Colposcopy Referral and CIN3+ Risk of Human Papillomavirus Genotyping Strategies in Cervical Cancer Screening.

IF 3.7 3区 医学 Q2 ONCOLOGY
Kelsi R Kroon, Johannes A Bogaards, Daniëlle A M Heideman, Chris J L M Meijer, Johannes Berkhof
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引用次数: 0

Abstract

Background: High-risk human papillomavirus (hrHPV)-based cervical cancer screening in the Netherlands led to a substantial increase in number of colposcopy referrals and low-grade lesions detected. Genotyping strategies may be employed to lower the screening-related burden.

Methods: We evaluated 14 triage strategies with genotyping (HPV16/18 or HPV16/18/31/33/45/52/58) for hrHPV-positive borderlineormilddyskaryosis (BMD)ornormal cytology,usingdata from a population-based hrHPV-based screening trial with 5-year interval (POBASCAM). We considered colposcopy referral at baseline, after 6-month repeat cytology and after 5-year hrHPV testing. Performance was evaluated by one-round positive and negative predictive value (PPVandNPV) for CIN3+ and by two-roundcolposcopy referral rate. To identify efficient strategies, they were ordered by the one-round colposcopy referral rate. Adjacent strategies were compared by the marginal PPV for detecting one additional CIN3+ (mPPV).

Results: The most conservative strategy (repeat cytology after BMD and HPV16/18/31/33/45/52/58-positive normal cytology, next round otherwise) yielded an mPPV of 28%, NPV of 98.2%, and two-round colposcopy referral rate of 47.2%. Adding direct referral after BMD or genotype-positive BMD yielded an mPPV ≤ 8.2%, NPV ≥ 98.5% and an increase in colposcopy referral rate of 1.9% to 6.5%. Adding direct referral after HPV16/18-positive normal cytology yielded an mPPV ≤ 3.5%, NPV ≥ 99.5% and an increase in colposcopy referral rate of 13.9%.

Conclusions: Direct colposcopy referral of women with BMD or normal cytology is unlikely to be efficient, but genotype-guided direct referral after BMD may be considered because the increase in colposcopies is limited.

Impact: hrHPV screening programs can become very efficient when immediate colposcopy referral is limited to women at highest CIN3+ risk. See related In the Spotlight, p. 979.

阴道镜检查转诊与宫颈癌筛查中人类乳头瘤病毒基因分型策略的 CIN3+ 风险。
背景:在荷兰,以高危人乳头瘤病毒(hrHPV)为基础的宫颈癌筛查导致阴道镜检查转诊人数和低级别病变检出率大幅上升。基因分型策略可用于降低筛查相关负担:方法:我们利用基于 hrHPV 的人群筛查试验(POBASCAM)的数据,对 hrHPV 阳性的边缘性或轻度核分裂不良(BMD)或细胞学正常者进行基因分型(HPV16/18 或 HPV16/18/31/33/45/52/58),评估了 14 种分流策略。我们考虑了基线、6 个月重复细胞学检查和 5 年 hrHPV 检测后的阴道镜转诊情况。根据 CIN3+ 的一轮阳性预测值和阴性预测值(PPV 和 NPV)以及两轮阴道镜检查转诊率来评估效果。为了确定有效的策略,根据一轮阴道镜检查转诊率对这些策略进行排序。通过检测出一个额外 CIN3+ 的边际 PPV(mPPV)对相邻策略进行比较:最保守的策略(BMD 和 HPV16/18/31/33/45/52/58 阳性正常细胞学检查后重复细胞学检查,否则进行下一轮检查)的 mPPV 为 28%,NPV 为 98.2%,阴道镜检查率为 47.2%。在 BMD 或基因型阳性 BMD 后增加直接转诊,mPPV≤8.2%,NPV≥98.5%,阴道镜检查率增加 1.9-6.5%。在HPV16/18阳性正常细胞学检查后增加直接转诊,mPPV≤3.5%,NPV≥99.5%,阴道镜检查率增加13.9%:影响:当立即转诊的阴道镜检查仅限于 CIN3+ 风险最高的妇女时,HrHPV 筛查项目会变得非常高效。
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来源期刊
Cancer Epidemiology Biomarkers & Prevention
Cancer Epidemiology Biomarkers & Prevention 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.50
自引率
2.60%
发文量
538
审稿时长
1.6 months
期刊介绍: Cancer Epidemiology, Biomarkers & Prevention publishes original peer-reviewed, population-based research on cancer etiology, prevention, surveillance, and survivorship. The following topics are of special interest: descriptive, analytical, and molecular epidemiology; biomarkers including assay development, validation, and application; chemoprevention and other types of prevention research in the context of descriptive and observational studies; the role of behavioral factors in cancer etiology and prevention; survivorship studies; risk factors; implementation science and cancer care delivery; and the science of cancer health disparities. Besides welcoming manuscripts that address individual subjects in any of the relevant disciplines, CEBP editors encourage the submission of manuscripts with a transdisciplinary approach.
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