis N, Vavoulidis E, Margioula-Siarkou C, Symeonidou M, Intzes S, Papanikolaou A, Dinas K, Daniilidis A. The Diagnostic Accuracy of Electrical Impedance Spectroscopy-Assisted Colposcopy, HPV mRNA Test, and P16/Ki67 Immunostaining as CIN2+ Predictors in Greek Population. Diagnostics (Basel) 2024; 14:1379. [PMID: 39001269 PMCID: PMC11240963 DOI: 10.3390/diagnostics14131379] [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: 06/04/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of Electrical Impedance Spectroscopy (EIS)-assisted colposcopy in detecting CIN2+ Greek women towards standalone colposcopy, HPV mRNA testing, and p16/Ki67 immunostaining. METHODS We conducted a cross-sectional observational study at the Cervical Pathology Clinic of the 2nd Obstetrics-Gynecology University Department of Hippokration Hospital Thessaloniki involving 316 patients from January 2022 to August 2023. All participants provided liquid-based cervical samples for cytology, HPV mRNA testing, and p16/Ki67 immunostaining. MAIN OUTCOME MEASURES Subsequently, participants underwent both standalone colposcopy and EIS/ZedScan-assisted colposcopy, followed by cervical punch biopsies. RESULTS The incorporation of EIS significantly enhanced the sensitivity of colposcopy, increasing it from 54.17% to 100%, equivalent to that of HPV mRNA testing and p16/Ki67 immunostaining, while achieving a high specificity (95.45%). The specificities observed with EIS/ZedScan-assisted and standalone colposcopy were notably superior to those of HPV-related biomarkers (HPV mRNA test and p16/Ki67 immunostaining). When compared to standalone colposcopy, HPV mRNA testing, and p16/Ki67 immunostaining, EIS/ZedScan-assisted colposcopy demonstrated the most favorable combination of Positive and Negative Predictive Values, at 90.57% and 100%, respectively. The inclusion of EIS/ZedScan in colposcopy led to the detection of 44 additional cases of true CIN2+ (100% of the total CIN2+ confirmed histologically) that were missed by standalone colposcopy. This discovery suggests a 45.83% increase in the detection of CIN2+ cases. CONCLUSIONS The integration of EIS with colposcopy has demonstrated effectiveness in detecting cervical lesions, resulting in a significant detection increase of CIN2+ cases while offering optimal levels of sensitivity, specificity, and predictive values for CIN2+ detection.
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Affiliation(s)
- Nikolaos Tsampazis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Marianthi Symeonidou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Stergios Intzes
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Alexios Papanikolaou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Angelos Daniilidis
- 1st Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 54124 Thessaloniki, Greece
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Ghahghaei-Nezamabadi A, Tehranian A, Feizabad E, Nikabadi P. The Effect of Random Biopsy and Endo-Cervical Curettage in Diagnosis of Precancerous Cervical Lesions in Women With Normal Colposcopy. J Family Reprod Health 2024; 18:108-114. [PMID: 39011413 PMCID: PMC11246732 DOI: 10.18502/jfrh.v18i2.15934] [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] [Indexed: 07/17/2024] Open
Abstract
Objective This study aimed to evaluate the effect of random biopsy and endo-cervical curettage (ECC), alone and together, in the diagnosis of high-grade cervical lesions in women with normal colposcopy. Materials and methods This cross-sectional study was conducted on 356 women who underwent colposcopy examination in the gynecology-oncology clinic of Roointan-Arash Women's Hospital, affiliated with Tehran University of Medical Sciences. All eligible women underwent colposcopy. In colposcopy examination, up to four biopsy samples were randomly taken for each quartile of the cervix and ECC was performed. Finally, the rate of intraepithelial neoplasia (CIN) and the relation between random biopsy and ECC and CIN diagnosis was determined. Results In total, 27 (7.6%) low-grade squamous intraepithelial lesions (LSIL) and 19 (5.3%) high-grade squamous intraepithelial lesions (HSIL) were detected in cases that underwent random biopsy. There was a significant association between the abnormal random biopsy results and having multiple sexual partners (p=0.001), cigarette (p=0.041), and hookah (p=0.033) smoking. Furthermore, 31 (8.7%) LSIL and 42 (11.8%) HSIL were reported in women who underwent ECC. There was a significant relation between the abnormal results of ECC and hookah consumption (p=0.008) and human papillomavirus (HPV) infection (p=0.011). The concordance (p=0.001) between random biopsy and ECC result was 71.2% and only in 28.8% of the cases one of the methods was normal and the other was abnormal. Conclusion The present study showed that the simultaneous use of ECC and random biopsy in women with normal colposcopy increases the detection rate of precancerous lesions by up to 28.8%.
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Affiliation(s)
- Akram Ghahghaei-Nezamabadi
- Department of Obstetrics and Gynecology, Arash Women’s Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Tehranian
- Department of Obstetrics and Gynecology, Arash Women’s Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Feizabad
- Department of Obstetrics and Gynecology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Nikabadi
- Department of Obstetrics and Gynecology, Arash Women’s Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Polleys CM, Singh P, Thieu HT, Genega EM, Jahanseir N, Zuckerman AL, Díaz FR, Patra A, Beheshti A, Georgakoudi I. Rapid, high-resolution, non-destructive assessments of metabolic and morphological homogeneity uniquely identify high-grade cervical precancerous lesions. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.10.593564. [PMID: 38798665 PMCID: PMC11118292 DOI: 10.1101/2024.05.10.593564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Purpose Two-photon microscopy (2PM) is an emerging clinical imaging modality with the potential to non-invasively assess tissue metabolism and morphology in high-resolution. This study aimed to assess the translational potential of 2PM for improved detection of high-grade cervical precancerous lesions. Experimental Design 2P images attributed to reduced nicotinamide adenine dinucleotide (phosphate) (NAD(P)H) and oxidized flavoproteins (FP) were acquired from the full epithelial thickness of freshly excised human cervical tissue biopsies (N = 62). Fifteen biopsies harbored high-grade squamous intraepithelial lesions (HSILs), 14 biopsies harbored low-grade SILs (LSILs), and 33 biopsies were benign. Quadratic discriminant analysis (QDA) leveraged morphological and metabolic functional metrics extracted from these images to predict the presence of HSILs. We performed gene set enrichment analysis (GSEA) using datasets available on the Gene Expression Omnibus (GEO) to validate the presence of metabolic reprogramming in HSILs. Results Integrating metabolic and morphological 2P-derived metrics from finely sampled, full-thickness epithelia achieved a high 90.8 ± 6.1% sensitivity and 72.3 ± 11.3% specificity of HSIL detection. Notably, sensitivity (91.4 ± 12.0%) and specificity (77.5 ± 12.6%) were maintained when utilizing metrics from only two images at 12- and 72-μm from the tissue surface. Upregulation of glycolysis, fatty acid metabolism, and oxidative phosphorylation in HSIL tissues validated the metabolic reprogramming captured by 2P biomarkers. Conclusion Label-free 2P images from as few as two epithelial depths enable rapid and robust HSIL detection through the quantitative characterization of metabolic and morphological reprogramming, underscoring the potential of this tool for clinical evaluation of cervical precancers.
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Affiliation(s)
| | - Pramesh Singh
- Data Intensive Studies Center, Tufts University, Medford, MA 02155, USA
| | - Hong-Thao Thieu
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | - Elizabeth M. Genega
- Department of Pathology and Laboratory Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | - Narges Jahanseir
- Department of Pathology and Laboratory Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | - Andrea L. Zuckerman
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | - Francisca Rius Díaz
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Málaga, 32 Louis Pasteur Boulevard, 29071 Málaga, Spain
| | - Abani Patra
- Data Intensive Studies Center, Tufts University, Medford, MA 02155, USA
| | - Afshin Beheshti
- Blue Marble Space Institute of Science, Seattle, WA, 98104 USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
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11
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Yang Z, Li D, Shi D. Photodynamic application in diagnostic procedures and treatment of non-melanoma skin cancers. Curr Treat Options Oncol 2024; 25:619-627. [PMID: 38581550 DOI: 10.1007/s11864-024-01193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 04/08/2024]
Abstract
OPINION STATEMENT Skin tumors commonly seen in dermatology are involved in all layers of the skin and appendages. While biopsy of affected skin remains an essential method to confirm diagnosis and to predicate tumor prognosis, it has its limitations. Recently, photodynamic diagnosis (PDD) has demonstrated high sensitivity in detecting affected skin and mucosal tissues, providing valuable guidance for precision surgery to resect skin and mucosal tumors. In this review, we summarized the literatures concerning the applications of PDD in diagnostic process and treatment of skin and mucosal conditions such as actinic keratoses (AK), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Bowen's disease (BD) and extramammary Paget's disease (EMPD). The findings suggest that PDD holds substantial promise for expanding clinical applications and deserves further research exploration.
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Affiliation(s)
- Zhiya Yang
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, 272000, Shandong, China
| | - Dongmei Li
- Department of Microbiology & Immunology, Georgetown University Medical Center, Washington, DC, 20057, USA
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, 272000, Shandong, China.
- Department of Dermatology, Jining No. 1 People's Hospital, Jining, 272001, Shandong, China.
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12
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Mongkolmafai O, Jeerakornpassawat D, Tantipalakorn C, Charoenkwan K, Suprasert P, Srisomboon J, Tongsong T. Efficacy of Lidocaine Spray for Pain Reduction during Colposcopy-Directed Cervical Biopsies: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:630. [PMID: 38674275 PMCID: PMC11051754 DOI: 10.3390/medicina60040630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Objectives: The objective of this study was to evaluate the efficacy of lidocaine spray in reducing the pain during colposcopy-directed cervical biopsy (CDB). Methods: From December 2017 to February 2019, 312 women undergoing CDBs were enrolled. The participants were randomized to three groups: group 1 (lidocaine spray), in which lidocaine spray was applied thoroughly to the cervix; group 2 (placebo), in which normal saline was applied thoroughly to the cervix; and group 3 (control), in which no anesthetic agent was applied to the cervix. Each woman completed a 10 cm visual analog scale to classify the subjective pain experience at three time points: baseline, immediately after biopsy, and 10 min after the procedure. The primary outcome of this study was the biopsy pain score. Results: The 312 enrolled women were randomly assigned to the three groups, amounting to 104 women per group. The clinical and pathological characteristics of the participants in all groups were comparable. The baseline, the biopsy, and the post-procedure pain scores were comparable among the three groups. There was a significant increase in the pain score from baseline to biopsy and from baseline to post-procedure in each group. The pain-score changes from baseline to biopsy in the lidocaine spray group significantly decreased when compared with the normal saline group (<0.001), and tended to decrease, though not significantly (p = 0.06), when compared with the control group. No complication with the intervention was observed. Conclusions: The application of lidocaine spray to the cervix has the benefit of reducing the pain associated with CDBs by a small amount. However, the intervention is safe and may be considered in nulliparous and/or overly anxious women undergoing the procedure.
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Affiliation(s)
| | | | - Charuwan Tantipalakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (O.M.); (D.J.); (K.C.); (P.S.); (J.S.); (T.T.)
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13
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Li Z, Zhou G, Jiang L, Wang M. Analysis of related factors for pathological upgrading of cervical biopsy from CIN3 to cancer after conical resection. BMC Cancer 2024; 24:401. [PMID: 38561685 PMCID: PMC10985929 DOI: 10.1186/s12885-024-12186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND To investigate related factors for postoperative pathological upgrading of cervical biopsy to cervical cancer (CC) in patients with cervical intraepithelial neoplasia (CIN)3 after conical resection. METHODS This retrospective study collected data from patients diagnosed with CIN3 by cervical biopsies at the author's Hospital between January 2012 and December 2022. The primary outcome was the pathological results of patients after conical resection. The pathological findings were categorized into the pathological upgrading group if postoperative pathology indicated CC, while those with normal, inflammatory, or cervical precancerous lesions were classified into the pathological non-upgrading group. The factors associated with upgrading were identified using multivariable logistic regression analysis. RESULTS Among 511 patients, there were 125 patients in the pathological upgrading group (24.46%). The patients in the upgrading group were younger (47.68 ± 9.46 vs. 52.11 ± 7.02, P < 0.001), showed a lower proportion of menopausal women (38.40% vs. 53.02%, P = 0.0111), a lower proportion of HSIL (40.00% vs. 57.77%, P = 0.001), a higher rate of HPV-16/18 positive (25.60% vs. 17.36%, P = 0.011), a higher rate of contact bleeding (54.40% vs. 21.50%, P < 0.001), lower HDL levels (1.31 ± 0.29 vs. 1.37 ± 0.34 mmol/L, P = 0.002), higher neutrophil counts (median, 3.50 vs. 3.10 × 109/L, P = 0.001), higher red blood cell counts (4.01 ± 0.43 vs. 3.97 ± 0.47 × 1012/L, P = 0.002), higher platelet counts (204.84 ± 61.24 vs. 187.06 ± 73.66 × 109/L, P = 0.012), and a smaller platelet volume (median, 11.50 vs. 11.90 fL, P = 0.002).The multivariable logistic regression analysis showed that age (OR = 0.90, 95% CI: 0.86-0.94, P < 0.001), menopausal (OR = 2.68, 95% CI: 1.38-5.22, P = 0.004), contact bleeding (OR = 4.80, 95% CI: 2.91-7.91, P < 0.001), and mean platelet volume (OR = 0.83, 95% CI: 0.69-0.99, P = 0.038) were independently associated with pathological upgrading from CIN3 to CC after conical resection. CONCLUSION Age, menopausal, contact bleeding, and mean platelet volume are risk factors of pathological upgrading from CIN3 to CC after conical resection, which could help identify high risk and susceptible patients of pathological upgrading to CC.
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Affiliation(s)
- Zhifang Li
- Department of Gynaecology, Anqing Municipal Hospital, Anhui Medical University, Anqing, Anhui Province, P.R. China.
| | - Guiju Zhou
- The Second Affiliated Hospital of Anhui Medical University, Anqing, Anhui Province, P.R. China
| | - Longfan Jiang
- Department of Gynaecology, Anqing Municipal Hospital, Anhui Medical University, Anqing, Anhui Province, P.R. China
| | - Mengjie Wang
- Department of Gynaecology, Anqing Municipal Hospital, Anhui Medical University, Anqing, Anhui Province, P.R. China
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14
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Li X, Zhao Y, Xiang F, Zhang X, Chen Z, Zhang M, Kang X, Wu R. Evaluation of the diagnostic performance of colposcopy in the detection of cervical high-grade squamous intraepithelial lesions among women with transformation zone type 3. BMC Cancer 2024; 24:381. [PMID: 38528547 DOI: 10.1186/s12885-024-12156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Inaccurate colposcopy diagnosis may lead to inappropriate management and increase the incidence of cervical cancer. This study aimed to evaluate the diagnostic accuracy of colposcopy in the detection of histologic cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women with transformation zone type 3 (TZ3). METHODS Records from 764 patients with TZ3 who underwent colposcopy-directed biopsy and/or endocervical curettage in Putuo Hospital China between February 2020 and March 2023 were retrospectively collected. Colposcopy was carried out based on 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) and Colposcopy nomenclature. The diagnostic performance of colposcopy for identifying CIN2 + was evaluated compared with biopsies. The Kappa and McNemar tests were used to perform statistical analyses. RESULTS Among the study population, 11.0% had pathologic CIN2+. The relative sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of colposcopy for histologic CIN2 + were 51.2%, 96.5%, 64.2% and 94.1%, respectively. The senior colposcopists (80.6%) had a higher colposcopic accuracy to diagnose histologic CIN2 + than junior colposcopists (68.6%). In subgroup analyses, age group ≥ 60 years (70.3%) showed lowest diagnostic accuracy when compared with age groups of < 45 years (84.4%) and 45-59 years (74.9%). CONCLUSION Our findings suggest an increased risk of diagnostic inaccuracy of colposcopy in identifying CIN2 + in those ≥ 60 years of age with TZ3, and the accuracy of colposcopy is required to be further improved.
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Affiliation(s)
- Xiaoxiao Li
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunzhi Zhao
- Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fenfen Xiang
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinpei Zhang
- Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zixi Chen
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengzhe Zhang
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiangdong Kang
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Rong Wu
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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15
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Desai KT, Hansen N, Rodriguez AC, Befano B, Egemen D, Gage JC, Wentzensen N, Lopez C, Jeronimo J, de Sanjose S, Schiffman M. Squamocolumnar junction visibility, age, and implications for cervical cancer screening programs. Prev Med 2024; 180:107881. [PMID: 38286273 PMCID: PMC10922959 DOI: 10.1016/j.ypmed.2024.107881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 01/31/2024]
Abstract
Visual assessment is currently used for primary screening or triage of screen-positive individuals in cervical cancer screening programs. Most guidelines recommend screening and triage up to at least age 65 years old. We examined cervical images from participants in three National Cancer Institute funded cervical cancer screening studies: ALTS (2864 participants recruited between 1996 to 1998) in the United States (US), NHS (7548 in 1993) in Costa Rica, and the Biopsy study (684 between 2009 to 2012) in the US. Specifically, we assessed the visibility of the squamocolumnar junction (SCJ), which is the susceptible zone for precancer/cancer by age, as reported by colposcopist reviewers either at examination or review of cervical images. The visibility of the SCJ declined substantially with age: by the late 40s the majority of people screened had at most partially visible SCJ. On longitudinal analysis, the change in SCJ visibility from visible to not visible was largest for participants from ages 40-44 in ALTS and 50-54 in NHS. Of note, in the Biopsy study, the live colposcopic exam resulted in significantly higher SCJ visibility as compared to review of static images (Weighted kappa 0.27 (95% Confidence Interval: 0.21, 0.33), Asymmetry chi-square P-value<0.001). Lack of SCJ visibility leads to increased difficulty in diagnosis and management of cervical precancers. Therefore, cervical cancer screening programs reliant on visual assessment might consider lowering the upper age limit for screening if there are not adequately trained personnel and equipment to evaluate and manage participants with inadequately visible SCJ.
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Affiliation(s)
- Kanan T Desai
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States; Internal Medicine Residency, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, United States.
| | - Natasha Hansen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Ana-Cecilia Rodriguez
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Brian Befano
- University of Washington, Seattle, United States; Information Management Services, MD, United States
| | - Didem Egemen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Julia C Gage
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Nicolas Wentzensen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | | | - Jose Jeronimo
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Silvia de Sanjose
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States; ISGlobal Barcelona, Spain
| | - Mark Schiffman
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
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16
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Harper DM, Yu TM, Fendrick AM. Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results. O&G OPEN 2024; 1:e001. [PMID: 38533459 PMCID: PMC10964775 DOI: 10.1097/og9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To model the potential number of cancers prevented and life-years saved over a range of adherence rates to cervical cancer screening, surveillance follow-up, and follow-up colposcopy that may result from removing financial barriers to these essential clinical services. METHODS A previously validated decision-analytic Markov microsimulation model was used to evaluate the increase in adherence to screening, surveillance, and colposcopy after an abnormal cervical cancer screening result. For each incremental increase in adherence, we modeled the number of cervical cancer cases avoided, the stages at which the cancers were detected, the number of cervical cancer deaths avoided, and the number of life-years gained. RESULTS Compared with current adherence rates, the model estimated that an optimized scenario of perfect screening, surveillance, and colposcopy adherence per 100,000 women currently eligible for screening in the United States was 128 (95% CI, 66-199) fewer cervical cancers detected (23%), 62 (95% CI, 7-120) fewer cervical cancer deaths (20%), and 2,135 (95% CI, 1,363-3,057) more life-years saved. Sensitivity analysis revealed that any increase in adherence led to clinically meaningful health benefits. CONCLUSION The consequences of not attending routine screening or follow-up after an abnormal cervical cancer screening result are associated with preventable cervical cancer morbidity and premature mortality. Given the potential for the removal of consumer cost sharing to increase the use of necessary follow-up after abnormal screening results and to ultimately reduce cervical cancer morbidity and mortality, public and private payers should remove cost barriers to these essential services.
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Affiliation(s)
- Diane M Harper
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - Tiffany M Yu
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - A Mark Fendrick
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
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17
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Dehghani A, Khajepour F, Dehghani M, Razmara E, Zangouey M, Abadi MFS, Nezhad RBA, Dabiri S, Garshasbi M. Hsa-miR-194-5p and hsa-miR-195-5p are down-regulated expressed in high dysplasia HPV-positive Pap smear samples compared to normal cytology HPV-positive Pap smear samples. BMC Infect Dis 2024; 24:182. [PMID: 38342922 PMCID: PMC10860252 DOI: 10.1186/s12879-023-08942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/20/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND The human papillomavirus (HPV) infection may affect the miRNA expression pattern during cervical cancer (CC) development. To demonstrate the association between high-risk HPVs and the development of cervix dysplasia, we examined the expression patterns of hsa-miR-194-5p and hsa-miR-195-5p in Pap smear samples from southeast Iranian women. We compared samples that were HPV-positive but showed no abnormality in the cytological examination to samples that were HPV-positive and had severe dysplasia. METHODS Pap smear samples were obtained from 60 HPV-positive (HPV-16/18) patients with histologically confirmed severe dysplasia (cervical intra-epithelial neoplasia (CIN 3) or carcinoma in situ) and the normal cytology group. The expression of hsa-miR-194-5p and hsa-miR-195-5p was analyzed by real-time quantitative PCR, using specific stem-loop primers and U6 snRNA as the internal reference gene. Clinicopathological features were associated with miRNA expression levels. Furthermore, functional enrichment analysis was conducted using in silico tools. The Kaplan-Meier survival method was also obtained to discriminate survival-significant candidate miRNAs in CC, and receiver operating characteristic (ROC) curves were constructed to assess the diagnostic value. RESULTS Compared to HPV-positive cytologically normal Pap smear samples, hsa-miR-194-5p and hsa-miR-195-5p relative expression decreased significantly in HPV-positive patients with a severe dysplasia Pap smear. Kaplan-Meier analysis indicated a significant association between the miR-194 decrease and poor CC survival. In essence, ROC curve analysis showed that miR-194-5p and miR-195-5p could serve as valuable markers for the development of cervix dysplasia in individuals who are positive for high-risk HPVs. CONCLUSIONS This study revealed that hsa-miR-194-5p and hsa-miR-195-5p may possess tumor suppressor capabilities in the context of cervical dysplasia progression. However, it remains uncertain whether these microRNAs are implicated in the transition of patients with high dysplasia to cervical cancer. We also showed the potential capability of candidate miRNAs as novel diagnostic biomarkers related to cervical dysplasia progression.
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Affiliation(s)
- Ali Dehghani
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fardin Khajepour
- Department of Immunology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Dehghani
- Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ehsan Razmara
- Australian Regenerative Medicine Institute, Monash University, Melbourne, Australia
| | - Mohammadreza Zangouey
- Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Reza Bahram Abadi Nezhad
- Department of Microbiology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Shahriar Dabiri
- Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Masoud Garshasbi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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18
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Cao D, Yang Z, Dong S, Li Y, Mao Z, Lu Q, Xu P, Shao M, Pan L, Han X, Yuan J, Fan Q, Chen L, Wang Y, Zhu W, Yu W, Wang Y. PCDHGB7 hypermethylation-based Cervical cancer Methylation (CerMe) detection for the triage of high-risk human papillomavirus-positive women: a prospective cohort study. BMC Med 2024; 22:55. [PMID: 38317152 PMCID: PMC10845746 DOI: 10.1186/s12916-024-03267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Implementation of high-risk human papillomavirus (hrHPV) screening has greatly reduced the incidence and mortality of cervical cancer. However, a triage strategy that is effective, noninvasive, and independent from the subjective interpretation of pathologists is urgently required to decrease unnecessary colposcopy referrals in hrHPV-positive women. METHODS A total of 3251 hrHPV-positive women aged 30-82 years (median = 41 years) from International Peace Maternity and Child Health Hospital were included in the training set (n = 2116) and the validation set (n = 1135) to establish Cervical cancer Methylation (CerMe) detection. The performance of CerMe as a triage for hrHPV-positive women was evaluated. RESULTS CerMe detection efficiently distinguished cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) from cervical intraepithelial neoplasia grade 1 or normal (CIN1 -) women with excellent sensitivity of 82.4% (95% CI = 72.6 ~ 89.8%) and specificity of 91.1% (95% CI = 89.2 ~ 92.7%). Importantly, CerMe showed improved specificity (92.1% vs. 74.9%) in other 12 hrHPV type-positive women as well as superior sensitivity (80.8% vs. 61.5%) and specificity (88.9% vs. 75.3%) in HPV16/18 type-positive women compared with cytology testing. CerMe performed well in the triage of hrHPV-positive women with ASC-US (sensitivity = 74.4%, specificity = 87.5%) or LSIL cytology (sensitivity = 84.4%, specificity = 83.9%). CONCLUSIONS PCDHGB7 hypermethylation-based CerMe detection can be used as a triage strategy for hrHPV-positive women to reduce unnecessary over-referrals. TRIAL REGISTRATION ChiCTR2100048972. Registered on 19 July 2021.
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Affiliation(s)
- Dan Cao
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Zhicong Yang
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shihua Dong
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuhong Li
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Zhanrui Mao
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi Lu
- Department of Obstetrics and Gynecology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Peng Xu
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Minfang Shao
- Department of Obstetrics and Gynecology, 2nd Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Pan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Xu Han
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jiangjing Yuan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Qiong Fan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Lei Chen
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yanzhong Wang
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK.
| | - Weipei Zhu
- Department of Obstetrics and Gynecology, 2nd Affiliated Hospital of Soochow University, Suzhou, China.
| | - Wenqiang Yu
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yudong Wang
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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19
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Ouh YT, Kim TJ, Ju W, Kim SW, Jeon S, Kim SN, Kim KG, Lee JK. Development and validation of artificial intelligence-based analysis software to support screening system of cervical intraepithelial neoplasia. Sci Rep 2024; 14:1957. [PMID: 38263154 PMCID: PMC10806233 DOI: 10.1038/s41598-024-51880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
Cervical cancer, the fourth most common cancer among women worldwide, often proves fatal and stems from precursor lesions caused by high-risk human papillomavirus (HR-HPV) infection. Accurate and early diagnosis is crucial for effective treatment. Current screening methods, such as the Pap test, liquid-based cytology (LBC), visual inspection with acetic acid (VIA), and HPV DNA testing, have limitations, requiring confirmation through colposcopy. This study introduces CerviCARE AI, an artificial intelligence (AI) analysis software, to address colposcopy challenges. It automatically analyzes Tele-cervicography images, distinguishing between low-grade and high-grade lesions. In a multicenter retrospective study, CerviCARE AI achieved a remarkable sensitivity of 98% for high-risk groups (P2, P3, HSIL or higher, CIN2 or higher) and a specificity of 95.5%. These findings underscore CerviCARE AI's potential as a valuable diagnostic tool for highly accurate identification of cervical precancerous lesions. While further prospective research is needed to validate its clinical utility, this AI system holds promise for improving cervical cancer screening and lessening the burden of this deadly disease.
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Tae Jin Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, Republic of Korea
| | - Woong Ju
- Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Seob Jeon
- Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Soo-Nyung Kim
- R&D Center, NTL Medical Institute, Yongin, Republic of Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Gil Medical Center, 24, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jae-Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
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20
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Lycke KD, Kalpathy-Cramer J, Jeronimo J, de Sanjose S, Egemen D, Del Pino M, Marcus J, Schiffman M, Hammer A. Agreement on Lesion Presence and Location at Colposcopy. J Low Genit Tract Dis 2024; 28:37-42. [PMID: 37963327 DOI: 10.1097/lgt.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES/PURPOSE The reproducibility and sensitivity of image-based colposcopy is low, but agreement on lesion presence and location remains to be explored. Here, we investigate the interobserver agreement on lesions on colposcopic images by evaluating and comparing marked lesions on digitized colposcopic images between colposcopists. METHODS Five colposcopists reviewed images from 268 colposcopic examinations. Cases were selected based on histologic diagnosis, i.e., normal/cervical intraepithelial neoplasia (CIN)1 ( n = 50), CIN2 ( n = 50), CIN3 ( n = 100), adenocarcinoma in situ ( n = 53), and cancer ( n = 15). We obtained digitized time-series images every 7-10 seconds from before acetic acid application to 2 minutes after application. Colposcopists were instructed to digitally annotate all areas with acetowhitening or suspect of lesions. To estimate the agreement on lesion presence and location, we assessed the proportion of images with annotations and the proportion of images with overlapping annotated area by at least 4 (4+) colposcopists, respectively. RESULTS We included images from 241 examinations (1 image from each) with adequate annotations. The proportion with a least 1 lesion annotated by 4+ colposcopists increased by severity of histologic diagnosis. Among the CIN3 cases, 84% had at least 1 lesion annotated by 4+ colposcopists, whereas 54% of normal/CIN1 cases had a lesion annotated. Notably, the proportion was 70% for adenocarcinoma in situ and 71% for cancer. Regarding lesion location, there was no linear association with severity of histologic diagnosis. CONCLUSION Despite that 80% of the CIN2 and CIN3 cases were annotated by 4+ colposcopists, we did not find increasing agreement on lesion location with histology severity. This underlines the subjective nature of colposcopy.
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Affiliation(s)
| | | | | | | | | | | | - Jenna Marcus
- Feinberg School of Medicine at Northwestern University, Chicago, IL
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21
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Yilmaz A, Gulbahar A, Sen S. Comparison of the efficacy of 5% versus 8% acetic acid concentrations for detecting premalignant and malignant lesions in colposcopy. Medicine (Baltimore) 2023; 102:e36341. [PMID: 38115367 PMCID: PMC10727527 DOI: 10.1097/md.0000000000036341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/05/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023] Open
Abstract
Although preventable; cervical cancer remains a significant cause of morbidity and mortality worldwide, especially in developing countries; thus, early diagnosis and treatment are essential to prevent its development into invasive cancer. Based on the screening results, diagnostic colposcopy was performed to evaluate women with abnormal Papinocalaou test results, high-risk human papillomavirus DNA positivity, or suspected cervical cancer. Therefore, this study aimed to determine the optimal acetic acid concentration (5% or 8%) for detecting cervical precancerous/cancerous lesions during colposcopy evaluation. This study included 607 patients admitted to our obstetrics and gynecology clinic. The medical records of the patients were obtained from the colposcopy registry in the hospital information system and retrospectively analyzed. The cases were divided into 2 groups according to the acetic acid concentrations (5% and 8%) used during colposcopy and examined. The duration of acetic acid application was 2 to 4 minutes. The probability of developing ≥ CIN2 was low in patients with negative for intraepithelial lesion or malignancy smear results in both groups, but increased in the high-grade squamous intraepithelial lesions/atypical squamous cells group with the 8% acetic acid concentration (P < .0001; P = .012). The probabilities of pathological detection of ≥ CIN2 in the 5% and 8% acetic acid groups were 17.3% and 46.6%, respectively (P < .0001). The enhancement of the efficiency of colposcopy should focus on improving the detectability of precancerous lesions. Given that this study compared the effectiveness of acetic acid concentration in colposcopy diagnostics, it can be considered a leading study in this field.
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Affiliation(s)
- Alpay Yilmaz
- Department of Obstetrics and Gynecology, Gynecologic Oncology Surgery, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Aysegul Gulbahar
- Department of Obstetrics and Gynecology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serhat Sen
- Department of Gynecologic Oncology, Istinye University Medical Park Hospital, Istanbul, Turkey
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22
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Lycke KD, Kahlert J, Damgaard RK, Eriksen DO, Bennetsen MH, Gravitt PE, Petersen LK, Hammer A. Clinical course of cervical intraepithelial neoplasia grade 2: a population-based cohort study. Am J Obstet Gynecol 2023; 229:656.e1-656.e15. [PMID: 37595822 DOI: 10.1016/j.ajog.2023.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Cervical intraepithelial neoplasia grade 2 has historically been the threshold for surgical excision, but because of high regression rates, many countries are transitioning to active surveillance. However, estimates for regression rates are based on small studies with heterogeneous definitions of regression and progression. OBJECTIVE This study aimed to describe regression and progression rates of cervical intraepithelial neoplasia grade 2 using nationwide healthcare registry data. STUDY DESIGN This was a nationwide population-based cohort study on women aged 18 to 40 years who had undergone active surveillance for cervical intraepithelial neoplasia grade 2 in Denmark from 1998 to 2020. This study excluded women with a previous record of cervical intraepithelial neoplasia grade 2 or worse or surgical excision. Cumulative incidence functions were used to estimate the rates of regression and progression at 6, 12, 18, and 24 months after diagnosis. In addition, a modified Poisson regression was used to estimate the crude and adjusted relative risks of progression within 24 months stratified by index cytology and age. RESULTS During the study period, 11,056 women underwent active surveillance, 6767 of whom regressed and 3580 of whom progressed within 24 months. This corresponded to regression rates of 62.9% (95% confidence interval, 61.9-63.8) and progression rates of 33.3% (95% confidence interval, 32.4-34.2) at 24 months of follow-up. Most women regressed (90%) or progressed (90%) within the first 12 months. Women with high-grade index cytology had a higher risk of progression than women with normal index cytology (adjusted relative, 1.58; 95% confidence interval, 1.43-1.76), whereas there was no difference in the risk of progression between women aged 30 and 40 years and women aged 23 to 29 years (adjusted relative risk, 0.98; 95% confidence interval, 0.88-1.10). CONCLUSION The observed high regression rates of cervical intraepithelial neoplasia grade 2 supported the transition in clinical management from surgical excision to active surveillance, particularly among women with low-grade or normal index cytology.
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Affiliation(s)
- Kathrine D Lycke
- Department of Gynecology and Obstetrics, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke K Damgaard
- Department of Gynecology and Obstetrics, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dina O Eriksen
- Department of Gynecology and Obstetrics, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mary H Bennetsen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Patti E Gravitt
- Center for Global Health, National Cancer Institute, Rockville, MD
| | - Lone K Petersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Hammer
- Department of Gynecology and Obstetrics, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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23
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Lycke KD, Kahlert J, Petersen LK, Damgaard RK, Cheung LC, Gravitt PE, Hammer A. Untreated cervical intraepithelial neoplasia grade 2 and subsequent risk of cervical cancer: population based cohort study. BMJ 2023; 383:e075925. [PMID: 38030154 PMCID: PMC10685285 DOI: 10.1136/bmj-2023-075925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To describe the long term risk of cervical cancer in women with untreated (that is, undergoing active surveillance) or immediately treated cervical intraepithelial neoplasia grade 2 (CIN2). DESIGN Nationwide population based historical cohort study. SETTING Danish healthcare registries. PARTICIPANTS Women with CIN2 diagnosed in 1998-2020 and aged 18-40 years at diagnosis, who had either active surveillance or immediate treatment with large loop excision of the transformation zone (LLETZ). Women with a previous record of CIN2 or worse or LLETZ were excluded. MAIN OUTCOME MEASURE A Weibull survival model for interval censored time-to-event data was used to estimate the cumulative risk of cervical cancer. Inverse probability treatment weighting was used to adjust estimates for age, index cytology, calendar year, and region of residence. RESULTS The cohort included 27 524 women with CIN2, of whom 12 483 (45%) had active surveillance and 15 041 (55%) had immediate LLETZ. During follow-up, 104 cases of cervical cancer were identified-56 (54%) in the active surveillance group and 48 (46%) in the LLETZ group. The cumulative risk of cervical cancer was comparable across the two groups during the active surveillance period of two years. Thereafter, the risk increased in the active surveillance group, reaching 2.65% (95% confidence interval 2.07% to 3.23%) after 20 years, whereas it remained stable in the LLETZ group at 0.76% (0.58% to 0.95%). CONCLUSIONS Undergoing active surveillance for CIN2, thereby leaving the lesion untreated, was associated with increased long term risk of cervical cancer compared with immediate LLETZ. These findings show the importance of continued follow-up of women having active surveillance.
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Affiliation(s)
- Kathrine Dyhr Lycke
- Department of Obstetrics and Gynaecology, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Kamp Damgaard
- Department of Obstetrics and Gynaecology, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Patti E Gravitt
- Centre for Global Health, National Cancer Institute, Rockville, MD, USA
| | - Anne Hammer
- Department of Obstetrics and Gynaecology, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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24
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Qian C, Zou X, Li W, Li Y, Yu W. The outpost against cancer: universal cancer only markers. Cancer Biol Med 2023; 20:j.issn.2095-3941.2023.0313. [PMID: 38018033 PMCID: PMC10690883 DOI: 10.20892/j.issn.2095-3941.2023.0313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/12/2023] [Indexed: 11/30/2023] Open
Abstract
Cancer is the leading cause of death worldwide. Early detection of cancer can lower the mortality of all types of cancer; however, effective early-detection biomarkers are lacking for most types of cancers. DNA methylation has always been a major target of interest because DNA methylation usually occurs before other detectable genetic changes. While investigating the common features of cancer using a novel guide positioning sequencing for DNA methylation, a series of universal cancer only markers (UCOMs) have emerged as strong candidates for effective and accurate early detection of cancer. While the clinical value of current cancer biomarkers is diminished by low sensitivity and/or low specificity, the unique characteristics of UCOMs ensure clinically meaningful results. Validation of the clinical potential of UCOMs in lung, cervical, endometrial, and urothelial cancers further supports the application of UCOMs in multiple cancer types and various clinical scenarios. In fact, the applications of UCOMs are currently under active investigation with further evaluation in the early detection of cancer, auxiliary diagnosis, treatment efficacy, and recurrence monitoring. The molecular mechanisms by which UCOMs detect cancers are the next important topics to be investigated. The application of UCOMs in real-world scenarios also requires implementation and refinement.
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Affiliation(s)
- Chengchen Qian
- Shanghai Epiprobe Biotechnology Co., Ltd, Shanghai 200233, China
| | - Xiaolong Zou
- Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Wei Li
- Shanghai Epiprobe Biotechnology Co., Ltd, Shanghai 200233, China
- Shandong Epiprobe Medical Laboratory Co., Ltd, Heze 274108, China
| | - Yinshan Li
- People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan 750002, China
| | - Wenqiang Yu
- Shanghai Public Health Clinical Center & Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Laboratory of RNA Epigenetics, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai 200032, China
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25
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Panagakis G, Papapanagiotou IK, Theofanakis C, Tsetsa P, Kontogeorgi A, Thomakos N, Rodolakis A, Haidopoulos D. Detection of High-Grade Cervical Intraepithelial Neoplasia by Electrical Impedance Spectroscopy in Women Diagnosed with Low-Grade Cervical Intraepithelial Neoplasia in Cytology. Life (Basel) 2023; 13:2139. [PMID: 38004279 PMCID: PMC10672316 DOI: 10.3390/life13112139] [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: 09/06/2023] [Revised: 10/19/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
The authors attempt to address the importance of timely detection and management of cervical intraepithelial neoplasia (CIN) to prevent cervical cancer. The study focused on the potential of electrical impedance spectroscopy (EIS) as an adjunct to colposcopy, aiming to enhance the accuracy of identifying high-grade cervical lesions. Colposcopy, a widely used technique, exhibited variable sensitivity in detecting high-grade lesions, which relies on the expertise of the operator. The study's primary objective is to evaluate the effectiveness of combining colposcopy with EIS in detecting high-grade cervical lesions among patients initially diagnosed with low-grade CIN based on cytology. We employed a cross-sectional observational design, recruiting 101 women with abnormal cervical cytology results. The participants underwent colposcopy with acetic acid and subsequent EIS using the ZedScan device. The ZedScan results are categorized into color-coded probability levels, with red indicating the highest likelihood of high-grade squamous intraepithelial lesions (HSIL) occurrence. Results revealed that ZedScan exhibits a sensitivity rate of 89.5% and a specificity rate of 84% for detecting high-grade lesions. Colposcopy, on the other hand, recorded a sensitivity rate of 85.5% and a specificity rate of 92%. The agreement rate between ZedScan and biopsy is 79.2%, as indicated by a kappa coefficient of 0.71, while the agreement rate between colposcopy and biopsy is 74.3%, with a kappa coefficient of 0.71.
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Affiliation(s)
- Georgios Panagakis
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Ioannis K. Papapanagiotou
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Charalampos Theofanakis
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Paraskevi Tsetsa
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Adamantia Kontogeorgi
- Department of Obstetrics and Gynecology, Attikon General Hospital, University of Athens, Rimini 1, 124 62 Haidari, Greece
| | - Nikolaos Thomakos
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Alexandros Rodolakis
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Dimitrios Haidopoulos
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
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26
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Bergqvist L, Heinonen A, Carcopino X, Redman C, Aro K, Kiviharju M, Virtanen S, Omar PL, Kotaniemi-Talonen L, Louvanto K, Nieminen P, Kalliala I. Added value of electrical impedance spectroscopy in adjunction of colposcopy: a prospective cohort study. BMJ Open 2023; 13:e074921. [PMID: 37899156 PMCID: PMC10619076 DOI: 10.1136/bmjopen-2023-074921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To assess whether electrical impedance spectroscopy (EIS) as an adjunctive technology enhances the performance of colposcopy. DESIGN Prospective cohort study. SETTING University Hospital colposcopy clinic. PARTICIPANTS Colposcopy with EIS for 647 women and conventional colposcopy for 962 women. INTERVENTIONS Comparison of the performance of colposcopy by referral cervical cytology in two cohorts, with and without EIS as an adjunctive technology. OUTCOME MEASURES Prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), diagnostic testing accuracy to detect CIN2+ with and without EIS and their relative differences between cohorts. RESULTS The prevalence of CIN2+ varied between the cohorts according to referral cytology: 17.0% after abnormal squamous cells of unknown significance referral cytology in EIS cohort and 9.1% in the reference cohort, 16.5% and 18.9% after low-grade squamous intraepithelial lesion (LSIL), 44.3% and 58.2% after atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (HSIL) (atypical squamous cells that cannot exclude HSIL), and 81.9% and 77.0% after HSIL cytology, respectively. Sensitivity to detect CIN2+ was higher in the EIS cohort, varying from 1.79 (95% CI 1.30 to 2.45) after LSIL referral cytology to 1.16 (95% CI 1.09 to 1.23) after HSIL referral cytology, with correspondingly lower specificity after any referral cytology. CONCLUSIONS Colposcopy with EIS had overall higher sensitivity but lower specificity to detect CIN2+ than conventional colposcopy. CIN2+ prevalence rates were, however, not consistently higher in the EIS cohort, suggesting innate differences between the cohorts or truly lower detection rates of CIN2+ for EIS, highlighting the need for randomised controlled trials on the effectiveness of EIS.
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Affiliation(s)
- Laura Bergqvist
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annu Heinonen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, APHM, AMU, Marseille, France
| | - Charles Redman
- Department of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Karoliina Aro
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mari Kiviharju
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Virtanen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirjo-Liisa Omar
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Kotaniemi-Talonen
- Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
- Department of Obstetrics and Gynaecology, Faculty of Medecine and Health Technology, Tampere University, Tampere, Finland
| | - Karolina Louvanto
- Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
- Department of Obstetrics and Gynaecology, Faculty of Medecine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Kalliala
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Metabolism, Digestion and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medecine, Imperial College, London, UK
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27
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Zhou Y, Wang C, Li W, Lu W, Liu X, Xi L, Li P, Lu J, Wei J. Fluorescence colposcope with TMTP1-PEG4-ICG is comparable to the conventional colposcope in identifying cervical precancerous lesions: A randomized controlled trial. Int J Gynaecol Obstet 2023; 162:969-976. [PMID: 36939553 DOI: 10.1002/ijgo.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE To compare the diagnostic efficiency of a fluorescence colposcope with TMTP1-PEG4-ICG dye versus a conventional colposcope with acetic acid and Lugol's iodine in identifying cervical precancerous lesions. METHODS In all, 218 women with abnormal cervical cancer screening results including cytology and/or human papillomavirus (HPV) test were involved in the randomized controlled trial. Patients in the fluorescence colposcope group had TMTP1-PEG4-ICG dye applied to the cervix uteri before colposcopy. Patients in the conventional colposcope group were routinely administered acetic acid and Lugol's iodine to stain the cervix uteri. Two to four cervical sites per patient were taken out for biopsy. The diagnostic efficiency of fluorescence colposcopy and conventional colposcopy was calculated on a per-patient and per-site basis. χ2 test or Fisher exact test was used. RESULTS A total of 194 patients and the corresponding 662 cervical sites were included in the final analysis. There was no statistically significant difference in the diagnostic efficiency between the two groups both on a per-patient and a per-site basis, including accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. CONCLUSIONS The fluorescence colposcope with TMTP1-PEG4-ICG dye was comparable to the conventional colposcope in identifying cervical precancerous lesions.
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Affiliation(s)
- Ying Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chen Wang
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wanrong Lu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaohu Liu
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Xi
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Pengcheng Li
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
- Research Unit of Multimodal Cross Scale Neural Signal Detection and Imaging, Chinese Academy of Medical Sciences, 2019RU002, HUST-Suzhou Institute for Brainsmatics, JITRI, Suzhou, China
| | - Jinling Lu
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Juncheng Wei
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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28
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Guido R, Perkins RB. Management of Abnormal Cervical Cancer Screening Test: A Risk-based Approach. Clin Obstet Gynecol 2023; 66:478-499. [PMID: 37650663 DOI: 10.1097/grf.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Cervical cancer screening plays a major role in preventing cervical cancer. The field is based on understanding the natural history of human papillomavirus and its role in cervical cancer. Screening has evolved to assessing the risk for cervical intraepithelial neoplasia grade 3, a true cancer precursor, and performing diagnostic tests based on those risks. This article summarizes the present state of management of abnormal cervical cancer screening tests in the United States, based on the most recent 2019 American Society of Colposcopy and Cervical Pathology guidelines.
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Affiliation(s)
- Richard Guido
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of the UPMC System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca B Perkins
- Boston University School of Medicine Chobanian & Avedisian School of Medicine, Boston Medical Center, Massachusetts
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29
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Abstract
Importance Each year in the US, approximately 100 000 people are treated for cervical precancer, 14 000 people are diagnosed with cervical cancer, and 4000 die of cervical cancer. Observations Essentially all cervical cancers worldwide are caused by persistent infections with one of 13 carcinogenic human papillomavirus (HPV) genotypes: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. HPV vaccination at ages 9 through 12 years will likely prevent more than 90% of cervical precancers and cancers. In people with a cervix aged 21 through 65 years, cervical cancer is prevented by screening for and treating cervical precancer, defined as high-grade squamous intraepithelial lesions of the cervix. High-grade lesions can progress to cervical cancer if not treated. Cervicovaginal HPV testing is 90% sensitive for detecting precancer. In the general population, the risk of precancer is less than 0.15% over 5 years following a negative HPV test result. Among people with a positive HPV test result, a combination of HPV genotyping and cervical cytology (Papanicolaou testing) can identify the risk of precancer. For people with current precancer risks of less than 4%, repeat HPV testing is recommended in 1, 3, or 5 years depending on 5-year precancer risk. For people with current precancer risks of 4% through 24%, such as those with low-grade cytology test results (atypical squamous cells of undetermined significance [ASC-US] or low-grade squamous intraepithelial lesion [LSIL]) and a positive HPV test of unknown duration, colposcopy is recommended. For patients with precancer risks of less than 25% (eg, cervical intraepithelial neoplasia grade 1 [CIN1] or histologic LSIL), treatment-related adverse effects, including possible association with preterm labor, can be reduced by repeating colposcopy to monitor for precancer and avoiding excisional treatment. For patients with current precancer risks of 25% through 59% (eg, high-grade cytology results of ASC cannot exclude high-grade lesion [ASC-H] or high-grade squamous intraepithelial lesion [HSIL] with positive HPV test results), management consists of colposcopy with biopsy or excisional treatment. For those with current precancer risks of 60% or more, such as patients with HPV-16-positive HSIL, proceeding directly to excisional treatment is preferred, but performing a colposcopy first to confirm the need for excisional treatment is acceptable. Clinical decision support tools can facilitate correct management. Conclusions and Relevance Approximately 100 000 people are treated for cervical precancer each year in the US to prevent cervical cancer. People with a cervix should be screened with HPV testing, and if HPV-positive, genotyping and cytology testing should be performed to assess the risk of cervical precancer and determine the need for colposcopy or treatment. HPV vaccination in adolescence will likely prevent more than 90% of cervical precancers and cancers.
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Affiliation(s)
- Rebecca B Perkins
- Boston University School of Medicine, Chobanian & Avedisian School of Medicine, Boston Medical Center, Massachusetts
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Richard S Guido
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Magee-Women's Hospital, Pittsburgh, Pennsylvania
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Harper DM, Anderson RJ, Baker E, Yu TM. Cost-effectiveness of p16/Ki-67 Dual-Stained Cytology Reflex Following Co-testing with hrHPV Genotyping for Cervical Cancer Screening. Cancer Prev Res (Phila) 2023; 16:393-404. [PMID: 37210751 PMCID: PMC10320467 DOI: 10.1158/1940-6207.capr-22-0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/20/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
The first biomarker-based cervical cancer screening test, p16/Ki-67 dual-stained cytology (DS), has been clinically validated and approved in the United States for triage of women being screened for cervical cancer who test positive for high-risk human papillomavirus (hrHPV). The primary aim of this work is to evaluate the cost-effectiveness of DS triage after co-testing findings of positive non-16/18 HPV types and atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions cytology. A payer-perspective Markov microsimulation model was developed to assess the impact of DS reflex testing. Each comparison simulated 12,250 screening-eligible women through health states defined by hrHPV status and genotype, cervical intraepithelial neoplasia grades 1-3, invasive cervical cancer (ICC) by stage, and cancer-related or non-cancer death. Screening test performance data were from the IMPACT clinical validation trial. Transition probabilities were from population and natural history studies. Costs of baseline medical care, screening visits, tests, procedures, and ICC were included. DS reflex after co-testing was cost-effective with incremental cost-effectiveness ratios per quality-adjusted life-year gained of $15,231 [95% confidence interval (CI), $10,717-$25,400] compared with co-testing with hrHPV pooled primary and genotyped reflex testing, and $23,487 (95% CI, $15,745-$46,175) compared with co-testing with hrHPV genotyping with no reflex test. Screening and medical costs and life-years increased, while ICC costs and risk of ICC death decreased. Incorporating DS reflex into co-testing cervical cancer screening algorithms is projected to be cost-effective. PREVENTION RELEVANCE The p16/Ki-67 dual-stained cytology (DS) test was recently approved in the United States as a reflex test for cervical cancer screening following positive high-risk human papillomavirus (hrHPV) test results. Adding DS reflex to hrHPV and cervical cytology co-testing strategies in the United States is expected to be cost-effective per life-year or quality-adjusted life-year gained.
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Affiliation(s)
- Diane M. Harper
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
- Department of Obstetrics & Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan
- Department of Women's and Gender Studies, University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan
- Department of Bioengineering, School of Engineering, University of Michigan, Ann Arbor, Michigan
| | | | - Ed Baker
- Roche Molecular Systems Inc., Pleasanton, California
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Cook IC, Fuhr LI, Flores SE, Novicoff WM, Cantrell LA. Cost-Conscious Colposcopy: A Single-Institution Review of Biopsy Submission Practices and Outcomes. J Low Genit Tract Dis 2023; 27:198-201. [PMID: 37097221 DOI: 10.1097/lgt.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE Distribution of cervical dysplasia may influence approach for excisional procedures. Separating colposcopy biopsies into multiple specimen cups for pathologic evaluation incurs additional costs. The authors aimed to determine whether the practice of separating biopsy specimens impacts patient outcomes. METHODS A retrospective review of all colposcopy cases from a single institution was performed. A total of 1,331 cases were reviewed from January 1, 2017, to December 31, 2019. Multibiopsy cohorts were separated by number of specimen cups received by pathology (single or multiple). Cohorts were compared for histology, need for excisional procedure, and final excisional pathology results. Specimen processing fees were acquired from the Department of Pathology ($70/specimen). Statistical analysis performed on MINITAB using Pearson chi-square and Fisher exact tests. RESULTS Excisional procedures were required by 30.4% (86/283) of multiple specimen submissions compared with 28.2% (154/547) of single specimen cup submissions ( p = .50). There was a higher, although not statistically significant, rate of additional procedures in the multiple specimen cup cohort (8.8 vs 2.9% [ p = .08]). Malignancy diagnosis was equivalent in each cohort. Cost analysis revealed adopting a single specimen cup model would reduce costs up to approximately $30,000/year. CONCLUSIONS Patient outcomes were not improved by the practice of submitting multiple specimen cups. Given the additional cost associated with separating specimens, the authors recommend during routine colposcopy that all cervical biopsies be sent for evaluation as a single pathology specimen unless a lesion of concern is identified in an area not normally excised during traditional excisional procedures.
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Affiliation(s)
- Ian C Cook
- The University of Kansas Health System, Kansas City, KS
| | - Laura I Fuhr
- The University of Virginia School of Medicine, Charlottesville, VA
| | - Sarah E Flores
- The University of Virginia School of Medicine, Charlottesville, VA
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Taghavi K, Moono M, Mwanahamuntu M, Roumet M, Limacher A, Kapesa H, Madliwa T, Rutjes A, Basu P, Low N, Manasyan A, Bohlius J. Accuracy of screening tests for cervical pre-cancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.31.23290779. [PMID: 37398043 PMCID: PMC10312869 DOI: 10.1101/2023.05.31.23290779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Introduction To provide evidence to improve cervical screening for women living with HIV (WLHIV), we assessed the accuracy of screening tests that can be used in low-resource settings and give results at the same visit. Methods We conducted a paired, prospective study among consecutive eligible WLHIV, aged 18-65 years, receiving cervical cancer screening at one hospital in Lusaka, Zambia. The histopathological reference standard was multiple biopsies taken at two time points. The target condition was high-grade cervical intraepithelial neoplasia (CIN2+). The index tests were high-risk human papillomavirus detection (hrHPV, Xpert HPV, Cepheid), portable colposcopy (Gynocular, Gynius), and visual inspection with acetic acid (VIA). Accuracy of stand-alone and test combinations were calculated as the point estimate with 95% confidence intervals. A sensitivity analysis considered disease when only visible lesions were biopsied. Results Among 371 participants with histopathological results, 27% (101/371) women had CIN2+ and 23% (23/101) was not detected by any index test. Sensitivity and specificity for stand-alone tests were: hrHPV, 67.3% (95% CI: 57.7-75.7) and 65.3% (59.4-70.7); Gynocular 51.5% (41.9-61.0) and 80.0% (74.8-84.3); and VIA 22.8% (15.7-31.9) and 92.6% (88.8-95.2), respectively. The combination of hrHPV testing followed by Gynocular had the best balance of sensitivity (42.6% [33.4-52.3]) and specificity (89.6% [85.3-92.7]). All test accuracies improved in sensitivity analysis. Conclusion The low accuracy of screening tests assessed might be explained by our reference standard, which reduced verification and misclassification biases. Better screening strategies for WLHIV in low-resource settings are urgently needed. Registration number The trial was registered prospectively at ClinicalTrials.gov (ref: NCT03931083 ). The study protocol has been previously published, and the statistical analysis plan can be accessed on ClinicalTrials.gov . Key messages What is already known on this topic: The 2021 World Health Organization guidelines recommend that women living with HIV (WLHIV) receive screening for high risk human papillomavirus high-risk human papillomavirus (hrHPV) genotypes at three- to five-year intervals, followed by a triage test to determine whether treatment is needed but this is based on low and moderate certainty evidence.What this study adds: This study among WLHIV in Lusaka, Zambia evaluated three screening tests that allow same-day treatment; hrHPV test, portable colposcopy (Gynocular), and visual inspection with acetic acid (VIA), using strict methods to reduce verification and misclassification biases. The test accuracy of the different screening was poor, with sensitivities and specificity for stand-alone tests: hrHPV, 67.3% and 65.3%; Gynocular 51.5% and 80.0%; and VIA 22.8% and 92.6%; respectively.How this study might affect research, practice or policy: Our findings have implications for research and cervical cancer screening policies among WLHIV if test-accuracy in this high-risk population has been overestimated from a majority of exsisting studies that are affected by verification and misclassification biases. Methodologically robust studies are crucial to inform cervical cancer screening practices and policies for the successful implementation of a cervical cancer elimination plan in sub-Saharan Africa, where 85% of women with cervical cancer and HIV live.
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Morello L, Mancini J, Carcopino X. Predictors factors of the absence of high-grade intraepithelial lesion in excisional therapy specimen. J Gynecol Obstet Hum Reprod 2023; 52:102550. [PMID: 36773647 DOI: 10.1016/j.jogoh.2023.102550] [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: 10/06/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To identify predictive factors of the absence of high-grade intraepithelial lesion (HGSIL) in cervical excisional therapy specimen. METHODS Data from 835 women who underwent excisional therapy for a cervical intra epithelial lesion at the department of Gynaecology from two university hospitals, between January 2015 and December 2020 were reviewed. Demographic data, referral cytology, colposcopic findings, results of cervical biopsy and endocervical curettage were retrieved. Primary outcome was the absence of HGSIL on cervical excisional specimen analysis defined by the identification of no intraepithelial lesion or of low-grade lesion only. RESULTS The absence of HGSIL on specimen was observed in 137 (16.4%) cases. Three factors were identified to have a significant and independent impact on the probability of the absence of HGSIL on specimen: age higher than 40 years (aOR: 1.8; 95%CI: 1.1-3.0; p=0.024), a small abnormal transformation zone (TZ) (aOR: 2.3; 95%CI: 1.4-3.7; p=0.001) and the result of the cervical biopsy at the time of colposcopic assessment not showing HGSIL (aOR: 8.6; 95%CI: 4.7-15.5; p < 0.001). No significant impact of the referral cytology nor of the colposcopic impression were observed. CONCLUSION Although the result of cervical biopsy performed at the time of colposcopic assessment is the key risk factor for the absence of HGSIL on excisional specimen, age over 40 and a small abnormal TZ are the two other identified risk factors. Practitioners should consider these findings when deciding for excisional therapy.
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Affiliation(s)
- Lea Morello
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Chemin des Bourrely, Marseille, France
| | - Julien Mancini
- Aix-Marseille University (AMU), Inserm, IRD, UMR912 SESSTIM, équipe cancers, biomédecine & société, 13273 Marseille, France; Department of biostatistics and technologies of information (BIOSTIC), Hôpital de la Timone (APHM), 264 Rue Saint Pierre, 13385 Marseille, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Chemin des Bourrely, Marseille, France; Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France.
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Hanczuk T, Weiss M, Henes L, Engler T, Neis F, Henes M. Certification as dysplasia unit and its impact on large loop electrosurgical excision (LEEP). Arch Gynecol Obstet 2023; 307:1177-1184. [PMID: 36209297 PMCID: PMC10023626 DOI: 10.1007/s00404-022-06807-7] [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: 07/28/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluates the overall treatment indicators and outcomes of patients who underwent loop electrosurgical excision procedure (LEEP) at the Department of Women's Health Tübingen and the impact of certification as a dysplasia unit on treatment quality. METHODS Retrospective data analysis of 1596 patients from 2013 to 2018 who underwent LEEP excision at the Department of Women's Health Tübingen. Data of cytology, colposcopy, biopsy, LEEP histology, repeat LEEP histology and general characteristics were collected and analyzed descriptively. RESULTS 85.4% (1364) of patients had CIN 2 + and 14.6% (232) had CIN 1 or normal findings on LEEP histology. The proportion of CIN 2 + excisions increased significantly from 82.4% in 2013 to 89% in 2018. The concordance of HSIL biopsy and LEEP histology was 89.1% in 2013 and 92.6% in 2018. In 2018, more biopsies and colposcopies were performed before excision. Complete resection (R0) was achieved in 88.3% of all excisions. R0 rates in patients with CIN 3 increased in 2014-2017 compared to 2013, resulting in fewer Re-LEEP excisions and hysterectomies. CONCLUSION Certification as a dysplasia unit and the associated requirements have improved the diagnostic quality for patients with cervical dysplasia undergoing LEEP. This was demonstrated by several treatment indicators such as the number of colposcopies and biopsies and treatment outcomes such as an increased proportion of CIN 2 + excisions and R0 resections.
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Affiliation(s)
| | - Martin Weiss
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Leon Henes
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Felix Neis
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Melanie Henes
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.
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Alfonzo E, Zhang C, Daneshpip F, Strander B. Accuracy of colposcopy in the Swedish screening program. Acta Obstet Gynecol Scand 2023; 102:549-555. [PMID: 36879505 PMCID: PMC10072243 DOI: 10.1111/aogs.14538] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/26/2023] [Accepted: 02/15/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Sensitivity and specificity of colposcopy vary greatly between studies and efficacy in clinical studies seldom corresponds with effectiveness in a real-life setting. It is unclear whether colposcopists' experience affects assessment; studies show divergent results. The study's objective was to investigate the accuracy of colposcopies in the Swedish screening program, the variability in colposcopists' assessments and whether degree of experience affects accuracy in a routine setting. MATERIAL AND METHODS Cross-sectional register study. All colposcopic assessments with a concomitant histopathological sample from women aged at least 18 years, performed between 1999 and September 2020 in Sweden. The main outcome measure was accuracy. The accuracy of colposcopic assessments was calculated as overall agreement with linked biopsies, with three outcomes: Normal vs Atypical, Normal vs Low-Grade Atypical vs High-Grade Atypical, and Non-High-Grade Atypical vs High-Grade Atypical. A time-trend analysis was performed. The accuracy of identifiable colposcopists related to experience was analyzed. RESULTS In total, 82 289 colposcopic assessments with linked biopsies were included for analysis of the outcome Normal vs Atypical; average accuracy was 63%. Overrating colposcopic findings was four times more common than underrating. No time trend in accuracy was noted during the study period. Accuracy in distinguishing High-Grade from Non-High-Grade lesions was better: 76%. Among identifiable colposcopists, overall accuracy was 67%. Some had significantly better accuracy than others, but no correlation with experience was found. CONCLUSIONS Colposcopy, including in a referral setting, has low accuracy in distinguishing Normal from Atypical. Increased experience alone does not lead to improvement. This is supported by the substantial differences in performance between colposcopists.
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Affiliation(s)
- Emilia Alfonzo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chenyang Zhang
- Regional Cancer Center West, Western Healthcare Region, Gothenburg, Sweden
| | - Forogh Daneshpip
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Strander
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regional Cancer Center West, Western Healthcare Region, Gothenburg, Sweden
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Ruff A, Harper DM, Dalton V, Fendrick AM. Coverage for the Entire Cervical Cancer Screening Process Without Cost-Sharing: Lessons From Colorectal Cancer Screening. Womens Health Issues 2023; 33:113-116. [PMID: 36529597 DOI: 10.1016/j.whi.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Allison Ruff
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Diane M Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Women and Gender Studies, University of Michigan, Ann Arbor, Michigan
| | - Vanessa Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - A Mark Fendrick
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Xue P, Seery S, Wang S, Jiang Y, Qiao Y. Developing a predictive nomogram for colposcopists: a retrospective, multicenter study of cervical precancer identification in China. BMC Cancer 2023; 23:163. [PMID: 36803785 PMCID: PMC9938572 DOI: 10.1186/s12885-023-10646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Colposcopic examination with biopsy is the standard procedure for referrals with abnormal cervical cancer screening results; however, the decision to biopsy is controvertible. Having a predictive model may help to improve high-grade squamous intraepithelial lesion or worse (HSIL+) predictions which could reduce unnecessary testing and protecting women from unnecessary harm. METHODS This retrospective multicenter study involved 5,854 patients identified through colposcopy databases. Cases were randomly assigned to a training set for development or to an internal validation set for performance assessment and comparability testing. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to reduce the number of candidate predictors and select statistically significant factors. Multivariable logistic regression was then used to establish a predictive model which generates risk scores for developing HSIL+. The predictive model is presented as a nomogram and was assessed for discriminability, and with calibration and decision curves. The model was externally validated with 472 consecutive patients and compared to 422 other patients from two additional hospitals. RESULTS The final predictive model included age, cytology results, human papillomavirus status, transformation zone types, colposcopic impressions, and size of lesion area. The model had good overall discrimination when predicting HSIL + risk, which was internally validated (Area Under the Curve [AUC] of 0.92 (95%CI 0.90-0.94)). External validation found an AUC of 0.91 (95%CI 0.88-0.94) across the consecutive sample, and 0.88 (95%CI 0.84-0.93) across the comparative sample. Calibration suggested good coherence between predicted and observed probabilities. Decision curve analysis also suggested this model would be clinically useful. CONCLUSION We developed and validated a nomogram which incorporates multiple clinically relevant variables to better identify HSIL + cases during colposcopic examination. This model may help clinicians determining next steps and in particular, around the need to refer patients for colposcopy-guided biopsies.
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Affiliation(s)
- Peng Xue
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China.
| | - Samuel Seery
- grid.9835.70000 0000 8190 6402Division of Health Research, Lancaster University, Lancaster, UK
| | - Sumeng Wang
- grid.506261.60000 0001 0706 7839Department of Cancer Epidemiology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital, 100021 Beijing, China
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China.
| | - Youlin Qiao
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China.
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Tsampazis N, Vavoulidis E, Siarkou CM, Siarkou GM, Pratilas GC, Symeonidou M, Intzes S, Petousis S, Papanikolaou A, Dinas K. Diagnostic comparison of electrical impedance spectroscopy with colposcopy and HPV mRNA-testing in the prediction of CIN2+ women in Greece. J Obstet Gynaecol Res 2023; 49:1222-1229. [PMID: 36658620 DOI: 10.1111/jog.15557] [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: 10/14/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
AIM To compare the diagnostic parameters of electrical impedance spectroscopy (EIS) via ZedScan, a device that measures spectra to differentiate between normal and abnormal cervical tissues, when used as an adjunct to colposcopies in the diagnosis of HSILs/CIN2+ in Greek women with abnormal referral cytology toward colposcopy alone and HPV mRNA-testing. METHODS This study analyzed 86 women, patients of the Colposcopy and Cervical Pathology Clinic of 2nd Obstetrics and Gynecology Department, Aristotle University of Thessaloniki at Hippokration General Hospital, between January 2022 and September 2022. During the visits, women were subjected to cytology, colposcopy alone and then with EIS/ZedScan and histological sampling. RESULTS Common use of colposcopies and EIS/ZedScan allowed detecting an additional 14 cases of CIN2+ (16.2%) that colposcopy alone failed to report. EIS enhanced the sensitivity of colposcopy from 80.65% to 100% equal with that of HPV-mRNA test while retaining a high specificity (94.74%) which is much higher than specificity of HPV mRNA-testing (65.45%). EIS-assisted colposcopy had the highest value combination of positive and negative predictive values (96.15% and 100%) compared to colposcopy alone (100% and 75%) and HPV mRNA-testing (72.46% and 100%). CONCLUSIONS Colposcopies performed with EIS/ZedScan demonstrated effectiveness in the diagnosing of CIN2+ leading to a significant increase in the number of CIN2+ that would have been missed if only colposcopy was applied especially in women with LSIL referral cytology. EIS/ZedScan seems to possess the ideal diagnostic threshold for sensitivity, specificity, and predictive values for CIN2+ compared to colposcopy alone and HPV mRNA-testing.
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Affiliation(s)
- Nikolaos Tsampazis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Chrysoula Margioula Siarkou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Georgia Margioula Siarkou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Georgios C Pratilas
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Marianthi Symeonidou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Stergios Intzes
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Alexios Papanikolaou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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Harper DM, Kamdar N, Dalton V, Fendrick AM. Equity enhancing policies that increase access and affordability of cervical cancer screening in the United States: A Preventive Medicine Golden Jubilee Commentary. Prev Med 2023; 166:107383. [PMID: 36495923 DOI: 10.1016/j.ypmed.2022.107383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Diane M Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, University of Michigan, AnnArbor, MI, USA; Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA.
| | - Neil Kamdar
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Vanessa Dalton
- Department of Obstetrics and Gynecology, University of Michigan, AnnArbor, MI, USA; Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - A Mark Fendrick
- Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI, USA
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Gustafson LW, Tranberg M, Christensen PN, Brøndum R, Wentzensen N, Clarke MA, Andersen B, Petersen LK, Bor P, Hammer A. Clinical utility of p16/Ki67 dual-stain cytology for detection of cervical intraepithelial neoplasia grade two or worse in women with a transformation zone type 3: A cross-sectional study. BJOG 2023; 130:202-209. [PMID: 35686564 PMCID: PMC10084097 DOI: 10.1111/1471-0528.17248] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the clinical utility of p16/Ki67 dual-stain (DS) compared with cytology for detecting cervical intraepithelial lesion grade two or worse (CIN2+) in women with a transformation zone type 3 (TZ3). DESIGN Cross-sectional study. SETTING Colposcopy clinics in Central Denmark Region. POPULATION Women aged 45 years or older referred for colposcopy because of an abnormal screening test. METHODS All women had a cervical sample collected for cytology and DS testing and underwent large-loop excision of the transformation zone (LLETZ). MAIN OUTCOME MEASURE Sensitivity, specificity and negative (NPV) and positive (PPV) predictive values of DS for CIN2+ detection were compared to those of cytology. RESULTS Of 166 women eligible, 93 (56.0%) were included in the final analysis. Median age was 68 years (interquartile range [IQR] 63.4-70.5 years). Most women were postmenopausal (95.7%) and referred based on a positive human papillomavirus screening test (86.0%). Fifty-two women (55.9%) were DS-positive, 29 (55.8%) of whom had CIN2+ detected. Twenty-seven (29.0%) women had atypical squamous cells of undetermined significance or worse (ASC-US+), and CIN2+ was detected in 21 women (77.8%). DS had a higher sensitivity (96.7% versus 70.0% p = 0.021) and NPV (97.6% versus 86.4%, p = 0.018) compared with cytology for CIN2+ detection. In contrast, the specificity (63.5% versus 90.5% p < 0.001) and PPV (55.8% versus 77.8%, p = 0.001) were lower for DS compared with cytology. CONCLUSIONS Dual stain may be a valuable risk marker to guide clinical management of women with a TZ3. The superior NPV of DS suggests that a diagnostic excision may safely be avoided in DS-negative women.
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Affiliation(s)
- Line Winther Gustafson
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Tranberg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | | | - Rikke Brøndum
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Megan A Clarke
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynaecology, Odense University Hospital and Open Patient Data Explorative Network, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pinar Bor
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Anne Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, NIDO Denmark, Gødstrup Hospital, Herning, Denmark
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Padavu S, Aichpure P, Krishna Kumar B, Kumar A, Ratho R, Sonkusare S, Karunasagar I, Karunasagar I, Rai P. An insight into clinical and laboratory detections for screening and diagnosis of cervical cancer. Expert Rev Mol Diagn 2023; 23:29-40. [PMID: 36697264 DOI: 10.1080/14737159.2023.2173580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Cervical cancer is the most frequent malignancy among women caused by an unresolved long-term infection with distinct human papillomavirus (HPV) genotypes. It is the fourth most common form of cancer among women worldwide. The two oncogenic genotypes, HPV 16 and 18, are responsible for >70% of all cervical cancers worldwide. Cervical cancer is one of the most successfully preventable and treatable forms of cancer if detected early. AREAS COVERED In this review article, we have summarizedsummarised the different approaches used in clinical diagnosis and research laboratories to detect HPV-related changes associated with cervical cancer for a better understanding of the advantages and limitations of these tests. EXPERT OPINION Despite the well-known screening strategies for cervical cancer, developing nations lack effective implementation due to various factors. With the current rate of cervical cancer cases, precise and timely identification of HPV can significantly impact the prevention and efficient management of cervical cancer. Cervical cancer is the most common gynecological cancer in developing countries. The primary screening test with cytology and molecular testing of HPV is important for preventing cervical cancer. To address these issues, several point-of-care assays have been developed to facilitate rapid screening of HPV with the least turnaround time.
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Affiliation(s)
- Shruthi Padavu
- Nitte (Deemed to Be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Infectious Diseases, Deralakatte, Mangaluru-575018, Karnataka, India
| | - Pooja Aichpure
- Nitte (Deemed to Be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Infectious Diseases, Deralakatte, Mangaluru-575018, Karnataka, India
| | - Ballamoole Krishna Kumar
- Nitte (Deemed to Be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Infectious Diseases, Deralakatte, Mangaluru-575018, Karnataka, India
| | - Anoop Kumar
- In Vivo Bioassay Laboratory & Animal Facility, National Institute of Biologicals (NIB), Ministry of Health & Family Welfare, Noida, India
| | - RadhaKanta Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shipra Sonkusare
- Nitte (Deemed to Be University), Department of Obstetrics & Gynaecology, KS Hegde Medical Academy (KSHEMA), Deralakatte, Mangaluru, India
| | - Indrani Karunasagar
- Nitte (Deemed to Be University), University Enclave, Medical Sciences Complex, Deralakatte, Mangaluru, India
| | - Iddya Karunasagar
- Nitte (Deemed to Be University), University Enclave, Medical Sciences Complex, Deralakatte, Mangaluru, India
| | - Praveen Rai
- Nitte (Deemed to Be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Infectious Diseases, Deralakatte, Mangaluru-575018, Karnataka, India
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Gustafson LW, Hammer A, Bennetsen MH, Kristensen C, Majeed H, Petersen LK, Andersen B, Bor P. Cervical intraepithelial neoplasia in women with transformation zone type 3: cervical biopsy versus large loop excision. BJOG 2022; 129:2132-2140. [PMID: 35488417 PMCID: PMC9796102 DOI: 10.1111/1471-0528.17200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare the proportion of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in cervical biopsies with that in large loop excision of the transformation zone (LLETZ) specimens in women aged ≥45 years with transformation zone type 3 (TZ3). DESIGN Multicentre cross-sectional study. SETTING Three colposcopy clinics in the Central Denmark Region. POPULATION Women aged ≥45 years referred to colposcopy as a result of a positive human papillomavirus (HPV) test and/or abnormal cytology and with TZ3 at colposcopy. METHODS Women had multiple biopsies taken and an LLETZ was performed. MAIN OUTCOME MEASURES Histologically confirmed CIN2+ in biopsies compared with that in LLETZ specimens. RESULTS Of 166 eligible women at colposcopy, 102 women with paired data from biopsies and LLETZ specimens were included for final analysis. The median age was 67.7 years (IQR 62.6-70.4 years), and most were postmenopausal (94.1%) and had undergone HPV-based screening (81.3%). The CIN2+ detection rate was significantly higher in LLETZ specimens than in biopsies (32.4% vs 14.7%, difference 17.7%, 95% CI 6.3-29.0%), resulting in more than half of CIN2+ cases being missed in biopsies (54.5%, 95% CI 36.4-71.9%). The overall agreement between biopsies and LLETZ was 82.4% (95% CI 73.6-89.2%). CONCLUSIONS CIN2+ detection is underestimated in women aged ≥45 years with TZ3 if detection relies on the results of biopsies alone. To reduce the risk of underdiagnosis and overtreatment, future studies should explore the use of new biomarkers for risk stratification to improve discrimination between women at increased risk of CIN2+ who need to undergo LLETZ and women who may undergo follow-up.
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Affiliation(s)
- Line Winther Gustafson
- Department of Public Health Programmes, Randers Regional HospitalUniversity Research Clinic for Cancer ScreeningRandersDenmark
- Department of Clinical MedicineAarhus UniversityHerningDenmark
| | - Anne Hammer
- Department of Clinical MedicineAarhus UniversityHerningDenmark
- Department of Obstetrics and GynaecologyGødstrup HospitalHerningDenmark
| | | | | | - Huda Majeed
- Department of Obstetrics and GynaecologyViborg Regional HospitalViborgDenmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and GynaecologyOdense University HospitalOdenseDenmark
- Open Patient data Explorative Network, Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional HospitalUniversity Research Clinic for Cancer ScreeningRandersDenmark
- Department of Clinical MedicineAarhus UniversityHerningDenmark
| | - Pinar Bor
- Department of Clinical MedicineAarhus UniversityHerningDenmark
- Department of Obstetrics and GynaecologyRanders Regional HospitalRandersDenmark
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Dang L, Kong L, Zhao Y, Dai Y, Ma L, Wei L, Zhang S, Liu J, Xi M, Chen L, Duan X, Xiao Q, Abulizi G, Zhang G, Hong Y, Zhou Q, Xie X, Li L, Niyazi M, Zhang Z, Tuo J, Ding Y, Qiao Y, Lang J. Evaluation of triage strategies for high-risk human papillomavirus-positive women in cervical cancer screening: A multicenter randomized controlled trial in different resource settings in China. Chin J Cancer Res 2022; 34:496-509. [PMID: 36398123 PMCID: PMC9646459 DOI: 10.21147/j.issn.1000-9604.2022.05.09] [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: 06/18/2022] [Accepted: 09/01/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus (hrHPV)-positive women in primary healthcare settings in China. METHODS This study was undertaken in 11 rural and 9 urban sites. Women aged 35-64 years old were enrolled. HrHPV-positive women were randomly allocated to liquid-based cytology (LBC), visual inspection with acetic acid and Lugol's iodine (VIA/VILI) (rural only) triage, or directly referred to colposcopy (direct COLP). At 24 months, hrHPV testing, LBC and VIA/VILI were conducted for combined screening. RESULTS In rural sites, 1,949 hrHPV-positive women were analyzed. A total of 852, 218 and 480 women were randomly assigned to direct COLP, LBC and VIA/VILI. At baseline, colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%-80%. LBC (n=3 and n=7) or VIA/VILI (n=8 and n=26) could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia (CIN) 2 or worse and CIN3+ compared with direct COLP (n=14 and n=23). For the 24-month cumulative detection rate of CIN2+, VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP. When stratified by age, baseline LBC triage+ performed best (P<0.001), peaking among women aged 35-44 years (Ptrend=0.002). In urban sites, 1,728 women were hrHPV genotyping test positive. A total of 408, 571 and 568 women were randomly assigned to direct COLP for HPV16/18+, direct COLP for other hrHPV subtypes+, and LBC triage for other hrHPV subtypes+. LBC (n=12 and n=31) significantly decreased the number of colposcopies needed to detect one CIN2+ and CIN3+ compared with direct COLP (n=14 and n=44). HPV16/18+ increased the 24-month cumulative detection rate of CIN2+ (17.89%, P<0.001). CONCLUSIONS LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+ women and LBC triage for other hrHPV subtype+ women in urban settings might be feasible strategies.
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Affiliation(s)
- Le Dang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Linghua Kong
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Yuqian Zhao
- Center for Cancer Prevention Research, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Yi Dai
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Li Ma
- Department of Epidemiology, Dalian Medical University, Dalian 116044, China
| | - Lihui Wei
- Department Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Shulan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, China
| | - Jihong Liu
- Department of Gynecology and Obstetrics, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Mingrong Xi
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Long Chen
- Department of Gynecology and Obstetrics, Zhejiang Xiaoshan Hospital Affiliated to Hangzhou Normal University, Chinese Academy of Medical Sciences/Zhejiang Xiaoshan Hospital Affiliated to Hangzhou Normal University, Hangzhou 310000, China
| | - Xianzhi Duan
- Department of Obstetrics and Gynecology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Qing Xiao
- Department of Gynecology and Obstetrics, the Eight Affiliated Hospital Sun Yat-sen University, Shenzhen 518000, China
| | - Guzhalinuer Abulizi
- 5th Department of Gynecology, the Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Guonan Zhang
- Department of Gynecologic Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Ying Hong
- Department of Gynecology and Obstetrics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qi Zhou
- Department of Gynecological Oncology, Chongqing University Cancer Hospital/Chongqing Cancer Hospital, Chongqing 400030, China
| | - Xing Xie
- Department of Gynecologic Oncology, Women’s Hospital, School of Medicine Zhejiang University, Hangzhou 310006, China
| | - Li Li
- Department of Gynecology and Obstetrics, Tumor Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Mayinuer Niyazi
- Department of Gynecology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China
| | - Zhifen Zhang
- Department of Gynecology, Hangzhou Women’s Hospital, Hangzhou 310016, China
| | - Jiyu Tuo
- Department of Gynecology and Obstetrics, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, China
| | - Yiling Ding
- Department of Gynecology and Obstetrics, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
| | - Jinghe Lang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
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Risk-Based Colposcopy for Cervical Precancer Detection: A Cross-Sectional Multicenter Study in China. Diagnostics (Basel) 2022; 12:diagnostics12112585. [PMID: 36359428 PMCID: PMC9689887 DOI: 10.3390/diagnostics12112585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
Recently published guidelines depend upon screening for cervical precancer risk stratification; however, colposcopy provides key information. There is no data from developing countries that could be used comparatively. Therefore, we assessed the potential benefits of intercalating colposcopic impressions with screening results to detect cervical precancers through a multicenter, cross-sectional study of a Chinese population. Anonymized data from 6012 women with cytologic assessment, human papillomavirus (HPV) testing, colposcopic impressions, and histological results were analyzed. Univariate and multivariate analysis showed that high-grade squamous intraepithelial lesion (HSIL) cytology, HPV16/18+, and/or high-grade colposcopic impressions markedly increased cervical precancer risk, while high-grade colposcopic impressions were associated with the highest risk. The risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) ranged from 0% for normal/benign colposcopic impressions, <HSIL cytologies, and HPV negative to 63.61% for high-grade colposcopy, HSIL+ cytology, and HPV16/18+, across 18 subgroups. High-grade colposcopic impressions were associated with a >19% increased risk of CIN3+, even in participants without HSIL+ cytology and/or HPV16/18+. Regardless of screening outcomes, normal/benign colposcopic impressions were associated with the lowest risk of CIN3+ (<0.5%). Integrating colposcopic impressions into risk assessment may therefore provide key information for identifying cervical precancer cases. Adopting this approach may improve detection rates while also providing reassurance for women with a lower risk of developing cervical cancer.
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Li ZF, Jia XH, Feng X, Zhang S, Zhang X, Pan QJ, Zou XW, Hao YQ, Sun XB, Qiao YL. Comparison of primary cytology, primary HPV testing and co-testing as cervical cancer screening for Chinese women: a population-based screening cohort. BMJ Open 2022; 12:e063622. [PMID: 36253033 PMCID: PMC9577894 DOI: 10.1136/bmjopen-2022-063622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We compared clinical performance of three strategies of primary human papillomavirus (HPV) testing, primary cytology and co-testing for cervical cancer screening. DESIGN A population-based prospective cohort study of clinical performance of screening strategy. SETTING Patients recruited from community in Changzhi County, Shanxi Province, China. PATIENT 3209 women aged 30-64 years without gynaecological issues. PRIMARY AND SECONDARY OUTCOME MEASURES The performance of different screening strategies for detecting cervical intraepithelial neoplasia grade 2 or more severe (CIN2+). RESULTS A total of 53 CIN2+ and 31 CIN3+ cases are detected. For CIN2+, sensitivity of primary HPV (95.9%) and co-testing (98.0%) are not statistically different, but significantly higher than primary cytology (48.0%). Specificity (86.8%), colposcopy referral rate (7.8%) and number of colposcopies required to detect one case (9.8) for primary HPV are better than co-testing (79.8%, 11.9%, 14.3%, respectively). For CIN3+, primary HPV, co-testing have 100% of sensitivity and specificity, which is significantly higher than primary cytology (56.7% and 90.2%). Number of colposcopies required to detect one case for primary HPV (15.9) is better than co-testing (23.8). CONCLUSIONS Compared with co-testing, HPV primary screening had comparable sensitivity and higher specificity for CIN2+ detection, and both of them showed better performance than cytology primary screening in cervical cancer screening.
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Affiliation(s)
- Zhi-Fang Li
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
- Department of Preventive Medicine, Changzhi Medical College, ChangZhi, Shanxi, China
| | - Xin-Hua Jia
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, Xiamen University, Xiamen, Fujian, china
| | - Xiangxian Feng
- Department of Preventive Medicine, Changzhi Medical College, ChangZhi, Shanxi, China
| | - Shaokai Zhang
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Xun Zhang
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Qin-Jing Pan
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Xun-Wen Zou
- Macalester College, Saint Paul, Minnesota, USA
| | - Yue-Qing Hao
- Department of Preventive Medicine, Changzhi Medical College, ChangZhi, Shanxi, China
| | - Xi-Bin Sun
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - You-Lin Qiao
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
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Desai KT, Adepiti CA, Schiffman M, Egemen D, Gage JC, Wentzensen N, de Sanjose S, Burk RD, Ajenifuja KO. Redesign of a rapid, low-cost HPV typing assay to support risk-based cervical screening and management. Int J Cancer 2022; 151:1142-1149. [PMID: 35666530 PMCID: PMC9378567 DOI: 10.1002/ijc.34151] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
Abstract
Accelerated cervical cancer control will require widespread human papillomavirus (HPV) vaccination and screening. For screening, sensitive HPV testing with an option of self-collection is increasingly desirable. HPV typing predicts risk of precancer/cancer, which could be useful in management, but most current typing assays are expensive and/or complicated. An existing 15-type isothermal amplification assay (AmpFire, Atila Biosystems, USA) was redesigned as a 13-type assay (ScreenFire) for public health use. The redesigned assay groups HPV types into four channels with differential cervical cancer risk: (a) HPV16, (b) HPV18/45, (c) HPV31/33/35/52/58 and (d) HPV39/51/56/59/68. Since the assay will be most useful in resource-limited settings, we chose a stratified random sample of 453 provider-collected samples from a population-based screening study in rural Nigeria that had been initially tested with MY09-MY11-based PCR with oligonucleotide hybridization genotyping. Frozen residual specimens were masked and retested at Atila Biosystems. Agreement on positivity between ScreenFire and prior PCR testing was very high for each of the channels. When we simulated intended use, that is, a hierarchical result in order of clinical importance of the type groups (HPV16 > 18/45 > 31/33/35/52/58 > 39/51/56/59/68), the weighted kappa for ScreenFire vs PCR was 0.90 (95% CI: 0.86-0.93). The ScreenFire assay is mobile, relatively simple, rapid (results within 20-60 minutes) and agrees well with reference testing particularly for the HPV types of greatest carcinogenic risk. If confirmed, ScreenFire or similar isothermal amplification assays could be useful as part of risk-based screening and management.
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Affiliation(s)
- Kanan T. Desai
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Clement A. Adepiti
- Department of Obstetrics, Gynecology, and PerinatologyThe Obafemi Awolowo UniversityIle‐IfeOsun StateNigeria
| | - Mark Schiffman
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Didem Egemen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Julia C. Gage
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Nicolas Wentzensen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Silvia de Sanjose
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
- ISGlobalBarcelonaSpain
| | - Robert D. Burk
- Albert Einstein Cancer CenterAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | - Kayode O. Ajenifuja
- Department of Obstetrics, Gynecology, and PerinatologyThe Obafemi Awolowo UniversityIle‐IfeOsun StateNigeria
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Chao CR, Chubak J, Beaber EF, Kamineni A, Mao C, Silverberg MJ, Tiro JA, Skinner C, Garcia M, Corley DA, Winer RL, Raine‐Bennett T, Feldman S, Wheeler CM. Gaps in the screening process for women diagnosed with cervical cancer in four diverse US health care settings. Cancer Med 2022; 12:3705-3717. [PMID: 36106421 PMCID: PMC9939213 DOI: 10.1002/cam4.5226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Potential care gaps in the cervical cancer screening process among women diagnosed with cervical cancer in an era with increased human papillomavirus (HPV) testing have not been extensively evaluated. METHODS Women diagnosed with cervical cancer between ages 21 and 65 at four study sites between 2010 and 2014 were included. Screening histories were ascertained from 0.5 to 4 years prior to cervical cancer diagnosis. We identified potential care gaps in the screening history for each woman and classified them into one of three mutually exclusive types: lack of a screening test, screening test failure, and diagnostic/treatment care gap. Distributions of care gaps were tabulated by stage, histology, and study site. Multivariable nominal logistic regression was used to examine the associations between demographic and cancer characteristics and type of care gap. RESULTS Of 499 women evaluated, 46% lacked a screening test in the time window examined, 31% experienced a screening test failure, and 22% experienced a diagnostic/treatment care gap. More than half of the women with advanced cancer and squamous cell carcinoma lacked a screening test compared to 31% and 24% of women with localized cancer and adenocarcinoma, respectively. Women aged 21-29 at diagnosis were more likely to experience screening test failure and diagnostic/treatment care gap, while those aged 50-65 were more likely to lack a screening test, compared to women aged 30-39. CONCLUSIONS Our findings demonstrate a continuing need to develop interventions targeting unscreened and under-screened women and improve detection and diagnosis of adenocarcinoma in women undergoing cervical cancer screening and diagnostic follow-up.
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Affiliation(s)
- Chun R. Chao
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Elisabeth F. Beaber
- Fred Hutchinson Cancer Research Center, Public Health Sciences DivisionSeattleWashingtonUSA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Connie Mao
- Department of Obstetrics and Gynecology, University of WashingtonSeattleWashingtonUSA
| | | | - Jasmin A. Tiro
- Department of Population and Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA,Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
| | - Celette Skinner
- Department of Population and Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA,Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
| | - Michael Garcia
- Fred Hutchinson Cancer Research Center, Public Health Sciences DivisionSeattleWashingtonUSA
| | - Douglas A. Corley
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Rachel L. Winer
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWashingtonUSA
| | - Tina Raine‐Bennett
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA,Medicines360San FranciscoCaliforniaUSA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Cosette M. Wheeler
- Center for HPV PreventionUniversity of New Mexico Comprehensive Cancer CenterAlbuquerqueNew MexicoUSA
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An Improved Image Classification Method for Cervical Precancerous Lesions Based on ShuffleNet. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:9675628. [PMID: 36148422 PMCID: PMC9489397 DOI: 10.1155/2022/9675628] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022]
Abstract
With the rapid development of deep learning, automatic lesion detection is used widely in clinical screening. To solve the problem that existing deep learning-based cervical precancerous lesion detection algorithms cannot meet high classification accuracy and fast running speed at the same time, a ShuffleNet-based cervical precancerous lesion classification method is proposed. By adding channel attention to the ShuffleNet, the network performance is improved. In this study, the image dataset is classified into five categories: normal, cervical cancer, LSIL (CIN1), HSIL (CIN2/CIN3), and cervical neoplasm. The colposcopy images are expanded to solve the problems of the lack of colposcopy images and the uneven distribution of images from each category. For the test dataset, the accuracy of the proposed CNN models is 81.23% and 81.38%. Our classifier achieved an AUC score of 0.99. The experimental results show that the colposcopy image classification network based on artificial intelligence has good performance in classification accuracy and model size, and it has high clinical applicability.
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Kamal M. Cervical Pre-cancers: Biopsy and Immunohistochemistry. Cytojournal 2022; 19:38. [PMID: 35928531 PMCID: PMC9345137 DOI: 10.25259/cmas_03_13_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
The existence of precursor lesions for invasive cervical cancer has been recognized for more than 50 years. Our understanding of the pathobiology and behavior of cervical cancer precursors has evolved considerably over the past five decades. Furthermore, the terminology used to classify pre-invasive lesions of the cervix has frequently changed. The realization that human papillomavirus (HPV) infections constitute a morphologic continuum has prompted efforts to include them within a single classification system, specifically the squamous intraepithelial lesions (SILs) which have now been embraced by the surgical pathologists. The reduced number of specific pathological categories has made clinical decision-making more straightforward. The generic criteria for SIL have two important histological parameters: Alterations in the density of superficial epithelial cells and superficial squamous atypia. The flat condyloma or cervical intraepithelial neoplasia (CIN) I is generally associated with intermediate and high-risk HPV types as against the low-risk viruses that cause exophytic/papillary growth patterns of condylomas. The diagnosis of low-grade SIL (LSIL) (flat and exophytic condylomas) requires first excluding benign mimics of LSIL and second to confirm the characteristic cytologic atypia. For high-grade SILs (HSILs), the extent and degree of atypia generally exceed the limits of that described in flat or exophytic condylomas (LSILs). Less maturation, abnormal cell differentiation, loss of cell polarity, and increased mitotic index with abnormal mitotic figures occupying increasing thickness of the epithelium define a lesion as CIN II or CIN III. Atypical immature metaplasia associated with inflammation and atrophy is a challenge in cervical biopsy interpretation. Careful attention to the growth pattern of the epithelium, the distribution of the atypia, nuclear spacing, and the degree of anisokaryosis and the presence of enlarged hyperchromatic nuclei help in differentiating a non-neoplastic from a neoplastic process. This chapter describes in depth the diagnostic difficulties in the interpretation of cervical biopsies. It also provides useful criteria in distinguishing benign mimics from true precancerous lesions and the role of biomarkers such as the p16ink4 and Ki-67 in the differential diagnosis of precursor lesions and the reactive and metaplastic epithelium.
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50
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Tidy JA, Brown BH. Increased detection of high grade CIN, when using electrical impedance spectroscopy as an adjunct to routine colposcopy, is maintained when used across international boundaries: Prospective data from nine European countries. Eur J Obstet Gynecol Reprod Biol 2022; 275:41-45. [PMID: 35724563 DOI: 10.1016/j.ejogrb.2022.05.025] [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: 02/28/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the performance of EIS (ZedScan) with colposcopy in the detection of high grade CIN (HG-CIN) in different health care settings. METHOD Pooled analysis of data from 26 colposcopy centres in 9 countries. All women underwent colposcopy and ZedScan examination. Data was recorded prospectively via a proforma. Indications for referral to colposcopy were according to national guidelines. Pathology was reported according to national guidelines. RESULTS 5257 women were examined by 82 colposcopists, median 93 women per centre (range 41 - 2684), 3 users per centre (range 1-8). Referral indications were; 19.3% high grade cytology, 50.4% low grade, 30.3% clinical or HPV positive / cytology negative. The prevalence of HG-CIN was 26.5%; 79.1% in high grade referrals, 16.7% low grade, 9.4% clinical or HPV positive / cytology negative. The use of ZedScan detected an extra 269 cases of high grade CIN (24% increase) (7.5% increase for high grade referrals, 57.9% for low grade and 52% for clinical or HPV positive/cytology negative). Based upon colposcopic impression (CI), the sensitivity of colposcopy for CIN2 + was 74.1% compared with 91.6% for colposcopy with ZedScan (Chi2 p < 0.0001). The PPV for a ZedScan directed biopsy varied according to referral cytology and colposcopic impression (19.5% to 85.7%). 489 women underwent treatment at first visit, when ZedScan suggested treatment, 95.1% had HG-CIN/HG-CGIN or cervical cancer. The pooled results for the whole 26 centres were consistent with the results obtained for the largest centre (Sheffield) alone and also with the results with this largest centre excluded. CONCLUSIONS The addition of EIS (ZedScan) increases detection of HG-CIN with the PPV for a ZedScan directed biopsy consistent with the published literature. Results were similar in multiple healthcare settings. With more women being referred to colposcopy at low risk of HG-CIN, due to HPV vaccination and primary HPV screening, this study confirms the value of a real time adjunctive technology.
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Affiliation(s)
- John A Tidy
- Gynaecological Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, UK.
| | - Brian H Brown
- Medical Physics Group, Department of, Infection, Immunity and Cardiovascular Science, The University of Sheffield, UK
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