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Sláma J, Dvořák V, Trnková M, Skřivánek A, Hrabcová K, Ovesná P, Nováčková M. Is phased implementation of HPV testing and triage with dual staining the way to transform organized cytology screening? Eur J Cancer Prev 2024; 33:168-176. [PMID: 37751376 PMCID: PMC10833184 DOI: 10.1097/cej.0000000000000844] [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: 08/05/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The substantial material and legislative investments in establishing and maintaining cytological screening in the Czech Republic represent barriers to a direct transition to primary HPV screening. Therefore, the LIBUSE project was implemented to test the efficacy of phasing in HPV DNA testing as a co-test to cytology in routine screening of women >30 years of age. METHODS Women aged 30 to 60 years who underwent regular annual Pap smears were co-tested for HPV DNA with selective 16/18 genotyping at 3-year intervals. All HPV 16/18-positive cases and/or cases with a severe abnormality in cytology were sent for colposcopy; HPV non-16/18-positive cases and LSILs were graded using p16/Ki67 dual-stain cytology, and positive cases were sent for colposcopy. RESULTS Overall, 2409 patients were included. After the first combined screening (year 'zero') visit, 7.4% of women were HPV-positive and 2.0% were HPV16/18-positive; only 8 women had severe Pap smear abnormalities. Triage by dual staining was positive in 21.9% of cases (28/128). Biopsy confirmed 34 high-grade precancer lesions. At the second combined visit (year 'three'), the frequency of HPV infection (5.3% vs. 7.4%) frequency of HPV16/18 (1.1% vs. 2.0%), referrals for colposcopy (35 vs. 83), and biopsy verified high-grade lesions (5 vs. 34) were significantly lower (all P ≤ 0.001). CONCLUSION The addition of HPV DNA testing with selective genotyping of HPV16/18 to existing cytology screening significantly increased the safety of the program. The gradual introduction of HPV testing was well received by healthcare professionals and patients, and can facilitate transformation of the cytology-based screening. ClinicalTrials.gov Identifier: NCT05578833.
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Affiliation(s)
- Jiří Sláma
- Department of Obstetrics, Gynecology and Neonatology, General University Hospital, 1 Medical Faculty, Charles University, Prague
| | | | | | | | | | - Petra Ovesná
- Institute of Biostatistics and Analyses, Brno, Czech Republic
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Øvestad IT, Dalen I, Andersland MS, Vintermyr OK, Moltu P, Berland JM, Janssen EAM, Haugland HK. Triaging HPV-Positive Cervical Samples with p16 and Ki-67 Dual Stained Cytology within an Organized Screening Program-A Prospective Observational Study from Western Norway. Int J Mol Sci 2023; 24:ijms24087158. [PMID: 37108319 PMCID: PMC10138375 DOI: 10.3390/ijms24087158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
The implementation of high-risk human papillomavirus testing (hrHPV testing) as a screening method in substitute for cytology has evoked the need for more sensitive and less objective tests for the triage of HPV-positive women. In a cohort of 1763 HPV-positive women, the potential of immunocytochemical p16 and Ki-67 dual staining as compared to cytology, alone or in combination with HPV partial genotyping, was tested for triage of women attending a cervical cancer screening program. Performance was measured using sensitivity, specificity, and positive and negative predictive values. Comparisons were assessed using logistic regression models and the McNemar test. Dual staining was evaluated in a prospectively collected study cohort of 1763 HPV-screened women. For triage of CIN2+ and CIN3+, NPV and sensitivity, 91.8% and 94.2% versus 87.9% and 89.7%, respectively, were significantly higher using dual staining together with HPV 16/18 positive, as compared to cytology (p < 0.001). The specificities, however, were lower for dual staining as compared to cytology. Conclusions: Dual staining is safer for decision-making regarding HPV-positive women's need for follow-up with colposcopy and biopsy, as compared to cytology.
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Affiliation(s)
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Marie S Andersland
- Department of Pathology, Haukeland University Hospital, 5053 Bergen, Norway
| | - Olav K Vintermyr
- Department of Pathology, Haukeland University Hospital, 5053 Bergen, Norway
- Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Pia Moltu
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Jannicke M Berland
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Emilius A M Janssen
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Technology, University of Stavanger, 4021 Stavanger, Norway
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Gilbert L, Ratnam S, Jang D, Alaghehbandan R, Schell M, Needle R, Ecobichon-Morris A, Wadhawan A, Costescu D, Elit L, Wang P, Zahariadis G, Chernesky M. Comparison of CINtec PLUS cytology and cobas HPV test for triaging Canadian patients with LSIL cytology referred to colposcopy: A two-year prospective study. Cancer Biomark 2021; 34:347-358. [PMID: 35001877 PMCID: PMC9535599 DOI: 10.3233/cbm-210366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES & METHODS: CINtec PLUS and cobas HPV tests were compared for triaging patients referred to colposcopy with a history of LSIL cytology in a 2-year prospective study. Cervical specimens were tested once at enrollment, and test positivity rates determined. Test performance was ascertained with cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3 or worse (CIN3+) serving as clinical endpoints. RESULTS: In all ages, (19–76 years, n= 598), 44.3% tested CINtec PLUS positive vs. 55.4% HPV positive (p< 0.001). To detect CIN2+ (n= 99), CINtec PLUS was 81.8% sensitive vs. 93.9% for HPV testing (p= 0.009); genotype 16/18-specific sensitivity was 46.5%. Specificity was 52.9% vs. 36.6%, respectively (p< 0.001). In all ages, to detect CIN3+ (n= 44), sensitivity was 93.2% for both tests; genotype 16/18-specific sensitivity was 52.3%. Specificity was 48.4% for CINtec PLUS vs. 31.1% for HPV testing (p< 0.001). In patients < 30 years, CINtec was 91.7% sensitive vs 95.8% for HPV testing (p= 0.549). CONCLUSIONS: CINtec PLUS or cobas HPV test could serve as a predictor of CIN3+ with high sensitivity in patients referred to colposcopy with a history of LSIL regardless of age while significantly reducing the number of LSIL referral patients requiring further investigations and follow-up in colposcopy clinics.
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Affiliation(s)
- Laura Gilbert
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | - Sam Ratnam
- Faculty of Medicine, Memorial University, St. John's, Canada.,McMaster University, St. Joseph's Healthcare, Hamilton, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Dan Jang
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | | | - Miranda Schell
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Rob Needle
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | | | - Arnav Wadhawan
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | - Dustin Costescu
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Laurie Elit
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Peter Wang
- Faculty of Medicine, Memorial University, St. John's, Canada
| | - George Zahariadis
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | - Max Chernesky
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
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Abreu ÂL, Silva RA, Fernandes S. Validation of CINtec® PLUS Cytology Kit in the Diagnosis of Persistent HPV Infections - Cohort Study in the Portuguese Population. J Cytol 2021; 38:94-100. [PMID: 34321776 PMCID: PMC8280859 DOI: 10.4103/joc.joc_173_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022] Open
Abstract
Context The use of the CINtec® PLUS Cytology Kit as a complementary method of diagnosis is intended to contribute to a risk assessment of CIN II+ cervical lesions development, thus avoiding unnecessary colposcopy in negative cases. This method has proved to be effective in the follow-up of cervical lesions, although there is need for consistency in the approach of equivocal or negative cytological results, with persistent positive High-Risk Human Papillomavirus (HR-HPV) test. Aims The present study intends to retrospectively evaluate the capacity of the CINtec® to add information to the clinical practice within the screening and follow-up of cervical lesions. Additionally, this study intends to define criteria for CINtec® referral in order to maximize its utilization in the Portuguese context. Materials and Methods For this purpose, 225 cases with CINtec® PLUS Cytology Kit and histology results were used, and data were analysed and compared according to the cytology and HR-HPV molecular test results. Results The data of this study show that CINtec® PLUS Cytology Kit is a valid test for the diagnosis of persistent HPV lesions (p = 0.0005), with excellent sensitivity and reliable values of specificity. Relevant patient groups to apply the kit are in agreement with the manufacturer recommendations: women with ASC-US/LSIL result and NILM cytology with HPV-positive test, essentially over 30 years old. Conclusions Although clinical data and previous cytological information must help guiding, authors considered that CINtec® is a really valid test for the prognosis of persistent HPV infections in the female population.
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Affiliation(s)
- Ângela L Abreu
- Department of Pathological, Cytological and Thanatological Anatomy, School of Health of the Polytechnic Institute of Porto, Porto, Portugal
| | - Regina A Silva
- Department of Pathological, Cytological and Thanatological Anatomy, School of Health of the Polytechnic Institute of Porto, Porto, Portugal.,Research Centre in Health and Environment/ Centro de Investigação em Saúde e Ambiente (CISA), Porto, Portugal
| | - Sílvia Fernandes
- Department of Pathological, Cytological and Thanatological Anatomy, School of Health of the Polytechnic Institute of Porto, Porto, Portugal.,Research Centre in Health and Environment/ Centro de Investigação em Saúde e Ambiente (CISA), Porto, Portugal
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El-Zein M, Gotlieb W, Gilbert L, Hemmings R, Behr MA, Franco EL. Dual staining for p16/Ki-67 to detect high-grade cervical lesions: Results from the Screening Triage Ascertaining Intraepithelial Neoplasia by Immunostain Testing study. Int J Cancer 2020; 148:492-501. [PMID: 32781481 DOI: 10.1002/ijc.33250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Abstract
We compared clinical performance of p16/Ki-67 dual-stained cytology and human papillomavirus (HPV) genotyping, via different algorithms-alone, or in combination with cytology-to identify cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+) in women referred to as colposcopy. We included 492 cervical specimens (134 normal, 130 CIN1, 99 CIN2, 121 CIN3, 8 cancers) randomly selected from 1158 specimens with valid conventional cytology, HPV (cobas 4800 HPV test) and biopsy results. Dual-stained cytology was retrospectively performed (CINtec PLUS assay) on PreservCyt material; slides were read by a cytologist and confirmed by two pathologists, blinded to cytology, biopsy and genotyping results. Sensitivity and specificity (95% confidence intervals in parentheses) of dual-stained cytology to detect CIN2+ and CIN3+ were compared to other screening tests available for the same women. Positivity rate for dual-stained cytology increased with histological severity: 30.6% in normal, 41.5% in CIN1, 72.7% in CIN2, 86.8% in CIN3 and 87.5% in cancer. Dual-stained cytology alone had lower sensitivity than HPV testing for CIN2+ [80.7% (75.0-85.6) vs 89.9% (85.3-93.5)] and CIN3+ [86.8% (79.7-92.1) vs 92.3% (86.2-96.2)]. However, corresponding specificity values were higher [64.0% (57.9-69.8) vs 56.1% (49.8-62.1) for CIN2+; 54.0% (48.7-59.2) vs 44.4% (39.2-49.6) for CIN3+]. Combining dual-stained cytology with an ASC-US abnormality threshold decreased specificity to 31.4% (25.9-37.4) for CIN2+ and 24.2% (19.9-29.0) for CIN3+. The corresponding values considering low squamous intraepithelial lesion threshold values were 42.8% (36.8-49.0) and 35.0% (30.1-40.1). Dual-stained cytology and HPV testing exhibited similar performance, although the former improved the specificity by 7.9% and 9.6% for CIN2+ and CIN3+, respectively.
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Affiliation(s)
- Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | - Walter Gotlieb
- Division of Gynecologic Oncology and Colposcopy, McGill University-Jewish General Hospital, Montréal, Quebec, Canada
| | - Lucy Gilbert
- Gynecologic Cancer Service, McGill University Health Centre-Glen Site Cedars Cancer Centre, Montréal, Quebec, Canada
| | - Robert Hemmings
- Department of Obstetrics and Gynecology, McGill University Health Centre-St Mary's Hospital Centre, Montréal, Quebec, Canada
| | - Marcel A Behr
- Department of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
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Beiersdorf J, Scheungraber C, Wunsch K, Schmitz M, Hansel A, Hoyer H, Gajda M, Greinke C, Runnebaum IB, Dürst M, Backsch C. Combined assessment of 3q26 amplification and promoter methylation in patients with high grade cervical lesions show age specific differences. Genes Chromosomes Cancer 2019; 59:168-177. [PMID: 31631454 DOI: 10.1002/gcc.22818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
A considerable proportion of high grade cervical intraepithelial lesions (CIN2/3) are known to resolve on their own especially among young women. However, since reliable prognostic markers are still lacking, the diagnosis "CIN3" is still an indication for surgery which may result in overtreatment. It is conceivable that a combination of different, ideally independent molecular markers may provide more reliable results. In the present cross-sectional study two established triage markers, 3q26 amplification and a methylation signature, were evaluated in an age-dependent manner. The patient cohort comprised 60 patients with histologically confirmed CIN2/3 in two equally sized age groups (<30 years, ≥30 years). Cervical scrapes were analyzed by interphase fluorescence in situ hybridization for 3q26 amplification and methylation specific PCR (GynTect®) for six different genome regions. Both assays showed a significantly different pattern of test outcome independent of age (P = .001). Moreover, the combination of both assays differed significantly for double positive and double negative cases when comparing the two age groups: In patients <30 years there were clearly less cases with positive methylation signature and amplification of 3q26 as in women ≥30 years (23% vs 63%, Bonferroni adjusted P = .016). Of particular interest is the finding that double negative results were exclusive for the young age group (0% vs 27%, Bonferroni adjusted P = .020). Since regression of CIN2/3 characteristically occurs among young women it is tempting to speculate that a double negative test result could be prognostic for regression of CIN2/3. This will have to be investigated further in a prospective longitudinal intervention study.
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Affiliation(s)
- Josefine Beiersdorf
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Cornelia Scheungraber
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | | | | | | | - Heike Hoyer
- Institute of Medical Statistics, Information Sciences and Documentation, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Mieczyslaw Gajda
- Institute of Pathology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Christiane Greinke
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Matthias Dürst
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Claudia Backsch
- Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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