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Xhaja A, Ahr A, Zeiser I, Ikenberg H. Histology Findings after Two Years of Cytology/HPV Co-Testing in Germany. Geburtshilfe Frauenheilkd 2024; 84:357-369. [PMID: 38618577 PMCID: PMC11006558 DOI: 10.1055/a-2265-3578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/08/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Since 1 January 2020, diagnostic confirmation of abnormalities detected in the context of cytology/HPV co-testing in cervical cancer screening under the statutory health insurance scheme in women aged 35 and over has been performed according to predefined algorithms. A colposcopy is indicated even in the case of borderline/low-grade cytological changes and/or HPV persistence. In this article we compare the histology findings after primary screening examinations in 2020/21 with those from 2018/19, thus also comparing the results of two different screening approaches. Patients and Methods Our analysis included all of the cytology, HPV, and histology results from all primary screening examinations, as well as the resulting diagnostic confirmation and curative cases, that could be obtained by 30 June 2023. In 2018/19 these comprised 650600 cytology and 1804 histology findings, and in 2020/21 there were 491450 cytology and 7156 histology findings. The absolute numbers of histology findings and the percentage ratios of these to all cytological diagnoses are presented with comparison factors. Results In 2020/21 there were 5.2 times more histology findings in relation to all previous cytology examinations than in 2018/19, as well as 10.6 times more biopsies, 3.8 times more conizations, and 1.2 times more hysterectomies. There was a particularly high increase in diagnostic confirmation of borderline/low-grade or only HPV-positive findings. With co-testing, 12.7 times more CIN1, 6.4 times more CIN2, and 3.5 times more CIN3 lesions were diagnosed. The proportion of biopsies without dysplasia was 7.6 times higher than in previous years. Cervical carcinomas were diagnosed 1.8 times more frequently, and endometrial carcinomas 0.7 times less frequently. Conclusion More CIN lesions were found with co-testing, but the increase in histology findings of low-grade or no dysplasia was far greater than findings of CIN3. Lesions not requiring treatment accounted for 94.4% of biopsy results in 2020/21. The use of computer-assisted LBC with progression markers could reduce this.
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Affiliation(s)
- Arjola Xhaja
- CytoMol, MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - André Ahr
- CytoMol, MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
- Universitätsfrauenklinik Frankfurt, Frankfurt, Germany
| | - Ilona Zeiser
- CytoMol, MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - Hans Ikenberg
- CytoMol, MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
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2
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Tanaka LF, Schoffer O, Schriefer D, Schauberger G, Ikenberg H, Klug SJ. An audit of 1632 routinely collected cervical cancer screening smears from 398 women in Germany: Results from the TeQaZ Study. Eur J Cancer 2024; 201:113915. [PMID: 38364626 DOI: 10.1016/j.ejca.2024.113915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE There is evidence in Germany that half of the cervical cancer (CC) cases had undergone screening frequently in the decade preceding their diagnosis, signaling cytology quality issues. This study investigates routine smear assessment accuracy in Germany. METHODS Within a population-based case-control study in 9 German states, we recruited cases (women with a histologically confirmed diagnosis of CC) and population controls (women with no history of CC or hysterectomy). Two independent expert cytologists audited Pap smears taken within the 10 years preceding CC diagnosis (cases)/study entry (controls). We report the prevalence of positive results, as well as routine assessment's accuracy, as sensitivity, specificity, false-positive and false-negative rates along with 95% confidence intervals (95% CI). We also examined cases' smear history, to investigate possible false-positive recurrence. RESULTS We audited 1632 smears of 392 women (18.9% cases, 81.1% controls). In the routine assessment, the overall prevalence of positive results was 4.5% (29.0% among cases). According to the expert audit, the overall prevalence of positive results was 7.7% (40.8% among cases). When restricting analyses to the 3 years preceding diagnosis/study entry, this prevalence increased to 11.9% overall (61.4% among cases). The overall sensitivity of the routine assessment was 54.9% (66.8% for cases). CONCLUSION As cytology remains an important part of CC screening, quality issues must be urgently addressed in Germany. Shifting to objective methods such as primary high-risk HPV screening followed by triaging may help CC elimination in Germany.
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Affiliation(s)
- Luana F Tanaka
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Olaf Schoffer
- Center of Evidence-Based Health Care, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Dirk Schriefer
- Center of Clinical Neuroscience, University Clinic Carl Gustav Carus Dresden, Dresden, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | | | - Stefanie J Klug
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
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3
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Ikenberg H, Lieder S, Ahr A, Wilhelm M, Schön C, Xhaja A. Comparison of the Hologic Genius Digital Diagnostics System with the ThinPrep Imaging System-A retrospective assessment. Cancer Cytopathol 2023. [PMID: 37068094 DOI: 10.1002/cncy.22695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Digital cytology (DC) with artificial intelligence (AI) is a new approach. The authors compared DC with liquid-based cytology (LBC) using computer assistance (CAS) in a retrospective, noninterventional study. METHODS In total, 1994 ThinPrep LBC slides (Hologic), which were previously analyzed in 2020 using an imaging system with CAS in routine cotesting for cytology/human papillomavirus, were reviewed in a blinded mode using the Genius Digital Diagnostics System (Hologic). In 555 cases, a histology result was available. The slides were digitally scanned (volumetric scan) at 14 levels integrated into one. AI algorithms were used to present a gallery of six tiles each (containing objects of interest) in five categories. Six additional tile rows were available, from which the diagnoses were made. All cases with a mismatch between DC and imaging system results were reviewed by an additional cytopathologist. RESULTS In 86.56% of cases, a complete match between both systems was observed using the same cytology categories. When also considering the histology results, the match was 90.37%. In addition, when a cytology follow-up and/or a retrospective review was applied, the match reached 97.34%. In only 0.65% of cases was a major discrepancy observed (two grades of cytology or a low-grade squamous intraepithelial lesion/high-grade squamous intraepithelial lesion [LSIL/HSIL] shift), and none were identified by DC. Significantly more cases of higher severity (atypical squamous cells cannot exclude high grade [ASC-H], high-grade squamous intraepithelial lesion [HSIL]) were identified with DC, and its negative predictive value was higher. The screening time was significantly shorter with DC. CONCLUSIONS With the Genius system for DC, the sensitivity for HSIL+/ASC-H and the specificity for LSIL and HSIL were superior to LBC and CAS. Screening time was significantly lower.
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Affiliation(s)
| | | | - André Ahr
- MVZ CytoMol, Frankfurt, Germany
- Universitätsfrauenklinik Frankfurt, Frankfurt, Germany
| | - Manfred Wilhelm
- Department of Mathematics, Natural and Economic Sciences, Ulm University of Applied Sciences, Ulm, Germany
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Liang LA, Zeissig SR, Schauberger G, Merzweiler S, Radde K, Fischbeck S, Ikenberg H, Blettner M, Klug SJ. Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study. BMC Womens Health 2022; 22:285. [PMID: 35810270 PMCID: PMC9270801 DOI: 10.1186/s12905-022-01851-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background A considerable proportion of cervical cancer diagnoses in high-income countries are due to lack of timely follow-up of an abnormal screening result. We estimated colposcopy non-attendance, examined the potential factors associated and described non-attendance reasons in a population-based screening study. Methods Data from the MARZY prospective cohort study were analysed. Co-test screen-positive women (atypical squamous cells of undetermined significance or worse [ASC-US+] or high-risk human papillomavirus [hrHPV] positive) aged 30 to 65 years were referred to colposcopy within two screening rounds (3-year interval). Women were surveyed for sociodemographic, HPV-related and other data, and interviewed for non-attendance reasons. Logistic regression was used to examine potential associations with colposcopy attendance. Results At baseline, 2,627 women were screened (screen-positive = 8.7%), and 2,093 again at follow-up (screen-positive = 5.1%; median 2.7 years later). All screen-positives were referred to colposcopy, however 28.9% did not attend despite active recall. Among co-test positives (ASC-US+ and hrHPV) and only hrHPV positives, 19.6% were non-attendees. Half of only ASC-US+ screenees attended colposcopy. Middle age (adjusted odds ratio [aOR] = 1.55, 95% CI 1.02, 4.96) and hrHPV positive result (aOR = 3.04, 95% CI 1.49, 7.22) were associated with attendance. Non-attendance was associated with having ≥ 3 children (aOR = 0.32, 95% CI 0.10, 0.86). Major reasons for non-attendance were lack of time, barriers such as travel time, need for childcare arrangements and the advice against colposcopy given by the gynaecologist who conducted screening. Conclusions Follow-up rates of abnormal screening results needs improvement. A systematic recall system integrating enhanced communication and addressing follow-up barriers may improve screening effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01851-6.
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Xhaja A, Ahr A, Zeiser I, Ikenberg H. Two Years of Cytology and HPV Co-Testing in Germany: Initial Experience. Geburtshilfe Frauenheilkd 2022; 82:1378-1386. [DOI: 10.1055/a-1886-3311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/23/2022] [Indexed: 10/15/2022] Open
Abstract
Abstract
Introduction On 1 January 2020 the screening programme for the prevention of cervical cancer in women from the age of 35 years of the Statutory Health Insurance (GKV) in Germany
changed from an annual cytology examination to cytological and HPV co-testing carried out every three years. A large standard diagnostics laboratory has been using liquid-based cytology
(LBC) with computer-assisted screening (CAS) since 1 January 2020 to assess the samples.
Patients and Methods The cytological and HPV results for all cases examined with co-testing from 01.01.2020 to 31.12.2021 (n = 395759) are reported and the cytology results obtained
using co-testing are compared with the results obtained using only conventional primary cytology screening from the two previous years (n = 588192). Cytology tests were carried out using LBC
and computer-assisted screening. A DNA PCR test which can identify 14 types of HPV was used for HPV testing. The cytology results are reported using the Munich Nomenclature III, which is
mandatory in Germany, and converted to The Bethesda System (TBS). Problems occurring during the implementation phase are described here.
Results A total of 983951 cases who had primary screening between 01.01.2018 and 31.12.2021 were analysed. The HR HPV-positive rate with co-testing for all age groups was 6.41%. Of
this group, 16.31% were positive for HPV-16, 4.43% for HPV-18, and 71.40% had one or more of the other 12 HR HPV types. Several different HPV types were identified in 7.86% of cases. The
HPV-positive rate for cases with unremarkable cytological findings was 4.03%. 0.46% of tests were technically invalid. The results of primary cytology screening for 2020/21 (LBC) were: Pap 0
(TBS: unsatisfactory) 0.09%, Pap I and Pap II-a (NILM) 96.82%, Pap II-p/g (~ASC-US/AGC) 1.23%, Pap III-p/g (~ASC-H/AGC) 0.19%, Pap III D1 (LSIL) 1.08%, Pap III D2 (HSIL) 0.31%, Pap IVa/b-p/g
(HSIL/AIS) 0.18%, and Pap V-p/g (carcinoma) 0.01%. The rates for 2018/19 (conventional cytology without routine testing for HPV) were significantly higher for Pap II-p/g (1.64%) and
significantly lower for Pap III-p/g (0.13%), Pap III D1 (0.45%), Pap III D2 (0.10%) and Pap IVa/b-p/g (0.05%).
Conclusion Evaluation of the data for the two first years of cytology and HPV co-testing from a standard diagnostics laboratory found low HR HPV-positive rates. As regards the
cytology tests, the Pap II-p/g rate was significantly lower and the ≥ Pap III rate was significantly higher compared to the two previous years. This points to a probable higher sensitivity
and specificity of the new method.
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Affiliation(s)
- Arjola Xhaja
- CytoMol, MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - André Ahr
- CytoMol, MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
- Universitätsfrauenklinik Frankfurt, Frankfurt, Germany
| | - Ilona Zeiser
- CytoMol, MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - Hans Ikenberg
- CytoMol, MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
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Liang L, Einzmann T, Zeissig SR, Franzen A, Schwarzer K, Schauberger G, Schriefer D, Radde K, Ikenberg H, Snijders PJF, Meijer CJLM, Kirkpatrick CJ, Koelbl H, Blettner M, Klug SJ. 976Screening for cervical cancer with Human Papillomavirus testing: stand-alone is preferable over co-testing with cytology. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cervical cancer screening can be conducted with cytology and Human Papillomavirus (HPV) testing but few studies have compared the latter directly to concomitant testing (co-testing). We compared these strategies to determine appropriate screening.
Methods
Within a randomised population-based cohort study conducted around Mainz, Germany, eligible women (≥30 years) were screened via Pap smear, liquid-based cytology (LBC) and HPV testing (HC2) and HPV genotyped post hoc (PCR). These tests formed three strategies: cytology (Pap or LBC) and HPV (HC2 or PCR) stand-alone and co-testing. Screen positives and 5% negative women were invited to colposcopy. Absolute and relative sensitivity, specificity, false positive rates (FPR) and number needed to colposcopy to detect one lesion (NNC) were calculated. Estimates were crude and verification bias-adjusted using stratified sampling with bootstrapped confidence intervals.
Results
Of 2,627 screened women, cytology stand-alone demonstrated lowest sensitivities (47%) and highest specificities (97%-99%) while HPV stand-alone demonstrated higher sensitivities (79%-95%) but lower specificities (94%-95%). Co-testing increased sensitivity (84%-99%) but not specificity (92%-95%). Relative sensitivities were similar between crude and adjusted estimates, with greater detection via HPV-based strategies. Specificity of co-testing with LBC relative to HPV stand-alone was near unity (0.99, 95% CI 0.99-1.00) but significantly lower than unity with Pap co-testing. FPR and NNC were greatest under co-testing.
Conclusions
HPV stand-alone screening in women over 30 years appears appropriate over co-testing as a screening strategy.
Key messages
Co-testing for cervical cancer does not appear to add any benefit in detection and may introduce unnecessary harms compared to HPV stand-alone screening.
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Affiliation(s)
- Linda Liang
- Epidemiology, Department of Sports and Health Sciences, Technical University Of Munich, Munich, Germany
| | - Thomas Einzmann
- Department of Obstetrics and Gynecology, University Hospital Cologne, Cologne, Germany
| | | | - Arno Franzen
- Department of Obstetrics and Gynecology, Kemperhof, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | | | - Gunther Schauberger
- Epidemiology, Department of Sports and Health Sciences, Technical University Of Munich, Munich, Germany
| | - Dirk Schriefer
- Center of Clinical Neuroscience, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Kathrin Radde
- Epidemiology, Department of Sports and Health Sciences, Technical University Of Munich, Munich, Germany
| | | | - Peter JF Snijders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Chris JLM Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Charles J Kirkpatrick
- Institute of Pathology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Heinz Koelbl
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stefanie J Klug
- Epidemiology, Department of Sports and Health Sciences, Technical University Of Munich, Munich, Germany
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7
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Gross GE, Werner RN, Avila Valle GL, Bickel M, Brockmeyer NH, Doubek K, Gallwas J, Gieseking F, Haase H, Hillemanns P, Ikenberg H, Jongen J, Kaufmann AM, Klußmann JP, von Knebel Doeberitz M, Knuf M, Köllges R, Laws HJ, Mikolajczyk R, Neis KJ, Petry KU, Pfister H, Schlaeger M, Schneede P, Schneider A, Smola S, Tiews S, Nast A, Gaskins M, Wieland U. Evidenz‐ und konsensbasierte (S3) Leitlinie: Impfprävention HPV‐assoziierter Neoplasien. J Dtsch Dermatol Ges 2021; 19:479-494. [PMID: 33709591 DOI: 10.1111/ddg.14438_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Gerd E Gross
- Klinik für Dermatologie und Venerologie, Universitätsklinik Rostock, Rostock.,Paul-Ehrlich-Gesellschaft für Chemotherapie e.V., HPV Management Forum
| | - Ricardo N Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, -corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin -Institute of Health, Berlin
| | - Gabriela L Avila Valle
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, -corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin -Institute of Health, Berlin
| | | | - Norbert H Brockmeyer
- Klinik für Dermatologie, Venerologie und Allergologie der Ruhr-Universität -Bochum, Zentrum für Sexuelle Gesundheit - WIR "Walk In Ruhr", Bochum
| | | | - Julia Gallwas
- Klinik für Gynäkologie und Geburtshilfe, Georg-August-Universität Göttingen
| | | | | | | | - Hans Ikenberg
- MVZ für Zytologie und Molekularbiologie Frankfurt GbR (CytoMol), Frankfurt am Main
| | | | - Andreas M Kaufmann
- Klinik für Gynäkologie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Jens Peter Klußmann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Medizinische Fakultät, Universität zu Köln
| | - Magnus von Knebel Doeberitz
- Abteilung für Angewandte Tumorbiologie, Institut für Pathologie, Universitätsklinikum Heidelberg und Klinische Kooperationseinheit G105 des Deutschen Krebsforschungszentrums (DKFZ)
| | - Markus Knuf
- Klinik für Kinder und Jugendliche, Helios Dr. Horst Schmidt Kliniken, Wiesbaden.,Pädiatrische Infektiologie, Universitätsmedizin Mainz, Mainz
| | - Ralf Köllges
- Praxis für Kinder und Jugendliche, Mönchengladbach
| | - Hans-Jürgen Laws
- Klinik für Kinderonkologie, -hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik (IMEBI), Martin-Luther Universität Halle-Wittenberg, Halle (Saale)
| | | | | | | | | | | | | | - Sigrun Smola
- Institut für Virologie, Universitätsklinikum des Saarlandes, Medizinische Fakultät, Universität des Saarlandes, Homburg/Saar
| | - Sven Tiews
- MVZ Labor für Cytopathologie Dr. Steinberg GmbH, Soest
| | - Alexander Nast
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, -corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin -Institute of Health, Berlin
| | - Matthew Gaskins
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, -corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin -Institute of Health, Berlin
| | - Ulrike Wieland
- Nationales Referenzzentrum für Papillom- und Polyomaviren, Institut für Virologie, Uniklinik Köln, Universität zu Köln, Köln
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8
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Gross GE, Werner RN, Avila Valle GL, Bickel M, Brockmeyer NH, Doubek K, Gallwas J, Gieseking F, Haase H, Hillemanns P, Ikenberg H, Jongen J, Kaufmann AM, Klußmann JP, von Knebel Doeberitz M, Knuf M, Köllges R, Laws HJ, Mikolajczyk R, Neis KJ, Petry KU, Pfister H, Schlaeger M, Schneede P, Schneider A, Smola S, Tiews S, Nast A, Gaskins M, Wieland U. German evidence and consensus-based (S3) guideline: Vaccination recommendations for the prevention of HPV-associated lesions. J Dtsch Dermatol Ges 2021; 19:479-494. [PMID: 33634583 DOI: 10.1111/ddg.14438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Abstract
Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline "Vaccination recommendations for the prevention of HPV-associated lesions", which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.
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Affiliation(s)
- Gerd E Gross
- Department of Dermatology and Venereology, University Hospital Rostock, Rostock, Germany.,Paul Ehrlich Society for Chemotherapy, HPV Management Forum, Germany
| | - Ricardo N Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gabriela L Avila Valle
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus Bickel
- Infektiologikum Frankfurt, Frankfurt am Main, Germany
| | - Norbert H Brockmeyer
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Center for Sexual Health - WIR "Walk In Ruhr", Bochum, Germany
| | - Klaus Doubek
- Gynecology Office Dr. Klaus Doubek, Wiesbaden, Germany
| | - Julia Gallwas
- Department of Gynecology and Obstetrics, Georg August University Göttingen, Göttingen, Germany
| | | | | | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Hans Ikenberg
- MVZ for Cytology and Molecular Biology (CytoMol), Frankfurt am Main, Germany
| | | | - Andreas M Kaufmann
- Department of Gynecology, Campus Virchow Hospital, Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens Peter Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, -University Hospital of Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, Clinical Cooperation Unit G105 of the German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Knuf
- Hospital for Child and Adolescent Health, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.,Pediatric Infectiology, University Medical Center Mainz, Mainz, Germany
| | - Ralf Köllges
- Office for Child and Adolescent Health, Mönchengladbach, Germany
| | - Hans-Jürgen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometry and Informatics (IMEBI), Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Klaus J Neis
- Gynecology Office am Staden, Saarbrücken, Germany
| | | | - Herbert Pfister
- Institute of Virology, University of Cologne, Cologne, Germany
| | | | | | | | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Medical Faculty, Saarland University, Homburg/Saar, Germany
| | - Sven Tiews
- MVZ Laboratory for Cytopathology Dr. Steinberg GmbH, Soest, Germany
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthew Gaskins
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - University Medical Center Berlin, corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrike Wieland
- National Reference Center for Papilloma and Polyoma Viruses, Institute of Virology, University Hospital of Cologne, University of Cologne, Cologne, Germany
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9
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Liang LA, Einzmann T, Franzen A, Schwarzer K, Schauberger G, Schriefer D, Radde K, Zeissig SR, Ikenberg H, Meijer CJLM, Kirkpatrick CJ, Kölbl H, Blettner M, Klug SJ. Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-alone or Cotesting Strategies. Cancer Epidemiol Biomarkers Prev 2020; 30:474-484. [PMID: 33187968 DOI: 10.1158/1055-9965.epi-20-1003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/17/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study. METHODS The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ≥30 years (n = 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants [ASC-US+ or high-risk HC2 (hrHC2)] and a random 5% sample of screen-negatives were referred to colposcopy. Post hoc HPV genotyping was conducted by GP5+/6+ PCR-EIA with reverse line blotting. Sensitivity, specificity (adjusted for verification bias), and potential harms, including number of colposcopies needed to detect 1 precancerous lesion (NNC), were calculated. RESULTS In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) were lower than HC2 (95%) and PCR (79%) for CIN2+. Cotesting demonstrated higher sensitivities (HC2 cotesting: 99%; PCR cotesting: 84%), but at the cost of lower specificities (92%-95%) compared with HPV stand-alone (HC2: 95%; PCR: 94%) and cytology (97% or 99%). Cotesting versus HPV stand-alone showed equivalent relative sensitivity [HC2: 1.06, 95% confidence interval (CI), 1.00-1.21; PCR: 1.07, 95% CI, 1.00-1.27]. Relative specificity of Pap cotesting with either HPV test was inferior to stand-alone HPV. LBC cotesting demonstrated equivalent specificity (both tests: 0.99, 95% CI, 0.99-1.00). NNC was highest for Pap cotesting. CONCLUSIONS Cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals. IMPACT HPV stand-alone screening offers a better balance of benefits and harms than cotesting.See related commentary by Wentzensen and Clarke, p. 432.
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Affiliation(s)
- Linda A Liang
- Epidemiology, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Thomas Einzmann
- Department of Obstetrics and Gynecology, University Hospital Cologne, Cologne, Germany
| | - Arno Franzen
- Department of Obstetrics and Gynecology, Kemperhof, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | | | - Gunther Schauberger
- Epidemiology, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Dirk Schriefer
- Epidemiology, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany.,Center of Clinical Neuroscience, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Kathrin Radde
- Epidemiology, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | | | | | - Chris J L M Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Charles J Kirkpatrick
- Institute of Pathology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Heinz Kölbl
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stefanie J Klug
- Epidemiology, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany.
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10
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Dippmann C, Schmitz M, Wunsch K, Schütze S, Beer K, Greinke C, Ikenberg H, Hoyer H, Runnebaum IB, Hansel A, Dürst M. Triage of hrHPV-positive women: comparison of two commercial methylation-specific PCR assays. Clin Epigenetics 2020; 12:171. [PMID: 33176878 PMCID: PMC7661165 DOI: 10.1186/s13148-020-00963-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/28/2020] [Indexed: 01/22/2023] Open
Abstract
Aim High-risk human papillomavirus (hrHPV)-based screening is becoming increasingly important, either by supplementing or replacing the traditional cytology-based cervical Pap smear. However, hrHPV screening lacks specificity, because it cannot differentiate between transient virus infection and clinically relevant hrHPV-induced disease. Therefore, reliable triage methods are needed for the identification of HPV-positive women with cervical intraepithelial neoplasia (CIN) in need of treatment. Promising tools discussed for the triage of these patients are molecular diagnostic tests based on epigenetic markers. Here, we compare the performance of two commercially available DNA methylation-based diagnostic assays—GynTect® and the QIAsure Methylation Test—in physician-taken cervical scrapes from 195 subjects.
Findings Both GynTect® and the QIAsure Methylation Test detected all cervical carcinoma and carcinoma in situ (CIS). The differences observed in the detection rates between both assays for the different grades of cervical lesions (QIAsure Methylation Test: CIN1 26.7%, CIN2 27.8% and CIN3 74.3%; GynTect®: CIN1 13.3%, CIN2 33.3% and CIN3 60%) were not significant. Concerning the false-positive rates, significant differences were evident. For the healthy (NILM) hrHPV-positive group, the false-positive rates were 5.7% for GynTect® and 26.4% for QIAsure Methylation Test (p = 0.003) and for the NILM hrHPV-negative group 2.2% vs. 23.9% (p = 0.006), respectively. When considering hrHPV-positive samples only for comparison (n = 149), GynTect® delivered significantly higher specificity compared to the QIAsure Methylation Test for CIN2 + (87.6% vs. 67.4% (p < 0.001)) and CIN3 + (84.1% vs. 68.2% (p = 0.002)). Overall our findings suggest that DNA methylation-based tests are suitable for the triage of hrHPV-positive women. With the goal to provide a triage test that complements the limited specificity of HPV testing in HPV-based screening, GynTect® may be preferable, due to its higher specificity for CIN2+ or CIN3+ .
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Affiliation(s)
- Carolin Dippmann
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.,Oncgnostics GmbH, Winzerlaer Straße 2, 07745, Jena, Germany
| | | | | | - Stefanie Schütze
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Katrin Beer
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Christiane Greinke
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hans Ikenberg
- MVZ CytoMol, Berner Straße 76, 60437, Frankfurt am Main, Germany
| | - Heike Hoyer
- Institut Für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, Bachstraße 18, 07743 Jena, Germany
| | - Ingo B Runnebaum
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alfred Hansel
- Oncgnostics GmbH, Winzerlaer Straße 2, 07745, Jena, Germany
| | - Matthias Dürst
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
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11
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Hillemanns P, Friese K, Dannecker C, Klug S, Seifert U, Iftner T, Hädicke J, Löning T, Horn L, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Sroczynski G, Sauerbrei W, Beckmann MW, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Kaufmann A, Petry KU, Schäfer APA, Pawlita M, Weis J, Mehnert A, Fehr M, Grimm C, Reich O, Arbyn M, Kleijnen J, Wesselmann S, Nothacker M, Follmann M, Langer T, Jentschke M. Prevention of Cervical Cancer: Guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017) - Part 1 with Introduction, Screening and the Pathology of Cervical Dysplasia. Geburtshilfe Frauenheilkd 2019; 79:148-159. [PMID: 30792545 PMCID: PMC6379164 DOI: 10.1055/a-0818-5440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/03/2018] [Accepted: 12/08/2018] [Indexed: 12/16/2022] Open
Abstract
Aims Annual opportunistic screening for cervical carcinoma has been carried out in Germany since 1971. The creation of this S3 guideline meets an important need, outlined in the National Cancer Plan, with regard to screening for cervical cancer, as the guideline aims to provide important information and support for planned organized screening for cervical cancer in Germany. Methods With the financial support of German Cancer Aid, 21 professional societies developed evidence-based statements and recommendations (classified using the GRADE system) for the screening, management and treatment of precancerous conditions of the cervix. Two independent scientific institutes compiled systematic reviews for this guideline. Recommendations The first part of this short summary presents the pathological basis and considers various questions related to screening for cervical cancer. As also reported in earlier reviews, the meta-analysis by Kleijnen Systematic Reviews showed that HPV-based screening offers better protection against invasive cervical cancer compared to cytology-based screening. The authors of this guideline therefore recommend - in accordance with the guideline of the Joint National Committee of Germany (Gemeinsamer Bundesauschuss, G-BA) - that women aged 35 and above should be examined at regular intervals (at least every 3 years) and undergo HPV-based screening. Co-testing can also be carried out. Women between the ages of 20 and 35 should have cytological screening every 2 years.
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Affiliation(s)
- Peter Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany
| | - Stefanie Klug
- Lehrstuhl für Epidemiologie, Technische Universität München, München, Germany
| | - Ulrike Seifert
- Tumorepidemiologie, Universitäts KrebsCentrum (UCC), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Thomas Iftner
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Juliane Hädicke
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Thomas Löning
- Institut für Pathologie, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Lars Horn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dietmar Schmidt
- Institut für Pathologie, Referenzzentrum für Gynäkopathologie, Mannheim, Germany
| | - Hans Ikenberg
- CytoMol - MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - Manfred Steiner
- Facharzt für Frauenheilkunde und Geburtshilfe, Ihringen, Germany
| | - Ulrich Freitag
- Facharzt für Frauenheilkunde und Geburtshilfe, Wismar, Germany
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria.,Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Willi Sauerbrei
- Institut für Med. Biometrie und Statistik (IMBI), Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Karsten Münstedt
- Frauenklinik, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Achim Schneider
- Medizinisches Versorgungszentrum im Fürstenberg-Karree, Berlin, Germany
| | - Andreas Kaufmann
- Klinik für Gynäkologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Joachim Weis
- Klinik für Tumorbiologie, Klinik für Onkologische Rehabilitation - UKF Reha gGmbH, Freiburg, Germany
| | - Anja Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Mathias Fehr
- Gynäkologie & Geburtshilfe in Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | | | - Olaf Reich
- Privatklinik Graz Ragnitz, Graz, Austria
| | - Marc Arbyn
- Cancer Center, Sciensano, Brüssel, Belgium
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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12
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Hillemanns P, Friese K, Dannecker C, Klug S, Seifert U, Iftner T, Hädicke J, Löning T, Horn L, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Sroczynski G, Sauerbrei W, Beckmann MW, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Kaufmann A, Petry KU, Schäfer APA, Pawlita M, Weis J, Mehnert A, Fehr M, Grimm C, Reich O, Arbyn M, Kleijnen J, Wesselmann S, Nothacker M, Follmann M, Langer T, Jentschke M. Prevention of Cervical Cancer: Guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017) - Part 2 on Triage, Treatment and Follow-up. Geburtshilfe Frauenheilkd 2019; 79:160-176. [PMID: 30792546 PMCID: PMC6379166 DOI: 10.1055/a-0828-7722] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
Aims Annual opportunistic screening for cervical carcinoma has been done in Germany since 1971. The creation of this S3 guideline meets an important need, outlined in the National Cancer Plan, with regard to screening for cervical cancer, as this guideline aims to provide important information and support for planned organized screening for cervical cancer in Germany. Methods With the financial support of German Cancer Aid, 21 professional societies developed evidence-based statements and recommendations (classified using the GRADE system) for the screening, management and treatment of precancerous conditions of the cervix. Two independent scientific institutes compiled systematic reviews for this guideline. Recommendations The second part of this short summary deals with the triage, treatment and follow-up care of cervical dysplasia. With regard to those women who do not participate in screening, the guideline authors recommend sending out repeat invitation letters or an HPV self-collection kit. Colposcopy should be carried out for further investigation if cytology findings are Pap II-p and HPV test results are positive or if the results of an HPV 16 or HPV 18 screening test are positive. A single abnormal Pap smear should be triaged and investigated using HPV testing or p16/Ki67 dual staining.
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Affiliation(s)
- Peter Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany
| | - Stefanie Klug
- Lehrstuhl für Epidemiologie, Technische Universität München, München, Germany
| | - Ulrike Seifert
- Tumorepidemiologie, Universitäts KrebsCentrum (UCC), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Thomas Iftner
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Juliane Hädicke
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Thomas Löning
- Institut für Pathologie, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Lars Horn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dietmar Schmidt
- Institut für Pathologie, Referenzzentrum für Gynäkopathologie, Mannheim, Germany
| | - Hans Ikenberg
- CytoMol - MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - Manfred Steiner
- Facharzt für Frauenheilkunde und Geburtshilfe, Ihringen, Germany
| | - Ulrich Freitag
- Facharzt für Frauenheilkunde und Geburtshilfe, Wismar, Germany
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.,Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Willi Sauerbrei
- Institut für Med. Biometrie und Statistik (IMBI), Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Karsten Münstedt
- Frauenklinik, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Achim Schneider
- Medizinisches Versorgungszentrum im Fürstenberg-Karree, Berlin, Germany
| | - Andreas Kaufmann
- Klinik für Gynäkologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Joachim Weis
- Klinik für Tumorbiologie, Klinik für Onkologische Rehabilitation - UKF Reha gGmbH, Freiburg, Germany
| | - Anja Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Mathias Fehr
- Gynäkologie & Geburtshilfe in Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | | | - Olaf Reich
- Privatklinik Graz Ragnitz, Graz, Austria
| | - Marc Arbyn
- Cancer Center, Sciensano, Brüssel, Belgium
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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13
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Schmitz M, Eichelkraut K, Schmidt D, Zeiser I, Hilal Z, Tettenborn Z, Hansel A, Ikenberg H. Performance of a DNA methylation marker panel using liquid-based cervical scrapes to detect cervical cancer and its precancerous stages. BMC Cancer 2018; 18:1197. [PMID: 30509219 PMCID: PMC6276155 DOI: 10.1186/s12885-018-5125-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/22/2018] [Indexed: 01/30/2023] Open
Abstract
Background A change of cervical cancer screening algorithms to an HPV-based screening setting is discussed in many countries, due to higher sensitivity of HPV testing compared to cytology. Reliable triage methods are, however, an essential prerequisite in such a setting to avoid overtreatment and higher screening costs. Results In this study, a series of cervical scrapes collected in PreservCyt liquid-based cytology (LBC) medium from women with cervical cancer (n = 5), cervical intraepithelial neoplasia grade 1–3 (n = 74), and normal cytology (n = 201; further n = 352 collected in SureThin®) were assessed for methylation of the marker regions ASTN1, DLX1, ITGA4, RXFP3, SOX17, and ZNF671 using the GynTect assay and compared to cobas® HPV and CINtec Plus® biomarker results. All samples from women with cervical cancer, 61.2% of CIN3, 44.4% of CIN2 and 20.0% of CIN1 cases were scored positive for the GynTect methylation assay. In contrast, all CIN, irrespective of severity grade, and carcinomas were positive by both, CINtec Plus and cobas HPV. The specificity of GynTect for CIN3+ was 94.6% compared to 69.9% for CINtec Plus and 82.6% for cobas HPV (all HPV types) and 90.6% for cobas HPV 16/18. DNA methylation analysis of this methylation marker panel (GynTect assay) in cervical scrapes consistently detects cervical cancer and the majority of CIN3 as well as a subset of CIN1/2 lesions. The detection rate among cytologically normal samples is extraordinarily low (1.5%). Conclusion GynTect shows excellent performance when using cervical scrape material collected in liquid-based cytology media, a prerequisite for employing such a test as a triage in screening programs. Compared to the other test systems used in this work, GynTect showed higher specificity while still detecting all cancer cases.
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Affiliation(s)
| | | | - Dana Schmidt
- oncgnostics GmbH, Winzerlaer Strasse 2, Jena, Germany
| | | | - Ziad Hilal
- ZyDoLab, Institute for Cytology and Immune Cytochemistry, Markt 10, Dortmund, Germany
| | - Zena Tettenborn
- ZyDoLab, Institute for Cytology and Immune Cytochemistry, Markt 10, Dortmund, Germany
| | - Alfred Hansel
- oncgnostics GmbH, Winzerlaer Strasse 2, Jena, Germany
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14
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Bergeron C, Ikenberg H, Sideri M, Denton K, Bogers J, Schmidt D, Alameda F, Keller T, Rehm S, Ridder R. Prospective evaluation of p16/Ki-67 dual-stained cytology for managing women with abnormal Papanicolaou cytology: PALMS study results. Cancer Cytopathol 2015; 123:373-81. [PMID: 25891096 DOI: 10.1002/cncy.21542] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Testing for the presence of the human papillomavirus (HPV) is widely accepted for triaging Papanicolaou cytology results categorized as atypical squamous cells of undetermined significance (ASC-US). In contrast, HPV testing has limited use in triaging cytological low-grade squamous intraepithelial lesions (LSILs) due to prevalence rates of typically >80%. In the current study, the authors assessed the diagnostic performance of p16/Ki-67 dual-stained cytology in triaging ASC-US and LSIL cases within the prospective, multicentric Primary ASC-US LSIL Marker Study (PALMS). METHODS A total of 575 ASC-US cases and 529 LSIL cases from a cohort of 27,349 women who were prospectively enrolled into the PALMS study in 5 European countries were tested with p16/Ki-67 dual-stained cytology and Hybrid Capture 2 (HC2) HPV testing. Colposcopy-guided biopsy results of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were used as clinical endpoints. RESULTS p16/Ki-67 dual-stained cytology demonstrated comparable (ASC-US: 94.4% for dual-stained cytology vs 100% for HC2 testing; P = .317) or lower (LSIL: 85.7% for dual-stained cytology vs 98.4% for HC2 testing; P = .005) sensitivity for CIN2+, but higher levels of specificity compared with HC2 HPV testing in both ASC-US (78.7% vs 60.4%; P<.001) and LSIL (53.3% vs 15.6%; P<.001) cases. Positive predictive values for CIN2+ were substantially higher for dual-stained cytology versus HC2 HPV testing, especially in LSIL, and in ASC-US cases for women aged <30 years. CONCLUSIONS The clinical usefulness and efficiency of triaging women with ASC-US or LSIL Papanicolaou cytology results by p16/Ki-67 dual-stained cytology testing has been confirmed in this prospective, pan-European study. The high positive predictive value of dual-stained cytology for the presence of high-grade CIN may help to reduce the number of unnecessary colposcopy referrals.
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Affiliation(s)
| | | | | | - Karin Denton
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Johannes Bogers
- Algemeen Medisch Laboratorium BVBA, Sonic Healthcare, Antwerp, Belgium
| | | | - Francisco Alameda
- Department of Pathology, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Ruediger Ridder
- Roche mtm laboratories, Mannheim, Germany.,Ventana Medical Systems Inc, Tucson, Arizona
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15
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Gross G, Becker N, Brockmeyer N, Esser S, Freitag U, Gebhardt M, Gissmann L, Hillemanns P, Grundhewer H, Ikenberg H, Jessen H, Kaufmann A, Klug S, Klussmann J, Nast A, Pathirana D, Petry K, Pfister H, Röllinghof U, Schneede P, Schneider A, Selka E, Singer S, Smola S, Sporbeck B, von Knebel Doeberitz M, Wutzler P. Impfprävention HPV-assoziierter Neoplasien. Laryngorhinootologie 2014; 93:848-56. [DOI: 10.1055/s-0034-1382013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G. Gross
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin, Universität Rostock, Rostock
| | - N. Becker
- Deutsches Krebsforschungszentrum (DKFZ), Epidemiologie von Krebserkrankungen (C020), Heidelberg
| | - N. Brockmeyer
- Klinik für Dermatologie und Allergologie der Ruhr-Universität, Bochum
| | - S. Esser
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Essen, Essen
| | | | | | - L. Gissmann
- Deutsches Krebsforschungszentrum (DKFZ), FS Infektion und Krebs, Heidelberg
| | - P. Hillemanns
- Medizinische Hochschule Hannover (MHH), Frauenklinik, Abt. I für Frauenheilkunde und Geburtshilfe, Hannover
| | - H. Grundhewer
- Ausschuss Prävention des Berufsverbandes der Kinder- und Jugendärzte (BVKJ), Berlin
| | - H. Ikenberg
- MVZ für Zytologie und Molekularbiologie (CytoMol), Frankfurt/M
| | | | - A. Kaufmann
- Gynäkologische Tumorimmunologie, Gynäkologie mit Hochschulambulanz, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S. Klug
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - J. Klussmann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität Gießen, Gießen
| | - A. Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - D. Pathirana
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - K. Petry
- Klinikum Wolfsburg, Abteilung Gynäkologische Onkologie, Wolfsburg
| | - H. Pfister
- Institut für Virologie der Universität zu Köln
| | | | - P. Schneede
- Klinikum Memmingen, Klinik für Urologie, Memmingen
| | - A. Schneider
- Klinik und Poliklinik für Gynäkologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - E. Selka
- VulvaKarzinom-SHG e. V., Wilhelmshaven
| | - S. Singer
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Abt. Epidemiologie und Versorgungsforschung, Mainz
| | - S. Smola
- Institut für Virologie, Institut für Infektionsmedizin, Universität des Saarlandes, Homburg/Saar
| | - B. Sporbeck
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - M. von Knebel Doeberitz
- Abteilung für Molekulare Pathologie, Pathologisches Institut des Universitätsklinikum Heidelberg, Heidelberg
| | - P. Wutzler
- Universitätsklinikum Jena (Friedrich-Schiller-Universität), Institut für Virologie und Antivirale Therapie, Beutenberg Campus, Jena
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16
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Gross G, Becker N, Brockmeyer NH, Esser S, Freitag U, Gebhardt M, Gissmann L, Hillemanns P, Grundhewer H, Ikenberg H, Jessen H, Kaufmann A, Klug S, Klußmann JP, Nast A, Pathirana D, Petry KU, Pfister H, Röllinghof U, Schneede P, Schneider A, Selka E, Singer S, Smola S, Sporbeck B, von Knebel Doeberitz M, Wutzler P. Vaccination against HPV-Associated Neoplasias: Recommendations from the Current S3 Guideline of the HPV Management Forum of the Paul-Ehrlich Society - AWMF Guidelines, Registry No. 082-002 (short version), valid until Dec. 31st, 2018. Geburtshilfe Frauenheilkd 2014; 74:233-241. [PMID: 27064858 DOI: 10.1055/s-0033-1360170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- G Gross
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin, Universität Rostock, Rostock
| | - N Becker
- Deutsches Krebsforschungszentrum (DKFZ), Epidemiologie von Krebserkrankungen (C020), Heidelberg
| | - N H Brockmeyer
- Klinik für Dermatologie und Allergologie der Ruhr-Universität, Bochum
| | - S Esser
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Essen, Essen
| | | | | | - L Gissmann
- Deutsches Krebsforschungszentrum (DKFZ), FS Infektion und Krebs, Heidelberg
| | - P Hillemanns
- Medizinische Hochschule Hannover (MHH), Frauenklinik, Abt. I für Frauenheilkunde und Geburtshilfe, Hannover
| | - H Grundhewer
- Ausschuss Prävention des Berufsverbandes der Kinder- und Jugendärzte (BVKJ), Berlin
| | - H Ikenberg
- MVZ für Zytologie und Molekularbiologie (CytoMol), Frankfurt/M
| | - H Jessen
- Praxis Jessen + Kollegen, Berlin
| | - A Kaufmann
- Gynäkologische Tumorimmunologie, Gynäkologie mit Hochschulambulanz, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S Klug
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - J P Klußmann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität Gießen, Gießen
| | - A Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - D Pathirana
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - K U Petry
- Klinikum Wolfsburg, Abteilung Gynäkologische Onkologie, Wolfsburg
| | - H Pfister
- Institut für Virologie der Universität zu Köln
| | | | - P Schneede
- Klinikum Memmingen, Klinik für Urologie, Memmingen
| | - A Schneider
- Klinik und Poliklinik für Gynäkologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - E Selka
- VulvaKarzinom-SHG e. V., Wilhelmshaven
| | - S Singer
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Abt. Epidemiologie und Versorgungsforschung, Mainz
| | - S Smola
- Institut für Virologie, Institut für Infektionsmedizin, Universität des Saarlandes, Homburg/Saar
| | - B Sporbeck
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - M von Knebel Doeberitz
- Abteilung für Molekulare Pathologie, Pathologisches Institut des Universitätsklinikum Heidelberg, Heidelberg
| | - P Wutzler
- Universitätsklinikum Jena (Friedrich-Schiller-Universität), Institut für Virologie und Antivirale Therapie, Beutenberg Campus, Jena
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Ikenberg H, Bergeron C, Schmidt D, Griesser H, Alameda F, Angeloni C, Bogers J, Dachez R, Denton K, Hariri J, Keller T, von Knebel Doeberitz M, Neumann HH, Puig-Tintore LM, Sideri M, Rehm S, Ridder R. Screening for cervical cancer precursors with p16/Ki-67 dual-stained cytology: results of the PALMS study. J Natl Cancer Inst 2013; 105:1550-7. [PMID: 24096620 PMCID: PMC3814411 DOI: 10.1093/jnci/djt235] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Pap cytology is known to be more specific but less sensitive than testing for human papillomavirus (HPV) for the detection of high-grade cervical intraepithelial neoplasia (CIN2+). We assessed whether p16/Ki-67 dual-stained cytology, a biomarker combination indicative of transforming HPV infections, can provide high sensitivity for CIN2+ in screening while maintaining high specificity. Results were compared with Pap cytology and HPV testing. Methods A total of 27349 women 18 years or older attending routine cervical cancer screening were prospectively enrolled in five European countries. Pap cytology, p16/Ki-67 immunostaining, and HPV testing were performed on all women. Positive test results triggered colposcopy referral, except for women younger than 30 years with only positive HPV test results. Presence of CIN2+ on adjudicated histology was used as the reference standard. Two-sided bias-corrected McNemar P values were determined. Results The p16/Ki-67 dual-stained cytology positivity rates were comparable with the prevalence of abnormal Pap cytology results and less than 50% of the positivity rates observed for HPV testing. In women of all ages, dual-stained cytology was more sensitive than Pap cytology (86.7% vs 68.5%; P < .001) for detecting CIN2+, with comparable specificity (95.2% vs 95.4%; P = .15). The relative performance of the tests was similar in both groups of women: younger than age 30 and 30 years or older. HPV testing in women 30 years or older was more sensitive than dual-stained cytology (93.3% vs 84.7%; P = .03) but less specific (93.0% vs 96.2%; P < .001). Conclusions The p16/Ki-67 dual-stained cytology combines superior sensitivity and noninferior specificity over Pap cytology for detecting CIN2+. It suggests a potential role of dual-stained cytology in screening, especially in younger women where HPV testing has its limitations.
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Affiliation(s)
- Hans Ikenberg
- Affiliations of authors: Cytomol, Frankfurt, Germany (HI); Laboratoire Cerba, Cergy Pontoise, France (CB); Institute for Pathology, Mannheim, Germany (DS); Center for Pathology and Cytodiagnostics, Cologne, Germany (HG); Hospital del Mar, Barcelona, Spain (FA); Unità Gestionale Screening Regionale, Ospedale Atri, Italy (CA); Labo Lokeren - Campus Riatol, Antwerp, Belgium (JB); Institute Alfred Fournier, Paris, France (RD); North Bristol NHS Trust, Bristol, United Kingdom (KD); Sønderborg Hospital, Sønderborg, Denmark (JH); Acomed statistik, Leipzig, Germany (TK); Institute for Pathology, University of Heidelberg, Heidelberg, Germany (MvkD); Institute for Pathology, Nordhorn, Germany (HHN); University of Barcelona, Barcelona, Spain (LMP-T); European Institute of Oncology, Milan, Italy (MS); Roche mtm laboratories, Mannheim, Germany (SR, RR)
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Klug SJ, Neis KJ, Harlfinger W, Malter A, König J, Spieth S, Brinkmann-Smetanay F, Kommoss F, Weyer V, Ikenberg H. A randomized trial comparing conventional cytology to liquid-based cytology and computer assistance. Int J Cancer 2012; 132:2849-57. [PMID: 23175270 DOI: 10.1002/ijc.27955] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 11/07/2012] [Indexed: 12/19/2022]
Abstract
Liquid-based cytology (LBC) has replaced conventional cytology (CC) for cervical cancer screening in some countries. However, it remains unclear whether LBC is superior to CC. A randomized controlled trial was conducted between August 2007 and March 2009 in Germany to compare LBC, alone and in combination with computer-assisted imaging technology (CAS), to CC in the detection of histologically confirmed cervical intraepithelial neoplasia (CIN). The main outcome measures were detection rates, relative sensitivities, positive predictive values (PPVs) and relative PPVs comparing LBC without and with CAS to CC. Primary histological outcome was CIN2 or higher. Included were 20,627 women participating in opportunistic cervical cancer screening at 20 gynecologic practices. The practices were randomized weekly to use LBC (n = 11,331) or CC (n = 9,296). Patients with positive findings were invited to expert colposcopy. The relative sensitivity of LBC versus CC using the CIN2+ cut-off was 2.74 (95% confidence interval [CI] 1.66-4.53). The relative sensitivity of LBC/CAS versus CC for CIN2+ was 3.17 (95% CI 1.94-5.19). The PPV of LBC and CC for CIN2+ was 48% and 38%, respectively. The PPV ratio did not differ significantly from unity. Differences between LBC and CC were smaller in some sensitivity and subgroup analyses; however, relative sensitivity of LBC remained increased. LBC without and with CAS compared with CC under the field conditions of an opportunistic screening system had a significantly higher sensitivity for the detection of CIN without deterioration of PPVs. Additional use of CAS did not further improve sensitivity of LBC. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Stefanie J Klug
- Cancer Epidemiology, University Cancer Center Dresden, University Hospital, Technical University of Dresden, Dresden, Germany.
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Ikenberg H. Kontroversen um die Prävention des Zervixkarzinoms. Gebärmutterhalskrebs: Hat die Zytologie noch eine Chance? Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1314973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hänselmann K, Börsch C, Ikenberg H, Strehlau J, Klug S. Weibliche Genitalverstümmelung in Deutschland. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0030-1270887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Schwamborn K, Krieg RC, Uhlig S, Ikenberg H, Wellmann A. MALDI imaging as a specific diagnostic tool for routine cervical cytology specimens. Int J Mol Med 2010; 27:417-21. [PMID: 21174066 DOI: 10.3892/ijmm.2010.587] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 11/15/2010] [Indexed: 11/05/2022] Open
Abstract
Cervical squamous cell carcinoma (SCC) is among the most common malignancies in women worldwide. In developed countries routine cytology screening has dramatically reduced SCC mortality within the last three decades. High risk (HR) human papilloma virus (HPV) infection is the main causal factor in nearly 100% of invasive SCCs, in most cases of low grade squamous intraepithelial lesion (LSIL) and in nearly all cases of high grade squamous intraepithelial lesion (HSIL). Detection of HR-HPV DNA has been extensively evaluated for the triage of patients with low grade cytological abnormalities in order to identify those at greatest risk for underlying or developing HSIL or SCC. However, the vast majority of HR-HPV-positive precursor lesions will not progress to invasive cancer. A variety of other screening tools are available which aim to stratify clinically significant HPV infections and cytological alterations. Matrix assisted laser desorption/ionization (MALDI) imaging mass spectrometry is a promising technology to assist in this endeavor. It delivers accurate mass spectrometric information of the sample's proteins and enables the visualization of the spatial distribution of protein expression profiles in correlation with histological features. In this study, 18 samples with Pap IIID or higher (>LSIL) and 14 samples with Pap I-II (WNL) were analyzed by MALDI imaging mass spectrometry (IMS). A genetic algorithm was applied to classify spectra resulting in an overall cross validation, sensitivity for Pap IIID and Pap I-II of 83.7%, 88.9% and 78.6%, respectively. As this IMS based approach allows for unbiased and automated classifiction of cytological samples it appears to be a promising tool for stratification of cervical Pap smears.
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Petry K, Quaas J, Ikenberg H. Kongressbericht. Bericht vom 5. EFC-Kongress in Berlin. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1250419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Gross G, Gissmann L, Hillemanns P, Ikenberg H, Kaufmann A, Petry K, Pfister H, Schneede P, Schneider A, Smola S. Die Impfprävention HPV-assoziierter Neoplasien – eine Zusammenfassung der deutschen S3-Leitlinie. Dtsch Med Wochenschr 2010; 135:1083-6. [DOI: 10.1055/s-0030-1253704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ikenberg H, Schmitt B, Kiechle-Schwarz M, Bauknecht T, Pfleiderer A. Low prevalence of human papillomavirus DNA in endometrial cancer. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619509020673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pathirana D, Hillemanns P, Petry KU, Becker N, Brockmeyer N, Erdmann R, Gissmann L, Grundhewer H, Ikenberg H, Kaufmann A, Klußmann J, Kopp I, Pfister H, Rzany B, Schneede P, Schneider A, Smola S, Winter-Koch N, Wutzler P, Gross G. Short version of the German evidence-based Guidelines for prophylactic vaccination against HPV-associated neoplasia. Vaccine 2009; 27:4551-9. [DOI: 10.1016/j.vaccine.2009.03.086] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/19/2009] [Accepted: 03/26/2009] [Indexed: 11/30/2022]
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Ikenberg H. Onkologie. Computerassistierte versus konventionelle Zytologie. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Gross G, Ikenberg H, Petry KU, Pfister H, Schneede P, Schöfer H, Szeimies RM. Condylomata acuminata und andere HPV-assoziierte Krankheitsbilder von Genitale, Anus und Harnröhre. J Dtsch Dermatol Ges 2008; 6:153-62. [DOI: 10.1111/j.1610-0387.2007.06659.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ikenberg H. Kongressbericht. „HPV 2007“ und 57. Jahrestagung der STD-Gesellschaft. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kaufmann AM, Nieland JD, Jochmus I, Baur S, Friese K, Gabelsberger J, Gieseking F, Gissmann L, Glasschröder B, Grubert T, Hillemanns P, Höpfl R, Ikenberg H, Schwarz J, Karrasch M, Knoll A, Küppers V, Lechmann M, Lelle RJ, Meissner H, Müller RT, Pawlita M, Petry KU, Pilch H, Walek E, Schneider A. Vaccination trial with HPV16 L1E7 chimeric virus-like particles in women suffering from high grade cervical intraepithelial neoplasia (CIN 2/3). Int J Cancer 2007; 121:2794-800. [PMID: 17721997 DOI: 10.1002/ijc.23022] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Persistent infection with human papillomaviruses (HPV) is a prerequisite for the development of cervical cancer. Vaccination with virus-like particles (VLP) has demonstrated efficacy in prophylaxis but lacks therapeutic potential. HPV16 L1E7 chimeric virus-like particles (CVLP) consist of a carboxy-terminally truncated HPV16L1 protein fused to the amino-terminal part of the HPV16 E7 protein and self-assemble by recombinant expression of the fusion protein. The CVLP are able to induce L1- and E7-specific cytotoxic T lymphocytes. We have performed a first clinical trial to gain information about the safety and to generate preliminary data on the therapeutic potential of the CVLP in humans. A randomized, double blind, placebo-controlled clinical trial has been conducted in 39 HPV16 mono-infected high grade cervical intraepithelial neoplasia (CIN) patients (CIN 2/3). Two doses (75 mug or 250 mug) of CVLP were applied. The duration of the study was 24 weeks with 2 optional visits after another 12 and 24 weeks. The vaccine showed a very good safety profile with only minor adverse events attributable to the immunization. Antibodies with high titers against HPV16 L1 and low titers against HPV16 E7 as well as cellular immune responses against both proteins were induced. Responses were equivalent for both vaccine concentrations. A trend for histological improvement to CIN 1 or normal was seen in 39% of the patients receiving the vaccine and only 25% of the placebo recipients. Fifty-six percent of the responders were also HPV16 DNA-negative by the end of the study. Therefore, we demonstrated evidence for safety and a nonsignificant trend for the clinical efficacy of the HPV16 L1E7 CVLP vaccine.
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Affiliation(s)
- Andreas M Kaufmann
- Klinik für Frauenheilkunde und Geburtshilfe, Friedrich-Schiller-Universität, Bachstrasse 18, 07740 Jena, Germany
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Gross G, Ikenberg H, Petry KU, Pfister H, Schneede P, Schöfer H, Szeimies RM. [Condyloma acuminata and other HPV-associated diseases of the genitals, anus and urethra]. Hautarzt 2007; 58:179-86. [PMID: 17582847 DOI: 10.1007/s00105-006-1270-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
MESH Headings
- Anus Diseases/diagnosis
- Anus Diseases/therapy
- Anus Neoplasms/diagnosis
- Anus Neoplasms/therapy
- Carcinoma in Situ/diagnosis
- Carcinoma in Situ/therapy
- Cell Transformation, Neoplastic/pathology
- Condylomata Acuminata/diagnosis
- Condylomata Acuminata/therapy
- Diagnosis, Differential
- Female
- Genital Diseases, Female/diagnosis
- Genital Diseases, Female/therapy
- Genital Diseases, Male/diagnosis
- Genital Diseases, Male/therapy
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/therapy
- Genital Neoplasms, Male/diagnosis
- Genital Neoplasms, Male/therapy
- Germany
- Human papillomavirus 11
- Human papillomavirus 16
- Human papillomavirus 18
- Humans
- Male
- Papillomavirus Infections/diagnosis
- Papillomavirus Infections/therapy
- Recurrence
- Urethral Diseases/diagnosis
- Urethral Diseases/therapy
- Urethral Neoplasms/diagnosis
- Urethral Neoplasms/therapy
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Sheriff SK, Petry KU, Ikenberg H, Crouse G, Mazonson PD, Santas CC. An economic analysis of human papillomavirus triage for the management of women with atypical and abnormal Pap smear results in Germany. Eur J Health Econ 2007; 8:153-60. [PMID: 17308921 DOI: 10.1007/s10198-007-0038-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 01/11/2007] [Indexed: 05/14/2023]
Abstract
We developed decision-analytic models to determine the cost effectiveness of incorporating human papillomavirus (HPV) testing into the management of atypical and abnormal Pap smear results in Germany. The models compare three management strategies: (1) repeat Pap smear, (2) triage with HPV DNA testing, or (3) immediate treatment. The primary outcome measure is incremental cost per case of cervical intraepithelial neoplasia (CIN) 2+ detected and treated. The models take the perspective of the German health system. For patients with initial PapIIw, III, and IIId results, incremental cost effectiveness ratios for HPV triage versus repeat Pap smears are 2,232 euro, 815 euro, and 487 euro per additional case of CIN2+ detected and treated. In addition, the number of cases of CIN2+ detected and treated in a hypothetical population of 1,000 women increases from 17 to 35, 61 to 130, and 157 to 332 for each population, respectively. For patients with initial PapIII and IIId results, immediate treatment of 1,000 patients detects only four and 11 additional cases of CIN2+ versus HPV triage at incremental cost effectiveness ratios of 39,684 euro and 10,716 euro per case, respectively. For each of the populations evaluated, HPV triage is the most cost-effective management strategy versus either repeat Pap smear or immediate treatment.
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Affiliation(s)
- Sara K Sheriff
- Mosaic Health Care Consultants, 15 Hillcrest Avenue, Larkspur, CA 94939, USA
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Ikenberg H. Kongressbericht. „HPV 2005“ und 55. Jahrestagung der STD-Gesellschaft. Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-865973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ikenberg H, Göppinger A, Bauer H, Schmitt B. Semiquantitative analysis of human papillomavirus DNA in cervical intraepithelial neoplasia by a differential polymerase chain reaction. J OBSTET GYNAECOL 2005; 17:176-9. [PMID: 15511816 DOI: 10.1080/01443619750113816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
A differential polymerase chain reaction (PCR), which takes account of both the human papillomavirus (HPV) type and the amount of viral DNA, was applied to 100 cervical intraepithelial neoplasias (CIN) in order to improve the characterisation of the lesions. One hundred women with cytological smears suggestive of CIN I-III and a colposcopically guided punch biopsy were studied. DNA was phenol-extracted and a consensus PCR with L1 primers and a type-specific PCR for HPV-16 and-18 E6 were performed in parallel. The different sensitivity of the PCR methods allowed a semiquantitative analysis of viral DNA. HPV analysis was possible in all 100 very small cervical punch biopsies. Of the lesions 79% were HPVpositive. The percentage of HPV-16-positive lesions increased significantly (P < 0.001) with the degree of severity of CIN (CIN I: 46%, CIN II: 63%, CIN III: 85%). The percentage of CIN with a high viral load increased also with the grade of CIN (CIN I: 8%, CIN II: 33%, CIN III: 44%). Cytologically positive lesions (Pap IIID or IVa) had significantly more frequently (p < 0.02) a high viral load: 39% vs. 10% of cytologically false negative lesions. In conclusion, type-specific PCR had a very high sensitivity in the detection of HPV-DNA also in cytologically false negative CIN. The addition of the less sensitive consensusPCR allowed a semiquantitative analysis of the viral copy number. The higher amount of viral DNA in cytologically positive lesions, which may correspond to a higher rate of proliferation, reflects a possible role of the viral load in the progression of CIN. In clinical practice, differential HPVPCR could help to improve the management of CIN.
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Trunk MJ, Dallenbach-Hellweg G, Ridder R, Petry KU, Ikenberg H, Schneider V, von Knebel Doeberitz M. Morphologic characteristics of p16INK4a-positive cells in cervical cytology samples. Acta Cytol 2004; 48:771-82. [PMID: 15581161 DOI: 10.1159/000326445] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Overexpression of p16INK4a has been proposed as a biomarker helpful for the identification of dysplastic cervical epithelial cells on histologic slides as well as in cervical smears. Since a few nontransformed cells in the genital tract in some instances may also express p16INK4a, we evaluated whether applying established morphologic criteria for cervical dysplasia allows a distinction of dysplastic from nondysplastic p16INK4a-stained cells in cytologic samples. STUDY DESIGN Liquid-based cytology samples were obtained from a screening population (n=50), and from patients attending a dysplasia clinic (n=40). Slides prepared from these samples were stained with the conventional Papanicolaou stain procedure. From each specimen, a second slide was prepared in parallel and immunostained for p16INK4a. Cytologic diagnoses for most patients attending the dysplasia clinic could be compared to the reported histologic diagnoses on punch biopsy samples taken from the patients at the time of colposcopy. This allowed a comparison of the cytology and p16INK4a immunostaining results with subsequent hematoxylin and eosin-based histologic diagnoses. RESULTS Overall, in 10% of slides obtained from patients with nonsuspicious smears, few p16INK4a-positive cells were found. Using established morphologic criteria and applying these criteria on cells showing any p16INK4a immunoreactivity, p16INK4a-positive normal or metaplastic cells could be discriminated from p16INK4a-expressing dysplastic cells. In 21 of 22 cases (95%) of high grade lesions (cervical intraepithelial neoplasia 2 or higher in follow-up histology), easily recognizable p16INK4a-positive dysplastic cells could be detected, with the remaining case lacking dysplastic cells in the thin-layer slide used for p16INK4a immunostaining. CONCLUSION Established morphologic criteria for cervical dysplasia can be readily applied to p16INK4a-immunostained cytologic specimens. Thus, p16INK4a immunostaining may help to avoid ambiguities in the interpretation of cervical cytology samples and facilitate more rapid diagnosis and possibly even automated screening of cytologic slides.
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Ikenberg H. HPV-Diagnostik und Therapie. Eine wesentliche Verbesserung der Prävention des Zervixkarzinoms. Geburtshilfe Frauenheilkd 2004. [DOI: 10.1055/s-2004-821199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Henke M, Sindlinger F, Ikenberg H, Gerds T, Schumacher M. Blood hemoglobin level and treatment outcome of early breast cancer. Strahlenther Onkol 2004; 180:45-51. [PMID: 14704844 DOI: 10.1007/s00066-004-1123-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2002] [Accepted: 09/19/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE To determine whether the blood hemoglobin concentration correlates with the prognosis of patients with early breast cancer and, if so, whether this is restricted to treatment modality. PATIENTS AND METHODS Data were collected retrospectively from patients with early breast cancer (T1,2 N0-2 M0) who underwent either breast-conserving surgery followed by adjuvant radiotherapy (BCS-RT; n=96) or a modified radical mastectomy (MRM; n=194). The effect of preoperative blood hemoglobin level, nodal status, histological grading and hormone receptor status on disease-free survival was determined for both treatment modalities using a Cox regression model and visualized by Kaplan-Meier plots. RESULTS The blood hemoglobin concentration significantly correlated with disease-free survival of patients receiving BCS-RT (relative risk [RR]: 0.67 per g/dl; p=0.007). This was independent of other known risk factors for breast cancer patients, as determined by multivariate analysis. By contrast, the blood hemoglobin level had no prognostic significance when patients were treated with MRM. CONCLUSION Blood hemoglobin concentration seems to affect the prognosis of patients with early breast cancer when a treatment schedule that includes radiotherapy is applied. Reduced radiosensitivity due to diminished tumor oxygenation may be the underlying cause. Confirmative trials and studies intended to elucidate the underlying mechanism are warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast/pathology
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal/drug therapy
- Carcinoma, Ductal/pathology
- Carcinoma, Ductal/radiotherapy
- Carcinoma, Ductal/surgery
- Chemotherapy, Adjuvant
- Cohort Studies
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Hemoglobinometry
- Humans
- Lymphatic Metastasis
- Mastectomy, Modified Radical
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Staging
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/pathology
- Neoplasms, Hormone-Dependent/radiotherapy
- Neoplasms, Hormone-Dependent/surgery
- Prognosis
- Radiotherapy, Adjuvant
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Retrospective Studies
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Affiliation(s)
- Michael Henke
- Department of Radiotherapy, Radiological University Clinic, University Freiburg, Germany.
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38
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Reichert A, Trunk-Gehmacher M, Petry K, Ikenberg H, Lang H, Herkert M, Knebel Doeberitz MV, Ridder R. p16INK4a immunocytochemistry — a novel tool in cervical cytology. Pathol Res Pract 2004. [DOI: 10.1016/s0344-0338(04)80776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Cervical carcinoma and its precursors are discriminated by their epidemiology from other malignant diseases. Human papillomavirusus (HPV) have been identified as the central etiologic factor in these diseases. Certain HPV gene products are tumor specific antigens in cervical cancer which leads to new perspectives in prevention and therapy. HPV testing is a realistic option in screening, triage and follow-up of cervical cancer and its precursors which has shown significant advantages over traditional methods in numerous large studies and proven cost effectiveness in recent model simulations.
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Meinhold-Heerlein I, Ninci E, Ikenberg H, Brandstetter T, Ihling C, Schwenk I, Straub A, Schmitt B, Bettendorf H, Iggo R, Bauknecht T. Evaluation of methods to detect p53 mutations in ovarian cancer. Oncology 2001; 60:176-88. [PMID: 11244334 DOI: 10.1159/000055316] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The p53 status is increasingly regarded as a marker predictive of response to particular cancer therapies, but for this approach it is self-evident that the p53 status must be determined correctly. METHODS We have tested ovarian cancers with single-strand conformation polymorphism analysis (SSCP), immunohistochemical staining with DO-1 anti-p53 antibody (IHC), and yeast p53 functional assay (FASAY). RESULTS These techniques commonly used to detect p53 mutations showed important differences in their sensitivity. Of 53 tumors tested with three indirect techniques, 27 (50%), 33 (62%) and 41 (77%) were positive by SSCP, IHC, and FASAY, respectively. In a subset of 32 tumors strongly suspected of containing mutations, 25 (78%), 26 (81%), 29 (91%) and 30 (94%) were positive by SSCP, immunostaining, DNA sequencing and yeast assay, respectively. CONCLUSIONS Under comparable routine conditions, the FASAY reached the highest sensitivity. Since no single technique detected all mutations, we recommend the use of at least two different techniques in situations where the p53 status will affect patient management.
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Riethdorf S, Riethdorf L, Schulz G, Ikenberg H, Jänicke F, Löning T, Park TW. Relationship between telomerase activation and HPV 16/18 oncogene expression in squamous intraepithelial lesions and squamous cell carcinomas of the uterine cervix. Int J Gynecol Pathol 2001; 20:177-85. [PMID: 11293165 DOI: 10.1097/00004347-200104000-00011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SILs (squamous intraepithelial lesions) comprise a wide spectrum of clinically and biologically heterogeneous lesions ranging from benign proliferations to precancerous lesions. Telomerase activation plays a critical role in cellular immortalization and might be important for malignant progression. The viral oncogenes E6 and E7 are the principal transforming genes of high-risk HPVs and are important in HPV-associated immortalization and neoplastic transformation. In this study we investigated the relationship between telomerase activity, telomerase RNA, and HPV 16/18 oncogene expression in low- and high-grade SILs and SCCs (squamous cell carcinomas) of the cervix uteri. Telomerase activity was examined by the TRAP-assay and expression of the telomerase RNA (hTR) and HPV 16/18 E6/E7 oncogenes by RNA/RNA-in situ hybridization (ISH). The associated HPV-type was determined by PCR. Telomerase activity was observed in 25/29 (86%) SCCs, 31/41 (76%) high-grade SILs, 6/14 (43%) low-grade SILs, and 1/28 (3.6%) normal cervical tissues. Expression of hTR and viral oncogenes increased significantly with histopathologic severity of the lesion (p < 0.0001). A correlation was found between telomerase activity and intensity of viral oncogene expression. These findings suggest that telomerase activation occurs early in cervical carcinogenesis and is predominantly found in high-grade SILs and cervical SCCs. Our findings support current experimental data that suggest that telomerase is at least partially activated by viral oncogenes of high-risk HPV types. Telomerase activity with concomitant strong viral oncogene expression might therefore characterize a subset of lesions that are at risk for malignant progression.
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Affiliation(s)
- S Riethdorf
- Institute of Pathology, Department of Gynecopathology, University of Hamburg, Germany
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Dall P, Hekele A, Ikenberg H, Göppinger A, Bauknecht T, Pfleiderer A, Moll J, Hofmann M, Ponta H, Herrlich P. Increasing incidence of CD44v7/8 epitope expression during uterine cervical carcinogenesis. Int J Cancer 1996; 69:79-85. [PMID: 8608987 DOI: 10.1002/(sici)1097-0215(19960422)69:2<79::aid-ijc2>3.0.co;2-s] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Splice variants of the cell surface glycoprotein CD44 (CD44v) have been implicated in the progression of various human tumors. In the present study, we have examined the expression pattern of a CD44v epitope encoded by the adjacent variant exons v7 and v8 during human cervical carcinogenesis. While only l/ll normal cervical squamous epithelia was positive for this epitope by immunohistochemistry, 4/21 samples of low-grade squamous intra-epithelial lesions (LSIL), 17/35 samples of high-grade squamous intra-epithelial lesions (HSIL), 11/12 samples of the HSIL subgroup of carcinomas in situ and 17/17 cases of invasive cervical carcinoma showed CD44v7/8 epitope expression. In addition to CD44 variant expression, we have analyzed 67 lesions for the presence of HPV16/18-DNA using PCR. Most of the samples expressing the v7/8 epitope were also HPV16-positive (29/32), whereas only 17/35 of the v7/8-negative samples were HPV16-positive. HPV18 DNA was found in only one invasive carcinoma. Our data suggests that high-risk HPV infection may precede CD44v7/8 expression and that the number of samples expressing the CD44v7/8 epitope increases during carcinogenesis and reaches nearly 100% at the carcinoma in situ stage. This CD44 epitope could, therefore, serve as a diagnostic marker of cervical squamous cell carcinomas and as a possible target for CD44v7/8 epitope-directed therapies.
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Affiliation(s)
- P Dall
- Institute of Genetics, Research Center Karlsruhe, Germany
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Pfisterer J, Kommoss F, Sauerbrei W, Baranski B, Kiechle M, Ikenberg H, Du Bois A, Pfleiderer A. DNA flow cytometry in stage IB and II cervical carcinoma. Int J Gynecol Cancer 1996. [DOI: 10.1046/j.1525-1438.1996.06010054.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ikenberg H, Wiegering I, Pfisterer J, Kiechle-Schwarz M, Schmitt B, Sauerbrei W, Pfleiderer A. Human papillomavirus DNA in tumor-free regional lymph nodes: a potential prognostic marker in cervical carcinoma. Cancer J Sci Am 1996; 2:28-34. [PMID: 9166495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The medical management of women with cervical carcinoma would benefit from a test that might predict which patients have a high risk of progression or recurrence. The detection of micrometastases in regional lymph nodes may be such a test. At least 90% of cervical carcinomas worldwide contain human papillomavirus (HPV) DNA. In a pilot study, we evaluated a polymerase chain reaction-based method for the detection of human papillomavirus DNA in archival routine sections of regional lymph nodes as a marker of micrometastasis in patients with a long-term follow-up period. PATIENTS AND METHODS We analyzed 134 archival routine slides of histologically tumor-free lymph nodes derived from 21 patients with clinically and pathologically determined stage Ib, IIa, and IIb HPV-16 positive cervical carcinoma. The patients had been selected for good (still alive with a follow-up time of at least 5 years) or fatal outcome (dead of disease within 3 years). The amount of HPV-16 DNA was estimated by comparison with standards. RESULTS All patients without strongly HPV-positive lymph nodes survived. In contrast, 8 of 12 women with strongly HPV-positive lymph nodes died of cervical carcinoma. CONCLUSIONS In patients with cervical cancer, an approach based on a PCR test for HPV DNA in tumor-free regional lymph nodes may allow early identification of women at high risk for relapse who should receive adjuvant treatment.
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Affiliation(s)
- H Ikenberg
- Department of Gynecology and Obstetrics, University of Freiburg, Freiburg, Germany
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Loeffler KU, Witschel H, Ikenberg H, Wiegering I, Sundmacher R. Pigmented conjunctival epithelial dysplasia in an HIV positive African: detection of human papillomavirus type 16. Br J Ophthalmol 1995; 79:1138-40. [PMID: 8562553 PMCID: PMC505358 DOI: 10.1136/bjo.79.12.1138-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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46
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Ikenberg H, Matthay K, Schmitt B, Bauknecht T, Kiechle-Schwarz M, Göppinger A, Pfleiderer A. p53 mutation and MDM2 amplification are rare even in human papillomavirus-negative cervical carcinomas. Cancer 1995; 76:57-66. [PMID: 8630877 DOI: 10.1002/1097-0142(19950701)76:1<57::aid-cncr2820760108>3.0.co;2-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mutation of the p53 tumor suppressor gene is the most commonly found genetic alteration in human cancer. The E6 gene product of human papillomavirus (HPV) 16 and 18 can inactivate the p53 protein by promoting its degradation. Because most HPV-positive cervical carcinoma cell lines contain wild-type p53 whereas HPV-negative cell lines have point mutations in the p53 gene, a major role in the development of HPV-negative cervical cancer has been attributed to p53. Recent studies, however, have observed no consistent presence of p53 mutation in HPV-negative primary cervical carcinomas. The MDM2 oncogene, which forms an autoregulatory loop with the wild-type p53 protein, has been found amplified in a high percentage of human sarcomas, thus abolishing the antiproliferative function of p53. METHODS Forty-three primary cervical carcinomas and 10 autopsy-derived distant metastases from one patient were examined for p53 mutation and MDM2 amplification. These tumors had been selected from 238 cervical cancers that had been HPV-typed by Southern blot hybridization and polymerase chain reaction as a representative sample for their HPV status and their clinicopathologic characteristics. Seventeen of the cases had a remarkably good or poor clinical outcome. Human papillomavirus DNA sequences had been detected in 30 of these 43 primary tumors and 13 were negative for HPV by both methods. p53 mutation in the highly conserved exons 5-8 was studied by single-strand conformation polymorphism analysis and direct sequencing. MDM2 amplification was analyzed by Southern blot hybridization. RESULTS Only two missense point mutations and one nucleotide sequence polymorphism were detected: a TAC-->TGC transition in codon 234 in exon 7, resulting in a Tyr-->Lys substitution, a CGT-->TGT transition in codon 273 in exon 8, resulting in an Arg-->Cys substitution and a polymorphism (CGA-->CGG) in codon 213 in exon 6. Both tumors revealing the point mutations were HPV-negative carcinomas. Amplification of the MDM2 gene was observed in 1 of the 53 specimens tested. CONCLUSIONS In contrast to data derived from cultured cervical carcinoma cell lines and primary sarcomas, these results indicate that p53 mutation and amplification of the MDM2 oncogene are rare even in HPV-negative primary cervical carcinomas. However, to the authors; knowledge, this is the first observation of MDM2 amplification in humans outside sarcomas and neuroepithelial tumors.
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Affiliation(s)
- H Ikenberg
- Department of Gynecology and Obstetrics, University of Freiburg, Germany
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Ikenberg H, Sauerbrei W, Schottmüller U, Spitz C, Pfleiderer A. Human papillomavirus DNA in cervical carcinoma--correlation with clinical data and influence on prognosis. Int J Cancer 1994; 59:322-6. [PMID: 7927936 DOI: 10.1002/ijc.2910590306] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Human papillomavirus (HPV) is a main factor in cervical carcinogenesis. However, data on the correlation of HPV with clinical features and the prognosis of cervical carcinoma remain controversial. The HPV status (positivity, type, copy number) in unfixed tissue specimens of 205 primary invasive cervical carcinomas was determined by Southern blot hybridization. A correlation with comprehensive clinical and histopathologic data and long-time survival was evaluated. HPV DNA was detected in 73% of the cases; 83% of the HPV-positive tumors contained HPV 16. HPV 16 was predominant among squamous-cell carcinomas (SCC) (p = 0.05). HPV 16 copy number was higher in keratinizing tumors (p < 0.05), and elevated levels of the SCC antigen were more common in patients positive for HPV 16 (p < 0.03). No association was found between the HPV status and 8 other clinical and histopathologic variables. Multivariate analysis after a median follow-up of 73 months demonstrated longer survival for patients with lower clinical stage (p = 0.001) and keratinizing SCC (p = 0.005). Women with HPV-negative tumors had a higher risk of death (RR 1.51; p = 0.07). HPV analysis does not clearly define biologically distinct sub-sets of cervical carcinoma. This underlines the importance of additional factors in cervical carcinogenesis.
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Affiliation(s)
- H Ikenberg
- Department of Obstetrics and Gynecology, University of Freiburg, Germany
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Ikenberg H, Hartmann M, Schmitt B, Göppinger A, Teufel G, Pfleiderer A. HPV DNA in autopsy-derived material from multiple metastases of a cervical carcinoma. Gynecol Oncol 1994; 54:316-20. [PMID: 8088607 DOI: 10.1006/gyno.1994.1216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fresh tissue from primary tumor and a metastasis of a cervical carcinoma and 13 autopsy-derived tissue specimens of the same patient were analyzed for HPV DNA by Southern blot hybridization and PCR. Primary tumor and 7 of 10 histologically proven distant metastases contained HPV 16 DNA by Southern blot. PCR detected HPV 16 in all 10 metastases and in 2 of 3 additional tumor-free autopsy-derived tissues. The restriction pattern was identical in all HPV-positive lesions and only slight variations in copy number occurred. Two-dimensional gel electrophoresis showed the viral DNA fully integrated in the cellular genome without any difference between primary tumor and metastasis. The relevance of HPV also for the metastatic spread of the malignant disease is indicated by its conserved presence in multiple distant metastases of cervical carcinoma.
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Affiliation(s)
- H Ikenberg
- Department of Obstetrics and Gynecology, University of Freiburg, Federal Republic of Germany
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50
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Abstract
Ten vaginal and central recurrences of cervical carcinoma were analyzed by Southern blot hybridization under nonstringent and stringent conditions for the presence of human papillomavirus (HPV) type 11, 16, 18, 31, and 35 DNA. Cases judged HPV-negative by this assay were tested with the polymerase chain reaction (PCR) for HPV 16 and 18. All 10 recurrences were HPV-positive. Seven tumors contained HPV 16, one contained HPV 18, one contained HPV 16 and 18, and one contained HPV-related sequences. In three cases, where the corresponding primary tumor could be studied, the identical HPV type was contained. The consistent presence of HPV DNA in local recurrences of invasive cervical carcinoma argues in favor of a role of these viruses also in the maintenance and reappearance of malignancy.
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Affiliation(s)
- H Ikenberg
- Department of Obstetrics and Gynecology, University of Freiburg, Federal Republic of Germany
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