Adult; Alphapapillomavirus/genetics; Cervical Intraepithelial Neoplasia/diagnosis/pathology/virology; DNA, Viral/chemistry; Early Detection of Cancer/methods; Female; Humans; Middle Aged; Papillomavirus Infections/diagnosis/pathology/virology; Sensitivity and Specificity; Triage/methods; Uterine Cervical Neoplasms/diagnosis/pathology
Abstract :
[en] High-risk human papillomavirus (hrHPV) testing has a higher sensitivity but lower specificity than cytology for detection of high-grade intraepithelial neoplasia (CIN). To avoid over-referral to colposcopy and overtreatment, hrHPV-positive women require triage testing and/or followup. A total of 25,658 women (30-60 years) enrolled in a population-based cohort study had an adequate baseline Pap smear and hrHPV test. The end-point was cumulative two-year risk of CIN grade 3 or worse (CIN3+). In a post-hoc analysis, fourteen triage/followup strategies for hrHPV-positive women (n = 1,303) were evaluated for colposcopy referral rate, positive (PPV) and negative predictive value (NPV). Five strategies involved triage testing without a repeat test and nine strategies involved triage testing followed by one repeat testing. The tests were cytology, hrHPV, HPV16/18 genotyping and HPV16/18/31/33/45 genotyping. Results were adjusted for women in the cohort study who did not attend repeat testing. Of the strategies without repeat testing, combined cytology and HPV16/18/31/33/45 genotyping gave the highest NPV of 98.9% (95%CI 97.6-99.5%). The corresponding colposcopy referral rate was 58.1% (95%CI 55.4-60.8%). Eight of the nine strategies with retesting had an estimated NPV of at least 98%. Of those, cytology triage followed by cytology at 12 months had a markedly lower colposcopy referral rate of 33.4% (95%CI 30.2-36.7%) than the other strategies. The NPV of the latter strategy was 99.3% (95%CI 98.1-99.8%). Triage hrHPV-positive women with cytology, followed by repeat cytology testing yielded a high NPV and modest colposcopy referral rate and appear to be the most feasible management strategy.
Disciplines :
Genetics & genetic processes
Author, co-author :
Rijkaart, Dorien C.
Berkhof, Johannes
van Kemenade, Folkert J.
Coupe, Veerle M. H.
Hesselink, Albertus T.
Rozendaal, Lawrence
Heideman, Danielle A. M.
Verheijen, Ren H.
BULK, Saskia ; Centre Hospitalier Universitaire de Liège - CHU > Génétique
Verweij, Wim M.
Snijders, Peter J. F.
Meijer, Chris J. L. M.
Language :
English
Title :
Evaluation of 14 triage strategies for HPV DNA-positive women in population-based cervical screening.
Publication date :
2012
Journal title :
International Journal of Cancer
ISSN :
0020-7136
eISSN :
1097-0215
Publisher :
John Wiley & Sons, Hoboken, United States - New York
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