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Giubbi C, Martinelli M, Di Meo ML, Njoku RC, Perdoni F, Fruscio R, Landoni F, Cocuzza CE. Evaluation of two alternative non-alcohol-based media for the suspension of self-collected vaginal swabs for HPV testing in cervical cancer screening. Heliyon 2024; 10:e31032. [PMID: 38813186 PMCID: PMC11133750 DOI: 10.1016/j.heliyon.2024.e31032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Abstract
The introduction of Human Papillomavirus (HPV) testing in cervical cancer screening enhanced the opportunity to introduce self-collection as an innovative approach to improve coverage rates. Validation and standardization of the pre-analytical and analytical procedures are crucial for the quality assurance of HPV tests on self-collected samples. This study evaluated the analytical performance and the stability of self-collected vaginal samples resuspended in 5 mL of two non-alcohol-based media, eNat® and MSwab® compared to a professionally collected cervical sample, resuspended in 20 mL ThinPrep®, for the detection of high-risk HPV (hrHPV). The impact of the suspension volumes on analytical performance was also evaluated (2 and 5 ml). A good analytical concordance in hrHPV detection in cervical and vaginal self-collected swabs suspended in 5 ml of both non-alcohol-based media was demonstrated (eNat®: 91.2 %, k = 0.821; MSwab®: 91.4 %; k = 0.798). A similar analytical performance was found for samples resuspended in 2 mL (eNat®: 92.9 %, k = 0.811; MSwab®: 92.9 %, k = 0.811) compared to cervical samples. Good nucleic acid stability was demonstrated for vaginal samples stored at 20-25 °C and 37 °C for up to 4 weeks. Results of this preliminary study support the introduction of these media for vaginal self-sampling-based prevention programs. Nevertheless, further research is necessary to evaluate clinical accuracy in larger settings.
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Affiliation(s)
- Chiara Giubbi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Ruth Chinyere Njoku
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- University of Sassari, Department of Biomedical Science, Sassari, Italy
| | - Federica Perdoni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Robert Fruscio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Fondazione IRCSS San Gerardo dei Tintori, Monza, Italy
| | - Fabio Landoni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Fondazione IRCSS San Gerardo dei Tintori, Monza, Italy
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Sahasrabuddhe VV. Cervical Cancer: Precursors and Prevention. Hematol Oncol Clin North Am 2024:S0889-8588(24)00032-7. [PMID: 38760198 DOI: 10.1016/j.hoc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Cervical cancer, caused due to oncogenic types of human papillomavirus (HPV), is a leading preventable cause of cancer morbidity and mortality globally. Chronic, persistent HPV infection-induced cervical precursor lesions, if left undetected and untreated, can progress to invasive cancer. Cervical cancer screening approaches have evolved from cytology (Papanicolaou test) to highly sensitive HPV-based molecular methods and personalized, risk-stratified, management guidelines. Innovations like self-collection of samples to increase screening access, innovative triage methods to optimize management of screen positives, and scalable and efficacious precancer treatment approaches will be key to further enhance the utility of prevention interventions.
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Affiliation(s)
- Vikrant V Sahasrabuddhe
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 5E-338, Rockville, MD, USA.
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3
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Watanabe J, Ichimasa K, Kataoka Y, Miki A, Someko H, Honda M, Tahara M, Yamashina T, Yeoh KG, Kawai S, Kotani K, Sata N. Additional staining for lymphovascular invasion is associated with increased estimation of lymph node metastasis in patients with T1 colorectal cancer: Systematic review and meta-analysis. Dig Endosc 2024; 36:533-545. [PMID: 37746764 DOI: 10.1111/den.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Lymphovascular invasion (LVI) is a critical risk factor for lymph node metastasis (LNM), which requires additional surgery after endoscopic resection of T1 colorectal cancer (CRC). However, the impact of additional staining on estimating LNM is unclear. This systematic review aimed to evaluate the impact of additional staining on determining LNM in T1 CRC. METHODS We searched five electronic databases. Outcomes were diagnostic odds ratio (DOR), assessed using hierarchical summary receiver operating characteristic curves, and interobserver agreement among pathologists for positive LVI, assessed using Kappa coefficients (κ). We performed a subgroup analysis of studies that simultaneously included a multivariable analysis for other risk factors (deep submucosal invasion, poor differentiation, and tumor budding). RESULTS Among the 64 studies (18,097 patients) identified, hematoxylin-eosin (HE) and additional staining for LVI had pooled sensitivities of 0.45 (95% confidence interval [CI] 0.32-0.58) and 0.68 (95% CI 0.44-0.86), specificities of 0.88 (95% CI 0.78-0.94) and 0.76 (95% CI 0.62-0.86), and DORs of 6.26 (95% CI 3.73-10.53) and 6.47 (95% CI 3.40-12.32) for determining LNM, respectively. In multivariable analysis, the DOR of additional staining for LNM (DOR 5.95; 95% CI 2.87-12.33) was higher than that of HE staining (DOR 1.89; 95% CI 1.13-3.16) (P = 0.01). Pooled κ values were 0.37 (95% CI 0.22-0.52) and 0.62 (95% CI 0.04-0.99) for HE and additional staining for LVI, respectively. CONCLUSION Additional staining for LVI may increase the DOR for LNM and interobserver agreement for positive LVI among pathologists.
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Affiliation(s)
- Jun Watanabe
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
- Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
- Department of Medicine, National University of Singapore, Singapore City, Singapore
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Kyoto, Japan
- Scientific Research WorkS Peer Support Group, Osaka, Japan
| | - Atsushi Miki
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hidehiro Someko
- Scientific Research WorkS Peer Support Group, Osaka, Japan
- General Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Munenori Honda
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Makiko Tahara
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Takeshi Yamashina
- Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Khay Guan Yeoh
- Department of Medicine, National University of Singapore, Singapore City, Singapore
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore City, Singapore
| | - Shigeo Kawai
- Department of Diagnostic Pathology, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
| | - Naohiro Sata
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
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Lopez Castro R, Escudero Rivas R, Ángeles Calderón M, Iglesias Linares L, Dolores Hurtado González M, Méndez Gómez N, de la Rosa Martos B, Esther Hidalgo Carmona M, Luis López Hidalgo J. Performance of a vaginal self-collection device versus clinician collected cervical samples for the detection of high-risk human papillomavirus. Prev Med Rep 2024; 41:102705. [PMID: 38595732 PMCID: PMC11002652 DOI: 10.1016/j.pmedr.2024.102705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Objective Screening for cervical cancer requires the participation of target women. Human papillomavirus (HPV) testing can be performed on vaginal self-samples and self-sampling can improve this participation. This study aims to validate the performance of the vaginal self-sampling device (Vitroveil®) to detect high risk human papillomavirus (hrHPV) in comparison to clinician collected samples and evaluate the degree of acceptability of the Vitroveil® device. Methods A cross-sectional observational study was carried out in a cohort of 385 participating women (median age of 44 ± 10.47 years) attending primary care centers and cervical pathology services of Granada, Spain. Two paired samples (vaginal self-sample and clinician collected cervical sample) where collected from each participant to compare the detection of HPV with the Vitro HPV Screening assay (Vitro, Granada, Spain). A questionnaire was also provided to the participants to analyze the degree of satisfaction with the device and the preference for sampling method. Results Overall concordance for hrHPV detection was substantial (ĸ 0.804). The prevalence of any hrHPV infection was higher in self-collected samples (30.6%) than in clinician-collected samples (24.3%). The participants found the self-sampling device easy to use and preferred self-collection as the collection method. Conclusion The Vitroveil® self-sampling device enables safe and accruable hrHPV testing, obtaining equivalent results to those of the clinician collected samples. High acceptability of the device has been demonstrated among women in the study. Nevertheless, additional studies are necessary to verify the efficacy and reliability of the device's performance.
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Affiliation(s)
- Rodrigo Lopez Castro
- UGC Provincial Intercentros de Anatomía Patológica de Granada, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Raquel Escudero Rivas
- Servicio de Ginecología y Obstetricia del Hospital Universitario Clínico San Cecilio de Granada, Granada, Spain
| | - María Ángeles Calderón
- Unidad de Tracto Genital Inferior, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Lucía Iglesias Linares
- Unidad de Tracto Genital Inferior, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Nadia Méndez Gómez
- Servicio de Ginecología y Obstetricia del Hospital Universitario Clínico San Cecilio de Granada, Granada, Spain
| | | | | | - Javier Luis López Hidalgo
- UGC Provincial Intercentros de Anatomía Patológica de Granada, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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Ngo O, Chloupková R, Cibula D, Sláma J, Mandelová L, Hejduk K, Hajdúch M, Minka P, Koudeláková V, Jaworek H, Trnková M, Vaněk P, Dvořák V, Dušek L, Májek O. Direct mailing of HPV self-sampling kits to women aged 50-65 non-participating in cervical screening in the Czech Republic. Eur J Public Health 2024; 34:361-367. [PMID: 38224266 PMCID: PMC10990530 DOI: 10.1093/eurpub/ckad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND A population-based cervical cancer screening programme is implemented in the Czech Republic. However, participation is insufficient among women over 50 years. This study aimed to estimate the potential improvement in participation through directly mailed HPV self-sampling kits (HPVssk) compared with standard invitation letters in women aged 50-65 non-participating in screening. METHODS The study recruited 1564 eligible women (no cervical cancer screening in the last 3 years or more, no previous treatment associated with cervical lesions or cervical cancer). Eight hundred women were mailed with an HPVssk (HPVssk group), and 764 women were sent a standard invitation letter (control group) inviting them to a routine screening (Pap test). The primary outcome was a comparison of the overall participation rate between study groups using a binominal regression model. RESULTS The participation rate in the HPVssk group was 13.4% [95% confidence interval (CI) 11.2-15.9%; 7.4% of women returned the HPVssk and 6.0% attended gynaecological examination] and 5.0% (95% CI 3.6-6.8%) in the control group. Using the binominal regression model, the difference between the groups was estimated as 7.6% (95% CI 5.0-10.2%; P < 0.001). In the HPVssk group, 22% of women who returned HPVssk had a positive result and 70% of them underwent a follow-up examination. CONCLUSIONS Compared with traditional invitation letters, the direct mailing of the HPVssk achieved a significantly higher participation rate, along with a notable HPV positivity rate among HPVssk responders. This approach offers a potentially viable method for engaging women who have not yet attended a cervical screening programme.
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Affiliation(s)
- Ondřej Ngo
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Renata Chloupková
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - David Cibula
- Department of Obstetrics, Gynaecology and Neonatology, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Sláma
- Department of Obstetrics, Gynaecology and Neonatology, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Mandelová
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Karel Hejduk
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marián Hajdúch
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Minka
- RBP, Health Insurance Company, Ostrava, Czech Republic
| | - Vladimíra Koudeláková
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Hana Jaworek
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Peter Vaněk
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Vladimír Dvořák
- Centre of Outpatient Gynaecology and Primary Care, Brno, Czech Republic
| | - Ladislav Dušek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondřej Májek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Nitkowski J, Giuliano AR, Ridolfi T, Chiao E, Fernandez ME, Schick V, Swartz MD, Smith JS, Nyitray AG. Concordance of Human Papillomavirus Genotypes in Mailed Home-Based Self-Collected Versus Clinician-Collected Anal Swabs Among Sexual and Gender Minority Individuals. Sex Transm Dis 2024; 51:270-275. [PMID: 38133570 PMCID: PMC10978280 DOI: 10.1097/olq.0000000000001916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Home-based self-sampling may be a viable option for anal cancer screening among sexual minority men (SMM). Yet limited research has compared home-based self-collected with clinician-collected anal swabs for human papillomavirus (HPV) genotyping. METHODS The Prevent Anal Cancer Self-Swab Study recruited SMM and transgender persons 25 years and over in Milwaukee, WI to participate in an anal cancer screening study. Participants were randomized to a home or clinic arm. Home-based participants were mailed an anal self-sampling kit to complete and return via postal mail. They were also asked to attend a clinic appointment where a clinician collected an anal swab. Swabs were HPV-genotyped using the SPF 10 -LiPA 25 assay. We analyzed 79 paired self and clinician swabs to determine HPV prevalence, percent agreement, and sensitivity and specificity of the mailed home-based anal self-swab to detect HPV genotypes using the clinician-collected swab as the reference. RESULTS The median number of days between the home and clinic swab was 19 days (range = 2 to 70). Human papillomavirus was detected in 73.3% of self and 75.0% of clinician anal swabs ( P = 0.99). Prevalence of any HPV, any high-risk HPV, any low-risk HPV, and individual HPV types did not significantly differ between self and clinician anal swabs. Agreement between self and clinician swabs was over 90% for 21 of the 25 HPV genotypes. Mailed home-based self-collected swabs had a sensitivity of 94.1% (95% confidence interval, 82.9-99.0) for detection of high-risk HPV versus clinician-collected sampling. CONCLUSIONS Mailed home-based self-collected and clinician-collected anal swabs demonstrated high concordance for HPV genotyping.
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Affiliation(s)
- Jenna Nitkowski
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tim Ridolfi
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Maria E. Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Jennifer S. Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan G. Nyitray
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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7
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Martinelli M, Latsuzbaia A, Bonde J, Pedersen H, Iacobone AD, Bottari F, Piana AF, Pietri R, Cocuzza CE, Arbyn M. Performance of BD Onclarity HPV assay on FLOQSwabs vaginal self-samples. Microbiol Spectr 2024; 12:e0287223. [PMID: 38323823 PMCID: PMC10913526 DOI: 10.1128/spectrum.02872-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
This study assessed the accuracy of high-risk human papillomavirus testing of BD Onclarity HPV (Onclarity) assay on vaginal self-collected FLOQSwab versus cervical samples to ensure similar accuracy to detect cervical intraepithelial neoplasia. Testing was performed on two automated platforms, BD Viper LT and BD COR, to evaluate the effect of machine and using two vaginal self-samples to analyze the influence of collection, transport, and freezing-unfreezing on the results. A cervical sample and two self-samples were collected from 300 women. The first collected vaginal and the cervical sample were tested on BD Viper LT, and the second swab was frozen and subsequently tested on both automated systems. Test results on vaginal and cervical specimens were considered the index and comparator, respectively; colposcopy and histology were reference standards. Relative sensitivity for ≥CIN2 on vaginal samples analyzed versus the cervical sample was 1.01 (0.97-1.06), 1.01 (0.97-1.06), and 1.00 (0.95-1.05), for the first, second self-collected sample tested on BD VIPER LT, and second self-collected sample tested on BD COR, respectively. Relative specificity was 0.83 (0.73-0.94), 0.76 (0.67-0.87), and 0.82 (0.73-0.92) using the three different workflows. Cut-off optimization for human papillomavirus (HPV) positivity defined at Ct ≤38.3 for HPV16, ≤ 34.2 for HPV18, and ≤31.5 for all other types showed an increased relative specificity with similar sensitivity. No significant difference was observed between self-samples tested with the two platforms and between first- and second-collected swabs. Onclarity assay on FLOQSwab using both platforms showed similar sensitivity but lower specificity to detect ≥CIN2 compared to cervical samples. By cut-off optimization, non-inferior specificity could be reached. IMPORTANCE Human papillomavirus (HPV) testing on self-collected vaginal samples has been shown to improve women's participation to cervical cancer screening programs, particularly in regions with limited access to health care. Nevertheless, the introduction of self-sampling in cervical cancer screening programs requires prior clinical validation of the HPV assay in combination with a self-sample collection device, including also the laboratory workflow and automation required for high-throughput testing in screening. In this study, the performance of BD Onclarity HPV on FLOQSwab-collected vaginal self-samples has been compared to clinician-taken liquid-based cytology samples, to detect high-grade cervical intraepithelial neoplasia using two high-throughput platforms, BD Viper LT and BD COR. The study findings have shown a similar performance of BD Onclarity on testing self-collected samples, confirming the validation of the proposed pre-analytical and analytical protocols for their use in cervical cancer screening programs based on self-collected vaginal samples.
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Affiliation(s)
- Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ardashel Latsuzbaia
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Jesper Bonde
- Department of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital, AHH-Hvidovre Hospital, Hvidovre, Denmark
| | - Helle Pedersen
- Department of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital, AHH-Hvidovre Hospital, Hvidovre, Denmark
| | - Anna D. Iacobone
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Bottari
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea F. Piana
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Roberto Pietri
- U.O. Coordinamento Consultori Familiari, ASSL Sassari – ATS Sardegna, Sassari, Italy
| | | | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Extended Valhudes Study GroupGiubbiChiara1Brask SonneSi2Korsgaard AndreaseEmilie2MartellaSilvia3PretiEleonora Petra3GuerrieriMaria Elena3PasseriniRita4MuresuNarcisa5SechiIllari5DettoriArianna5GhiMaria Eugenia6BagellaMaria Paola6MarrazzuAdriano6Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyDepartment of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital, Hvidovre, DenmarkPreventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, ItalyDivision of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, ItalyDepartment of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, ItalyU.O. Coordinamento Consultori Familiari, ASSL Sassari – ATS Sardegna, Sassari, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Pathology, Molecular Pathology Laboratory, Copenhagen University Hospital, AHH-Hvidovre Hospital, Hvidovre, Denmark
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- U.O. Coordinamento Consultori Familiari, ASSL Sassari – ATS Sardegna, Sassari, Italy
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
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8
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Yoo JG, Lee SJ, Nam EJ, No JH, Park JY, Song JY, Shin SJ, Yun BS, Park ST, Lee SH, Suh DH, Kim YB, Lee TS, Bae JM, Lee KH. Clinical practice guidelines for cervical cancer: the Korean Society of Gynecologic Oncology guidelines. J Gynecol Oncol 2024; 35:e44. [PMID: 38389404 PMCID: PMC10948982 DOI: 10.3802/jgo.2024.35.e44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/24/2023] [Accepted: 12/25/2023] [Indexed: 02/24/2024] Open
Abstract
This fifth revised version of the Korean Society of Gynecologic Oncology practice guidelines for the management of cervical cancer incorporates recent research findings and changes in treatment strategies based on version 4.0 released in 2020. Each key question was developed by focusing on recent notable insights and crucial contemporary issues in the field of cervical cancer. These questions were evaluated for their significance and impact on the current treatment and were finalized through voting by the development committee. The selected key questions were as follows: the efficacy and safety of immune checkpoint inhibitors as first- or second-line treatment for recurrent or metastatic cervical cancer; the oncologic safety of minimally invasive radical hysterectomy in early stage cervical cancer; the efficacy and safety of adjuvant systemic treatment after concurrent chemoradiotherapy in locally advanced cervical cancer; and the oncologic safety of sentinel lymph node mapping compared to pelvic lymph node dissection. The recommendations, directions, and strengths of this guideline were based on systematic reviews and meta-analyses, and were finally confirmed through public hearings and external reviews. In this study, we describe the revised practice guidelines for the management of cervical cancer.
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Affiliation(s)
- Ji Geun Yoo
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - So-Jin Shin
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Bo Seong Yun
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University, Goyang, Korea
| | - Sung Taek Park
- Department of Obstetrics and Gynecology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - San-Hui Lee
- Department of Obstetrics and Gynecology, Wonju Severance Christian Hospital, Yonsei University College of Medicine, Wonju, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Man Bae
- Department of Obstetrics and Gynecology, Hanyang University Medical Center, Seoul, Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
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9
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Chou HH, Yang CY, Chao A, Lin H, Lu CH, Ou YC, Hsu ST, Shih YH, Huang HJ, Lin CT, Chen MY, Sun L, Tsai CC, Fu HC, Huang KG, Wu KY, Wu CH, Hsieh WC, Huang YT, Chen LH, Yang LY, Chang WY, Chang TC, Lai CH. Consistency in human papillomavirus type detection between self-collected vaginal specimens and physician-sampled cervical specimens. J Med Virol 2024; 96:e29426. [PMID: 38420851 DOI: 10.1002/jmv.29426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 03/02/2024]
Abstract
With the rising need for accessible cervical cancer screening, self-sampling methods offer a promising alternative to traditional physician-led sampling. This study aims to evaluate the efficacy of the HygeiaTouch Self Sampling Kit for Women in detecting human papillomavirus (HPV) types and predicting cervical lesions. We studied the concordance in identifying high-risk HPV (hrHPV) types between samples collected by physicians and those self-collected by women using a self-sampling kit for validation. Women aged 21-65, fitting into specific categories based on their cervical health history were eligible. Cohen's kappa coefficient to gauge concordance between the two specimen types and relative accuracy metrics in identifying cervical intraepithelial neoplasia (CIN) were also calculated, with physician-sampled specimens serving as a reference. A total of 1210 participants from three institutes were involved. The self-sampling kit closely matched the physician-led method in terms of collecting valid specimens (100% vs. 100%), identifying hrHPV types (kappa: 0.75, 95% confidence interval [95% CI]: 0.72-0.79; agreement: 87.7%, 95% CI: 85.8-89.6) and predicting CIN grade 2 or worse (CIN2+) (relative sensitivity: 0.949, relative accuracy: 0.959). Kappa values varied between 0.71 and 0.83 for different hrHPV types and combinations, with an overall value 0.75 (95% CI: 0.72-0.79) signifying robust compatibility between the two methods. Our study underscores the potential of the HygeiaTouch Self Sampling Kit as a reliable, efficient, and user-friendly alternative to traditional sampling methods. This suggests that self-sampling could be pivotal in expanding cervical cancer screening accessibility and enhancing detection rates.
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Affiliation(s)
- Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chung-Yao Yang
- Department of Research and Development, Hygeia Touch Inc., Taipei, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Hsing Lu
- Department of Gynecology and Obstetrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Tien Hsu
- Department of Gynecology and Obstetrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Tao Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Min-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lou Sun
- Department of Gynecology and Obstetrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Chou Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hung-Chun Fu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chen-Hsuan Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wu-Chiao Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Ting Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Liang-Hsuan Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Yang Chang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Research and Development, Hygeia Touch Inc., Taipei, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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10
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Thompson HM, Rusie LK, Schneider JA, Mehta SD. Bacterial vaginosis testing gaps for transmasculine patients may exacerbate health disparities. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1344111. [PMID: 38449898 PMCID: PMC10916334 DOI: 10.3389/frph.2024.1344111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Bacterial vaginosis (BV) is associated with non-optimal changes in the vaginal microbiome and increased susceptibility to STIs and HIV in cisgender women. Much less is known about the sexual health of transmasculine people and susceptibility to BV, STIs, and HIV. This study's objective was to assess BV testing and outcomes of transmasculine and cisgender women patient populations at a large, LGBTQ + federally qualified health center. Methods Retrospective electronic health record data were extracted for eligible patients having at least one primary care visit between January 1, 2021, and December 31, 2021. Transmasculine patients were limited to those with a testosterone prescription in 2021. We conducted log binomial regression analysis to determine the probability of receiving a BV test based on gender identity, adjusting for sociodemographic characteristics. Results During 2021, 4,903 cisgender women patients and 1,867 transmasculine patients had at least one primary care visit. Compared to cisgender women, transmasculine patients were disproportionately young, White, queer, privately insured, living outside Chicago, and had a lower rate of BV testing (1.9% v. 17.3%, p < 0.001). Controlling for sociodemographics, transmasculine patients were less likely to receive a BV test [Prevalence Ratio = 0.19 (95% CI 0.13-0.27)]. Discussion The low rate of BV testing among transmasculine patients may contribute to disparities in reproductive health outcomes. Prospective community- and provider-engaged research is needed to better understand the multifactorial determinants for sexual healthcare and gender-affirming care for transmasculine patients. In particular, the impact of exogenous testosterone on the vaginal microbiome should also be determined.
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Affiliation(s)
- Hale M. Thompson
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
| | - Laura K. Rusie
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
- Division of Infectious Disease Medicine, Rush University Medical Center, Chicago, IL, United States
| | - John A. Schneider
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
- Chicago Center for HIV Elimination, Department of Infectious Disease, The University of Chicago, Chicago, IL, United States
| | - Supriya D. Mehta
- Division of Infectious Disease Medicine, Rush University Medical Center, Chicago, IL, United States
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11
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Brentnall AR, Cuschieri K, Sargent A, Berkhof J, Rebolj M. Staged design recommendations for validating relative sensitivity of self-sample human papillomavirus tests for cervical screening. J Clin Epidemiol 2024; 166:111227. [PMID: 38065518 DOI: 10.1016/j.jclinepi.2023.111227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To ensure that the emerging methods for human papillomavirus (HPV) testing on self-collected samples in cervical screening are evaluated robustly. STUDY DESIGN AND SETTING We assess paired study designs for relative sensitivity of self-collected vs. traditional clinician-collected samples in detection of high-grade cervical intraepithelial neoplasia. RESULTS Designs considered are (D1) both samples at screening, with clinical actions triggered by HPV positivity; (D2) offering a self-sample test to clinician-collected HPV-positive women; (D3) as D2 but using a repeat clinician-sample as comparator; (D4) offering a choice of self- vs. clinician-sampling, and the alternative test in HPV-positive women; (D5) paired samples at referral appointment. D1 is simple to analyze but requires the largest sample size and referral of self-sample positive, clinician-sample negative women. D2 requires a much smaller sample size, and no change to clinical practice, and could be used to rule-in a test because estimates are conservative (against self-sampling). D3 mitigates this bias but requires a second clinician sample. D4 is only manageable where self-sampling already occurs. The liberal D5 might be used to rule-out a self-sampling test. CONCLUSION A universal recommendation for an optimal study design is challenging. Staged validation might be useful with D5 as a gatekeeper for D1-D4.
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Affiliation(s)
- Adam R Brentnall
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary Universityof London, Charterhouse Square, London EC1M 6BQ, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Alexandra Sargent
- Cytology Department, Clinical Sciences Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Johannes Berkhof
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Location VUMC, Amsterdam, The Netherlands
| | - Matejka Rebolj
- Centre for Cancer Screening, Prevention and Early Detection, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK.
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12
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Hang S, Haruyama R, Uy K, Fujita N, Kimura T, Koum K, Kawana K. Feasibility, accuracy and acceptability of self-sampled human papillomavirus testing using careHPV in Cambodia: a cross-sectional study. J Gynecol Oncol 2024; 35:e6. [PMID: 37743059 PMCID: PMC10792213 DOI: 10.3802/jgo.2024.35.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE Self-sampled human papillomavirus (HPV) testing is a potential option for cervical cancer screening, but research is scarce in Cambodia. We evaluated the feasibility, accuracy, and acceptability of self-sampled HPV testing using careHPV. METHODS A cross-sectional study including women aged 20-49 years attending 2 national hospitals in the capital city was conducted. Women underwent both self-sampling and clinician-sampling of specimens, and were then asked to complete an acceptability questionnaire. The paired samples were analyzed for high-risk HPV by careHPV and genotyped by polymerase chain reaction (PCR). RESULTS A total of 375 women were eligible for inclusion. Based on PCR, 78.9% were negative for HPV in both self and clinician-samples, 9.9% had a complete HPV type match, and 6.1% had all HPV types in clinician-samples also detected in self-samples. In 5.1%, one or more HPV types identified in the clinician-samples were missed in self-samples. When using careHPV, the overall agreement between the 2 sampling methods was 95.7% (95% confidence interval [CI]=95.8-95.6) with good concordance (κ=0.66, 95% CI=0.56-0.76). Nearly 90% of the women preferred clinician-sampling over self-sampling, citing greater comfort, ease, and speed. CONCLUSION Self-sampled HPV testing using careHPV could be an option for cervical cancer screening in Cambodia; however, it requires periodic quality control of handling procedures. In addition, women's health education regarding the accuracy of self-sampled HPV testing and the importance of follow-up in cases of positive results is needed.
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Affiliation(s)
- Sovanara Hang
- Department of Obstetrics and Gynecology, National Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Rei Haruyama
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Kyna Uy
- Department of Obstetrics and Gynecology, Khmer-Soviet Friendship Hospital, Phnom Penh, Cambodia
| | - Noriko Fujita
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kanal Koum
- Cambodian Society of Gynecology and Obstetrics, Phnom Penh, Cambodia
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
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13
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Pasquier C, Raymond S, Duchanois D, Sauné K, Oliveira-Mendes K, Vayssiere C, Izopet J. Human papillomavirus testing using HPV APTIMA® assay and an external cellularity control in self-collected samples. J Med Virol 2023; 95:e29283. [PMID: 38088528 DOI: 10.1002/jmv.29283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/06/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
In cervical cancer screening programs, the detection of high-risk human papillomavirus (HR-HPV) is now widely implemented on physician-collected samples and has expanded to include self-collected samples. The use of a cellularity control (CC) is needed to reduce false-negative HPV results. An external mRNA CC for the HPV APTIMA® assay was assessed for its analytical performance and the results were compared with both cervix cytobrush samples taken by physicians and self-collected vaginal samples from 148 women. The performance of the CC was adjusted to control for the presence of cellular mRNA in the ThinPrep® and Multitest® transport media. This CC is user-friendly but implies to perform two independent assays on PANTHER® automate. Self-collected vaginal sampling gives a lower median CC results (13.2 vs. 16.9 min) but a higher risk of negative CC results (3.3 vs. 0%). The usefulness of the CC for the HR-HPV assay may be optimized by the definition of a threshold for a minimum cell number to be tested to increase confidence in HPV-negative results. The systematic use of an RNA CC increases confidence for HPV RNA assays on self-collected vaginal samples.
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Affiliation(s)
| | - Stéphanie Raymond
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | - Delphine Duchanois
- Research Unit in Obstetrics and Gynaecology (UROG), Toulouse University Hospital, Toulouse, France
| | - Karine Sauné
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | | | - Christophe Vayssiere
- Research Unit in Obstetrics and Gynaecology (UROG), Toulouse University Hospital, Toulouse, France
| | - Jacques Izopet
- Department of Virology, Toulouse University Hospital, Toulouse, France
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14
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Lee NK, Tiro JA, Odunsi K. Disparities in Gynecologic Cancers. Cancer J 2023; 29:343-353. [PMID: 37963369 DOI: 10.1097/ppo.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Gynecologic cancer disparities have different trends by cancer type and by sociodemographic/economic factors. We highlight disparities in the United States arising due to poor delivery of cancer care across the continuum from primary prevention, detection, and diagnosis through treatment and identify opportunities to eliminate/reduce disparities to achieve cancer health equity. Our review documents the persistent racial and ethnic disparities in cervical, ovarian, and uterine cancer outcomes, with Black patients experiencing the worst outcomes, and notes literature investigating social determinants of health, particularly access to care. Although timely delivery of screening and diagnostic evaluation is of paramount importance for cervical cancer, efforts for ovarian and uterine cancer need to focus on timely recognition of symptoms, diagnostic evaluation, and delivery of guideline-concordant cancer treatment, including tumor biomarker and somatic/germline genetic testing.
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15
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Chan AHY, Ngu SF, Lau LSK, Tsun OKL, Ngan HYS, Cheung ANY, Chan KKL. Evaluation of an Isothermal Amplification HPV Assay on Self-Collected Vaginal Samples as Compared to Clinician-Collected Cervical Samples. Diagnostics (Basel) 2023; 13:3297. [PMID: 37958193 PMCID: PMC10647996 DOI: 10.3390/diagnostics13213297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to evaluate the concordance of HPV results between the SentisTM HPV assay (Sentis) (BGI Group, Shenzhen, China), an isothermal amplification-based HPV assay, on self-collected and clinician-collected samples and the agreement of Sentis on self-collected samples with the BD OnclarityTM HPV assay (Onclarity) (Becton, Dickinson, and Company, Franklin Lakes, New Jersey, USA), a PCR-based HPV assay, on clinician-collected samples. This was a prospective study of 104 women attending the colposcopy clinic for abnormal smears. After informed consent, participants self-collected vaginal samples before having clinician-collected cervical samples. Self-collected samples underwent HPV testing with Sentis (Self-Sentis HPV) and clinician-collected samples were tested with Sentis (Clinician-Sentis HPV) and Onclarity (Clinician-Onclarity), which was used as a reference standard. The concordance was assessed using Cohen's kappa. The prevalence of HPV and the acceptability of self-sampling were also evaluated. The concordance rate between Self-Sentis HPV and Clinician-Sentis HPV was 89.8% with a kappa of 0.769. The concordance rate between Self-Sentis HPV and Clinician-Onclarity was 84.4% with a kappa of 0.643. The prevalence of HPV was 26.0% on Clinician-Onclarity, 29.3% on Clinician-Sentis HPV, and 35.6% on Self-Sentis HPV. Overall, 65% of participants would undergo self-sampling again. This was attributed to mainly not feeling embarrassed (68%) and being convenient (58%). Our study showed a substantial agreement between Self-Sentis HPV with Clinician-Sentis HPV and Clinician-Onclarity. Self-sampling was also shown to be a generally well-accepted method of screening.
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Affiliation(s)
- Aaron H. Y. Chan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
| | - Siew-Fei Ngu
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
| | - Lesley S. K. Lau
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
| | - Obe K. L. Tsun
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (O.K.L.T.); (A.N.Y.C.)
| | - Hextan Y. S. Ngan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
| | - Annie N. Y. Cheung
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (O.K.L.T.); (A.N.Y.C.)
| | - Karen K. L. Chan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; (A.H.Y.C.); (L.S.K.L.); (H.Y.S.N.); (K.K.L.C.)
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16
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Franco EL. The time has come to implement primary human papillomavirus screening for cervical cancer in the United States. Cancer 2023; 129:2765-2768. [PMID: 37347988 DOI: 10.1002/cncr.34899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
For the American Cancer Society (ACS), the time for primary human papillomavirus (HPV) screening implementation has unequivocally arrived for the United States, but it will require broad knowledge mobilization and addressing logistical barriers to engage the public and health providers. The ACS is using its convener role and marshalling its considerable educational and knowledge dissemination resources to advance primary HPV screening in the United States and to share best practices from countries that have done the same through the ACS Primary HPV Screening Initiative.
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Affiliation(s)
- Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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17
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Martinelli M, Giubbi C, Di Meo ML, Perdoni F, Musumeci R, Leone BE, Fruscio R, Landoni F, Cocuzza CE. Accuracy of Human Papillomavirus (HPV) Testing on Urine and Vaginal Self-Samples Compared to Clinician-Collected Cervical Sample in Women Referred to Colposcopy. Viruses 2023; 15:1889. [PMID: 37766295 PMCID: PMC10537107 DOI: 10.3390/v15091889] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
In the context of cervical cancer prevention, where human papillomavirus (HPV) infection is pivotal, HPV testing is replacing Pap Smear in primary screening. This transition offers an opportunity for integrating self-sampling to enhance coverage. We evaluated the accuracy of HPV testing using self-collected urine and vaginal samples, comparing them to physician-collected cervical swabs. From a cohort of 245 women with abnormal cytology, we collected self-sampled vaginal, urine, and clinician-administered cervical specimens. Employing Anyplex™II HPV28 assay, outcomes revealed HPV positivity rates of 75.1% (cervical), 78.4% (vaginal), and 77.1% (urine). Significant, hr-HPV detection concordance was observed between self-taken cervical samples and clinical counterparts (k = 0.898 for vaginal; k = 0.715 for urine). This study extends beyond accuracy, highlighting self-collected sample efficacy in detecting high-grade cervical lesions. The insight underscores self-sampling's role in bolstering participation and aligns with WHO's goal to eliminate cervical cancer by 2030.
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Affiliation(s)
- Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
| | - Chiara Giubbi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
| | | | - Federica Perdoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
| | - Rosario Musumeci
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
| | - Biagio Eugenio Leone
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
- IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
- IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
- IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Clementina Elvezia Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.); (F.P.); (R.M.); (B.E.L.); (R.F.); (F.L.); (C.E.C.)
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18
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Latsuzbaia A, Vanden Broeck D, Van Keer S, Weyers S, Donders G, Doyen J, Tjalma W, De Sutter P, Vorsters A, Arbyn M. Comparison of the Clinical Accuracy of Xpert HPV Assay on Vaginal Self-Samples and Cervical Clinician-Taken Samples within the VALHUDES Framework. J Mol Diagn 2023; 25:702-708. [PMID: 37354994 DOI: 10.1016/j.jmoldx.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023] Open
Abstract
The accuracy of high-risk human papillomavirus testing with the Xpert HPV assay on vaginal self-samples was compared with clinician-taken samples within the VALidation of HUman papillomavirus assays and collection DEvices for Self-samples and urine samples (VALHUDES) framework. Five-hundred and twenty-three women were recruited in five Belgian colposcopy clinics, of whom 483 (median age, 40 years; interquartile range, 31 to 49 years) were included in the main analysis (226 collected with Evalyn Brush and 257 collected with Qvintip). Cervical samples were collected with Cervex-Brush. Colposcopy and histology outcomes were considered as the reference standard. The Xpert HPV assay had similar accuracy for cervical intraepithelial neoplasia ≥2 on self-collected versus clinician-collected samples [relative sensitivity, 0.96 (95% CI, 0.91-1.02); and relative specificity, 0.96 (95% CI, 0.89-1.04)]. The relative accuracy slightly differed by vaginal collection device [sensitivity ratios of 0.98 (95% CI, 0.90-1.06) and 0.94 (95% CI, 0.87-1.02) for Evalyn and Qvintip, respectively; specificity ratios of 1.06 (95% CI, 0.95-1.19) and 0.88 (95% CI, 0.80-0.98) for Evalyn and Qvintip, respectively]. No difference in cycle threshold values was observed between vaginal and cervical samples. In conclusion, the sensitivity of Xpert HPV assay for cervical intraepithelial neoplasia ≥2 on vaginal self-samples was similar to that of cervical specimens. The clinical specificity was lower than on clinician-collected samples when self-samples were taken with Qvintip.
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Affiliation(s)
- Ardashel Latsuzbaia
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Davy Vanden Broeck
- Laboratory of Molecular Pathology, Algemeen Medisch Laboratorium Sonic Healthcare, Antwerp, Belgium; National Reference Centre for HPV, Brussels, Belgium; AMBIOR, Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium; International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Severien Van Keer
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Gilbert Donders
- Department of Obstetrics and Gynaecology of the General Regional Hospital Heilig Hart, Tienen, Belgium; Femicare vzw, Clinical Research for Women, Tienen, Belgium; Department of Obstetrics and Gynaecology, University Hospital Antwerp, Antwerp, Belgium
| | - Jean Doyen
- Department Gynaecology-Obstetrics, University Hospital Liège, Liège, Belgium
| | - Wiebren Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital, Edegem, Belgium; Molecular Imaging, Pathology, Radiotherapy, Oncology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Philippe De Sutter
- Department Gynaecology-Oncology, University Hospital Brussels, Brussels, Belgium
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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19
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Rebolj M, Sargent A, Njor SH, Cuschieri K. Widening the offer of human papillomavirus self-sampling to all women eligible for cervical screening: Make haste slowly. Int J Cancer 2023; 153:8-19. [PMID: 36385698 PMCID: PMC10952475 DOI: 10.1002/ijc.34358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/20/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
Self-collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among underscreened women and will likely form a crucial part of the WHO's strategy to eliminate cervical cancer by 2030. In high-income countries with long-standing, organised cervical screening programmes, self-collection is increasingly becoming available as a routine offer for women regardless of their screening histories, including under- and well-screened women. For these contexts, a validated microsimulation model determined that adding self-collection to clinician collection is likely to be cost-effective on the condition that it meets specific thresholds relating to (1) uptake and (2) sensitivity for the detection of high-grade cervical intraepithelial neoplasia (CIN2+). We used these thresholds to review the 'early-adopter' programme-level evidence with a mind to determine how well and how consistently they were being met. The available evidence suggested some risk to overall programme performance in the situation where low uptake among underscreened women was accompanied by a high rate of substituting clinician sampling with self-collection among well-screened women. Risk was further compounded in a situation where the slightly reduced sensitivity of self-sampling vs clinician sampling for the detection of CIN2+ was accompanied with lack of adherence to a follow-up triage test that required a clinician sample. To support real-world programmes on their pathways toward implementation and to avoid HPV self-collection being introduced as a screening measure in good faith but with counterproductive consequences, we conclude by identifying a range of mitigations and areas worthy of research prioritisation.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Alexandra Sargent
- Cytology Department, Manchester Royal InfirmaryManchester University NHS Foundation TrustManchesterUK
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Department of Public Health ProgrammesRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian ScotlandEdinburghUK
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20
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Chu D, Liu T, Yao Y. Implications of viral infections and oncogenesis in uterine cervical carcinoma etiology and pathogenesis. Front Microbiol 2023; 14:1194431. [PMID: 37293236 PMCID: PMC10244558 DOI: 10.3389/fmicb.2023.1194431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 06/10/2023] Open
Abstract
Background Uterine Cervical Carcinoma (UCC) is the most prevalent gynecological malignancy globally, with a rising incidence in recent years. Accumulating evidence indicates that specific viral infections, including human papillomavirus (HPV), Epstein-Barr virus (EBV), Hepatitis B and C viruses (HBV and HCV), and human herpesvirus (HHV), may contribute to UCC development and progression. Understanding the complex interplay between viral infections and UCC risk is crucial for developing novel preventative and therapeutic interventions. Methods This comprehensive review investigates the association between viral infections and UCC risk by examining the roles of various viral pathogens in UCC etiology and pathogenesis, and possible molecular mechanisms. Additionally, we evaluate current diagnostic methods and potential therapeutic strategies targeting viral infections for UCC prevention or treatment. Results The prevention of UCC has been significantly advanced by the emergence of self-sampling for HPV testing as a crucial tool, allowing for early detection and intervention. However, an essential challenge in UCC prevention lies in understanding how HPV and other viral coinfections, including EBV, HBV, HCV, HHV, HIV, or their concurrent presence, may potentially contribute to UCC development. The molecular mechanisms implicated in the association between viral infections and cervical cancer development include: (1) interference of viral oncogenes with cellular regulatory proteins, resulting in uncontrolled cell proliferation and malignant transformation; (2) inactivation of tumor suppressor genes by viral proteins; (3) evasion of host immune responses by viruses; (4) induction of a persistent inflammatory response, contributing to a tumor-promoting microenvironment; (5) epigenetic modifications that lead to aberrant gene expression; (6) stimulation of angiogenesis by viruses; and (7) activation of telomerase by viral proteins, leading to cellular immortalization. Additionally, viral coinfections can also enhance oncogenic potential through synergistic interactions between viral oncoproteins, employ immune evasion strategies, contribute to chronic inflammation, modulate host cellular signaling pathways, and induce epigenetic alterations, ultimately leading to cervical carcinogenesis. Conclusion Recognizing the implications of viral oncogenes in UCC etiology and pathogenesis is vital for addressing the escalating burden of UCC. Developing innovative preventative and therapeutic interventions requires a thorough understanding of the intricate relationship between viral infections and UCC risk.
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Affiliation(s)
- Daming Chu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tengteng Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuan Yao
- Department of Oncology, The People’s Hospital of Liaoning Province, Shenyang, China
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21
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Asare M, Elizondo A, Dwumfour-Poku M, Mena C, Gutierrez M, Mamudu HM. Intervention to Increase Cervical Cancer Screening Behavior among Medically Underserved Women: Effectiveness of 3R Communication Model. Healthcare (Basel) 2023; 11:healthcare11091323. [PMID: 37174865 PMCID: PMC10178119 DOI: 10.3390/healthcare11091323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Human Papillomavirus (HPV) self-sampling has the potential to increase Cervical Cancer Screening (CCS) and reduce the cervical cancer burden in Medically Underserved Women (MUW). However, interventions promoting self-sampling are limited. We examined the effectiveness of an intervention study in increasing CCS among MUW. We conducted a quasi-experimental intervention study. A face-to-face verbal approach was used to recruit MUW (n = 83, mean age 48.57 ± 11.02) living in a small city in the US. Behavioral intervention based on reframing, reprioritizing, and reforming (3R model) was used to educate the women about CCS in a group format. The women (n = 83) completed pre-and post-intervention assessments, and 10 of them were invited for follow-up interviews. The primary outcome was CCS uptake. Mixed methods analyses were conducted using a t-test for the primary outcome, PROCESS for mediation analysis, and NVivo for interview data. The majority of women (75%) completed self-testing. High-risk HPV among women was 11%, and of those, 57% followed up with physicians for care. We found that the significant increase in the women's post-intervention screening behaviors was mediated by the increase in knowledge (Indirect Effect [IE] = 0.1314; 95% CI, 0.0104, 0.4079) and attitude (IE = 0.2167; 95% CI, 0.0291, 0.6050) scores, (p < 0.001). Interview analyses offered further explanations why MUW found the intervention messages acceptable (encourages proactive behavior), feasible (simple and easy to understand), and appropriate (helpful and informative). Barriers, including lack of trust and fear of results, were identified. The findings suggest that an intervention that combines the 3R model and self-sampling may increase CCS among MUW.
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Affiliation(s)
- Matthew Asare
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Anjelica Elizondo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Mina Dwumfour-Poku
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Carlos Mena
- North American University, Stafford, TX 77477, USA
| | - Mariela Gutierrez
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Hadii M Mamudu
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
- Center for Cardiovascular Risk Research, East Tennessee State University, Johnson City, TN 37614, USA
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22
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Barger MK, Howe-Heyman A, Harris NR. Systematic Reviews to Inform Practice, May/June 2023. J Midwifery Womens Health 2023; 68:395-403. [PMID: 37212532 DOI: 10.1111/jmwh.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Mary K Barger
- Midwifery researcher and consultant, San Diego, California
| | | | - Nena R Harris
- Family Nursing, Frontier Nursing University, Fort Mill, South Carolina
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23
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Daponte N, Valasoulis G, Michail G, Magaliou I, Daponte AI, Garas A, Grivea I, Bogdanos DP, Daponte A. HPV-Based Self-Sampling in Cervical Cancer Screening: An Updated Review of the Current Evidence in the Literature. Cancers (Basel) 2023; 15:cancers15061669. [PMID: 36980555 PMCID: PMC10046242 DOI: 10.3390/cancers15061669] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Identifying and reaching women at higher risk for cervical cancer is all-important for achieving the ambitious endpoints set in 2020 by the WHO for global cervical cancer control by 2030. HPV-based (vaginal) self-sampling (SS) represents a cost-effective screening strategy, which has been successfully implemented during the last decade both in affluent and constrained settings. Among other advantages, SS strategies offer convenience, diminished costs, flexibility to obtain a sample in the office or home, avoiding a pelvic exam and uncomfortable appointment with a healthcare professional, as well as social and cultural acceptability. SS implementation has been globally boosted during the COVID-19 pandemic. In pragmatic terms, social distancing, local lockdowns, discontinuation of clinics and reallocation of human and financial resources challenged established clinician-based screening; self-collection strategies apparently surpassed most obstacles, representing a viable and flexible alternative. With time, sufficient reassuring data has accumulated regarding specially designed SS devices, aspects of sample preparation, transport and storage and, importantly, optimization of validated PCR-based HPV testing platforms for self-collected specimens. Suboptimal rates of clinical follow-up post-SS screening, as well as overtreatment with reliance solely on molecular assays, have both been documented and remain concerning. Therefore, effective strategies are still required to ensure linkage to follow-up testing and management following positive SS results by trained health professionals with knowledge of HPV biology and management algorithms. Because of the prolonged SS screening intervals, implementation data are limited regarding subsequent screening rounds of SS-screened individuals; however, these are accumulating gradually. With further refinement of assays and validation of novel biomarkers in self-collected samples, there is a clear potential for increasing SS accuracy and PPV. The potential differentiation of self-collection protocols for vaccinated versus non-vaccinated individuals also represents an open issue. In conclusion, HPV-based self-collection techniques can effectively address limited uptake alongside other conventional cervical screening drawbacks; however, assays, logistics and infrastructures need further optimization to increase the efficacy, effectiveness and cost-effectiveness of SS approaches.
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Affiliation(s)
- Nikoletta Daponte
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - George Valasoulis
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
- Hellenic National Public Health Organization-ECDC, Marousi, 15123 Athens, Greece
- Department of Midwifery, School of Health Sciences, University of Western Macedonia, 50100 Kozani, Greece
| | - Georgios Michail
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Ioulia Magaliou
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
- Department of Midwifery, School of Health Sciences, University of Western Macedonia, 50100 Kozani, Greece
| | - Athina-Ioanna Daponte
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, 54124 Thessaloniki, Greece
| | - Antonios Garas
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Ioanna Grivea
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
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24
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IPVS policy statement on HPV nucleic acid testing guidance for those utilising/considering HPV as primary precancer screening: Quality assurance and quality control issues. J Clin Virol 2023; 159:105349. [PMID: 36584621 DOI: 10.1016/j.jcv.2022.105349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
We advise that only clinically validated HPV assays which have fulfilled internationally accepted performance criteria be used for primary cervical screening. Further, assays should be demonstrated to be fit for purpose in the laboratory in which they will ultimately be performed, and quality materials manuals and frameworks will be helpful in this endeavor. Importantly, there is a fundamental shortage of well validated, low-cost, low complexity HPV tests that have demonstrated utility in a near-patient setting; representing a significant challenge and focus for future development in order to reach the WHO's goal of eliminating cervical cancer.
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25
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Martinelli M, Giubbi C, Sechi I, Bottari F, Iacobone AD, Musumeci R, Perdoni F, Muresu N, Piana A, Fruscio R, Landoni F, Cocuzza CE. Evaluation of BD Onclarity™ HPV Assay on Self-Collected Vaginal and First-Void Urine Samples as Compared to Clinician-Collected Cervical Samples: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12123075. [PMID: 36553082 PMCID: PMC9776973 DOI: 10.3390/diagnostics12123075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
The accuracy of available HPV molecular assays on self-samples needs to be evaluated as compared to clinician-collected samples. This pilot study aimed to investigate the BD Onclarity™ HPV assay on vaginal and first-void urine samples. Sixty-four women referred to colposcopy for cervical dysplasia performed a vaginal self-collection and provided a first-void urine sample, after informed consent. A cervical specimen was collected during the clinician examination. All samples were tested using BD Onclarity™ HPV assay on the BD Viper™ LT System. Overall positive agreement (OPA) between cervical and self-sample results was evaluated using Cohen's kappa value (κ). Using a clinical cut-off of 38.3 Ct for HPV 16 and 34.2 Ct for other HR genotypes, compared to cervical sample, the self-collected vaginal sample OPA was 85.9%, and κ = 0.699. Without a clinical cut-off, the OPA was 95.3%, and the κ = 0.890. Data obtained comparing cervical and urine samples showed an OPA of 87.5% with a κ = 0.79 using a clinical cut-off, and an OPA of 90.6% with a κ = 0.776 without a clinical cut-off. Data showed a substantial agreement between both self-collected and clinician-collected samples. A specific clinical cut-off analysis should be considered based on type of sample analysed.
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Affiliation(s)
- Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Giubbi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Illari Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Fabio Bottari
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Anna Daniela Iacobone
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Rosario Musumeci
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Federica Perdoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Narcisa Muresu
- Department of Humanities and Social Sciences, University of Sassari, 07100 Sassari, Italy
| | - Andrea Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan Bicocca, 20900 Monza, Italy
| | - Fabio Landoni
- Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan Bicocca, 20900 Monza, Italy
| | - Clementina Elvezia Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-02-64488358
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26
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The Influence of Vaginal HPV Self-Sampling on the Efficacy of Populational Screening for Cervical Cancer-An Umbrella Review. Cancers (Basel) 2022; 14:cancers14235913. [PMID: 36497396 PMCID: PMC9740498 DOI: 10.3390/cancers14235913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Early detection of cervical cancer is a matter of great importance as the prognosis depends on the stage of the disease. The objective of the study consisted in the assessment of the impact of HPV self-sampling on the efficacy of populational screening programs aimed at early CC detection. METHODS The analysis was performed taking into account the Cochrane Collaboration guidelines for systematic reviews. The analyzed articles were searched for in the following databases: Medline (PubMed), Embase (Ovid), and Cochrane Library. RESULTS From a total of 60 citations, 16 studies were included in this review. The HPV test is highly sensitive and specific although the diagnostic accuracy of tests carried out in self-collected samples is slightly lower than that of tests carried out in samples collected by clinicians. The results of meta-analyses for HPV tests performed on self-collected samples indicate that the sensitivity for detecting CIN2+ ranges from 74% to 86% (depending on the publication and the analyzed population), and for CIN3+ from 75% to 86%. One publication showed a clearly lower sensitivity of 42% in detecting CIN3+, but the result is for a high-risk population and comes from only 1 RCT. The specificity of the assay exceeds 80% and 79.5% with regard to the detection of CIN2+ and CIN3+, respectively. As shown by the studies included in the review, both the offering of HPV self-sampling kits to patients and the mailing of such kits significantly increase the uptake of and participation in cervical cancer screening programs. In addition, self-sampling was found to be acceptable by the female subjects. CONCLUSIONS HPV self-sampling is an innovative and cost-effective way to perform screening tests. In addition, self-sampling significantly increases the willingness to participate in screening programs among female subjects.
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27
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Brentnall AR, Rebolj M. Comments on: "Meta-analysis of agreement/concordance statistics in studies comparing self- vs clinician-collected samples for HPV testing in cervical cancer screening". Int J Cancer 2022; 151:481-483. [PMID: 35377465 DOI: 10.1002/ijc.34014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Adam R Brentnall
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Kings College London, London, UK
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28
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Sahasrabuddhe VV, Castle PE, Schiffman M, Wentzensen N, Heckman-Stoddard B, Arbyn M. Reply to: Comments on 'Meta-analysis of agreement/concordance statistics in studies comparing self- versus clinician-collected samples for HPV testing in cervical cancer screening'. Int J Cancer 2022; 151:484-487. [PMID: 35377490 DOI: 10.1002/ijc.34013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Philip E Castle
- Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, Maryland, USA.,Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
| | | | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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29
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Wielgos A, Pietrzak B, Suchonska B, Sikora M, Rudnicka L, Wielgos M. A Six-Year Gynecological Follow-Up of Immunosuppressed Women with a High-Risk Human Papillomavirus Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063531. [PMID: 35329222 PMCID: PMC8953826 DOI: 10.3390/ijerph19063531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022]
Abstract
Immunocompromised women are at an increased risk of developing malignancies, especially those that are viral-induced, such as invasive cervical cancer caused by the human papillomavirus (HPV). The aim of the study was to describe gynecological follow-up of women undergoing chronic immunosuppressive therapy for various reasons (e.g., kidney/liver transplant, systemic lupus erythematosus), diagnosed with a high-risk HPV (hrHPV) infection based on a self-sampling test. Twenty-six hrHPV-positive women were invited to take part in a gynecological follow-up, including a visual assessment of the anogenital region, two-handed gynecological examination, and cervical cytology as well as a colposcopy and cervical biopsy when necessary. Four women declined taking part in the study. Over six years of observation, low-grade squamous intraepithelial lesions (LSIL) were detected at least once in 7/22 women (31.8%), and a cervical intraepithelial lesion 1 (CIN 1) histopathologic result was obtained five times in 3/22 women. No cases of high-grade squamous intraepithelial lesions, CIN 2/3, or invasive cervical cancers were observed. Loop electrosurgical excision procedure (LEEP) was performed in three patients. As immunocompromised women are prone to persistent hrHPV infections, they should be under strict gynecological supervision because only vigilant surveillance enables fast detection and treatment of early dysplasia and, therefore, provides a chance for the reduction of the cervical cancer burden.
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Affiliation(s)
- Aleksandra Wielgos
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland;
- Correspondence:
| | - Bronisława Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
| | - Barbara Suchonska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
| | - Mariusz Sikora
- National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-006 Warsaw, Poland;
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland;
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
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