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Xiao X, Cao Y, Bi K, Wang W, Yang J, Wang J, Li Y, Li C, Guan R, Zhang Y, Wang J, Song S, Zhu L, Shi H. The Triaging Effect of the Human Papillomavirus 16/18 E7 Oncoprotein Assay in HPV 16/18-Positive Patients for High-Grade Cervical Intraepithelial Neoplasia Screening: A Cross-Sectional Study. J Womens Health (Larchmt) 2023; 32:1136-1141. [PMID: 37615520 DOI: 10.1089/jwh.2023.0058] [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] [Indexed: 08/25/2023] Open
Abstract
Objective: To investigate the triaging efficacy of the human papillomavirus (HPV) 16/18 E7 oncoprotein assay for high-grade cervical intraepithelial neoplasia (CIN2+) screening in HPV 16/18-positive patients in a tertiary hospital in China. Methods: We collected 476 cervical cell samples from women who tested positive for HPV 16/18 in the gynecological clinic of Peking Union Medical College Hospital between September 2018 and September 2022 and analyzed them by the HPV 16/18 E7 oncoprotein assay before colposcopy and biopsy. The study assessed the triaging efficacy of the HPV 16/18 E7 oncoprotein assay in HPV 16/18-positive patients by analyzing its performance against the gold standard of histologically confirmed CIN2+. Results: The positive rate of the HPV 16/18 E7 oncoprotein assay was 41.0% (114/278) in the negative for intraepithelial lesions and malignancy/CIN1 group and 80.3% (159/198) in the CIN2+ group. For triage of women with a positive HPV 16/18 test for CIN2+ detection, the HPV 16/18 E7 oncoprotein assay had a sensitivity, specificity, positive predictive value, and negative predictive value of 80.3%, 59.4%, 58.5%, and 80.9%, respectively. Furthermore, longitudinal follow-up of five patients showed a good correlation between the expression of the HPV 16/18 E7 oncoprotein and cervical lesion grades. Conclusions: As a triage method for HPV 16/18-positive patients, the HPV 16/18 E7 oncoprotein assay improves the specificity, reduces the colposcopy referral rate, and has the potential for long-term monitoring of high-grade CIN.
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Affiliation(s)
- Xiaoping Xiao
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Cao
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaihua Bi
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Wang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junjun Yang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinhui Wang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Li
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Caijuan Li
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruoli Guan
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Zhang
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jin Wang
- Department of Endocrinology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Shuhui Song
- Research and Development Department, FAMID Biomedical Technology (Tianjin) Co., Ltd., Tianjin, China
| | - Lan Zhu
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Honghui Shi
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Clinical Utility of ZedScan When Used as an Adjunct to Colposcopy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00540-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reich O, Pickel H. 100 years of iodine testing of the cervix: A critical review and implications for the future. Eur J Obstet Gynecol Reprod Biol 2021; 261:34-40. [PMID: 33873086 DOI: 10.1016/j.ejogrb.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aim to describe the history of iodine testing of the cervix and identify areas where further work is required. STUDY DESIGN We conducted a search of PubMed and Google Scholar. Full article texts were reviewed. Reference lists were screened for additional articles and books. 37 basic articles in journals including ones written in German and three basic articles in books were identified. RESULTS Glycogen staining of the ectocervical squamous epithelium with iodine goes back to Paul Ehrlich (1854-1915). Walter Schiller (1887-1960) examined nearly 200 different dyes and found that vital staining of the cervical squamous epithelium was best achieved with Lugol's iodine solution, which was indicated by Jean Guillaume Lugol (1786-1851) for disinfection of the vagina. In 1928 W. Lahm observed that the glycogen content of a squamous epithelium cell decreases as anaplasia increases. From the outset, H. Hinselmann included the iodine test in the minimum requirements for colposcopy. In 1946 H. J. Wespi first mentioned the finding of an "uncharacteristic iodine negative area." The first international colposcopic terminology from Graz in 1975 lists the "iodine light area" among the different colposcopy findings. The IFCPC nomenclatures from Rome 1990, Barcelona 2002, and Rio de Janeiro 2011 have evaluated the iodine test and classified their findings differently. A breakthrough to effective cervical cancer screening in resource-limited settings in Africa, India, and Latin America was achieved with R. Sankaranarayanan's publication on naked-eye visual inspection of the cervix after application of Lugol's iodine. CONCLUSIONS This paper is a step toward a better understanding of what we think and do today with iodine testing and what problems and upcoming tasks will arise in future.
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Affiliation(s)
- Olaf Reich
- Department of Obstetrics & Gynecology, Medical University of Graz, Austria.
| | - Hellmuth Pickel
- Department of Obstetrics & Gynecology, Medical University of Graz, Austria
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Tidy JA, Lyon R, Ellis K, Macdonald M, Palmer JE. The impact of age and high-risk human papillomavirus (hrHPV) status on the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women with persistent hrHPV-positive, cytology-negative screening samples: a prospective cohort study. BJOG 2020; 127:1260-1267. [PMID: 32279427 DOI: 10.1111/1471-0528.16250] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To establish the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women referred to colposcopy with persistent high-risk human papillomavirus (hrHPV) cytology-negative screening sample according to hrHPV genotype, age at referral and colposcopic performance. DESIGN Prospective cohort study. SETTING Single colposcopy clinic linked to a population-based screening programme. POPULATION Women referred with persistent hrHPV cytology-negative routine screening samples. METHODS Prospective study with descriptive statistics from a single colposcopy unit between June 2014 and July 2019. MAIN OUTCOME MEASURES Prevalence of hrHPV genotypes and CIN2+, positive predictive value for colposcopic impression, and inadequate colposcopic examinations. RESULTS A total of 3107 women were referred. Prevalence of CIN2+ was highest for persistent HPV16 infections (10.7%) compared with HPV18 (3.6%) or HPVO (4.7%). Prevalence of CIN2+ declined with age (25-34 years 14.2% to 55-64 years 1.1%) whereas the percentage of women with an inadequate colposcopic examination increased (25-34 years 0.9% to 55-64 years 29.5%). High-grade colposcopic impression fell over time during the study from 16.1 to 5.1%. The positive predictive value for colposcopic impression of CIN2+ was affected by hrHPV genotype (57.3% for HPV16 versus 32.1% for nonHPV16). The adjunctive use of electrical impedance spectroscopy detected an extra 42 cases of CIN2+, which was irrespective of hrHPV genotype. CONCLUSIONS Primary hrHPV cervical screening increases detection of CIN2+; however, low specificity results in more women being referred to colposcopy with a low prevalence of CIN2+. Colposcopy performs poorly in some groups, particularly with HPVO infections and women over 50 years of age. An appropriate threshold for referral to colposcopy in primary hrHPV screening has not been established. TWEETABLE ABSTRACT Low prevalence of CIN2+ in HPV-positive negative cytology samples. HPV genotype, age and prevalence of CIN2+ affect colposcopic performance.
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Affiliation(s)
- J A Tidy
- Department of Gynaecological Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Lyon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - K Ellis
- Department of Cytology, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - M Macdonald
- Department of Gynaecological Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J E Palmer
- Department of Gynaecological Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Brown BH, Highfield P, Tidy JA. Prognostic Value of Electrical Impedance Spectroscopy (EIS) When Used as an Adjunct to Colposcopy - A Longitudinal Study. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2020; 11:81-86. [PMID: 33584907 PMCID: PMC7851983 DOI: 10.2478/joeb-2020-0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Colposcopy can be used with Electrical Impedance Spectroscopy (EIS) as an adjunct, to assess the presence of High Grade Cervical Intra-epithelial Neoplasia (CIN2+). This analysis of longitudinal data has used the results from women with a negative colposcopy, in order to see if the initial (index) EIS results were able to predict the women who subsequently developed CIN2+. A further objective was to investigate what tissue structural changes might be reflected in the electrical impedance spectra. METHODS 847 patients were referred with low grade cytologly. EIS measurements were made around the transformation zone of the cervix during colposcopy. Every EIS spectrum was matched to a template representing CIN2+ and the result was positive if the match exceeded a probability index threshold. The colposcopic impression was also recorded. All the women who developed biopsy proven CIN2+ within three years of the index colposcopy were identified. RESULTS The median follow-up was 30.5 months. Where both CI and EIS were initially positive, there was an increased prevalence (8.13%) of CIN2+ developing as opposed to 3.45% in the remaining patients (p=0.0159). In addition, if three or more EIS spectra were positive there was a higher prevalence (9.62% as opposed to 3.56% p=0.0132) of CIN2+ at three years. The index spectra recorded from the women who developed CIN2+ showed EIS changes consistent with increases in the extracellular volume and in cell size inhomogeneity. CONCLUSION EIS does offer prognostic information on the risk of CIN2+ developing over the three-year period following the EIS measurements. The changes in EIS spectra are consistent with an increase in cell size diversity as pre-malignancy develops. These changes may be a consequence of increased genetic diversity as neoplasia develops.
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Affiliation(s)
| | | | - J. A. Tidy
- Department of Gynaecological Oncology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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Torres-Poveda K, Ruiz-Fraga I, Madrid-Marina V, Chavez M, Richardson V. High risk HPV infection prevalence and associated cofactors: a population-based study in female ISSSTE beneficiaries attending the HPV screening and early detection of cervical cancer program. BMC Cancer 2019; 19:1205. [PMID: 31823749 PMCID: PMC6905062 DOI: 10.1186/s12885-019-6388-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/21/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cervical cancer is the second cause leading of malignancy-related death among Mexican women. The present study determined the population-based prevalence of high risk Human Papillomavirus (HR-HPV) infection and associated cofactors in female beneficiaries of the Institute of Security and Social Services for State Workers (ISSSTE) attending the Program for HPV Screening and Early Detection of Cervical Cancer and registered in the Women's Cancer Detection System (SIDECAM). METHODS In a cross-sectional study, cervical samples from 115,651 female users of the program for HPV screening and early detection of cervical cancer recruited in 23 ISSSTE care centers were analyzed for HR-HPV. Logistic regression analyses, adjusting for potential confounders, were performed to determine the association of HR-HPV infection with sexual health and behavior variables and with positivity to cervical premalignant lesions by cytology. RESULTS The overall prevalence of HR-HPV infection among female ISSSTE beneficiaries in the 2013-2015 period was 13%. A bivariate analysis of relevant variables for HR-HPV infection showed a statistically significant association for age, number of sexual partners, use of hormonal contraceptives and smoking. A statistical association was found between infection by HR-HPV with the use of hormonal contraceptives, number of sexual partners and smoking and association of HPV 16 and other non-16/18 HR-HPV infection with number of lifetime sexual partners and tobacco use adjusted for age, history of hormonal contraception, number of sexual partners and tobacco use with the exception of exposition variable itself. Similarly, an association was found between HR-HPV infection, regardless of the virus genotype, with positivity to cervical premalignant lesions adjusted for age, number of lifetime sexual partners, history of hormonal contraception and tobacco use. CONCLUSIONS HR-HPV prevalence in female ISSSTE Women's Cancer Program users is similar to the population-based prevalence previously reported in Mexican women without cervical alterations. The ISSSTE robust screening and early detection program, based on cytology studies and HPV co-testing, allows us to know the prevalence of HR-HPV infection among female users of the service.
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Affiliation(s)
- K Torres-Poveda
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP), Av. Universidad 655, Santa María Ahuacatitlán, Cuernavaca, 62100, Cuernavaca, Mexico. .,CONACYT-INSP, Cuernavaca, Morelos, Mexico.
| | - I Ruiz-Fraga
- Subdirección de Prevención y Protección a la Salud, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, (ISSSTE) Cd, Mexico, Mexico
| | - V Madrid-Marina
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP), Av. Universidad 655, Santa María Ahuacatitlán, Cuernavaca, 62100, Cuernavaca, Mexico
| | - M Chavez
- Subdirección de Prevención y Protección a la Salud, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, (ISSSTE) Cd, Mexico, Mexico
| | - V Richardson
- Subdirección de Prevención y Protección a la Salud, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, (ISSSTE) Cd, Mexico, Mexico
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7
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Abstract
Zusammenfassung
Zielstellung
Das CIN2+-/CIN3+(zervikale intraepitheliale Neoplasie)-Risiko plattenepithelialer zytologischer Befunde (Gruppe II‑p, IIID1, III‑p, IIID2 der Münchner Nomenklatur [MN] III) soll bewertet und mit Empfehlungen für das Patienten-Management korreliert werden.
Material und Methoden
Alle 4321 Frauen mit einer Gruppe II‑p, IIID1, III‑p, IIID2, IVa‑p, IVb-p und V‑p von Januar 2014 bis Dezember 2016 wurden in einer Praxis für Pathologie erfasst. Zytologische Vorbefunde, alle zytologischen und histologischen Folgebefunde bis Juli 2019 wurden dokumentiert. Für die Erstbefunde wurde pro Befundgruppe mittels Kaplan-Meier-Schätzung das Risiko für CIN2+/CIN3+ ermittelt. Das Risiko bei persistierenden Befunden und der Einfluss des Alters wurden untersucht.
Ergebnisse
Für die Erstbefunde der Gruppen II‑p, IIID1, III‑p und IIID2 beträgt das Risiko für CIN2+ nach 12, 24 und 60 Monaten 1,0/3,3/11,8; 3,1/9,4/22,7; 33,4/38,4/55,5 bzw. 35,1/46,2/64,4 (%). Das Risiko für CIN3+ beträgt für die gleichen Zeiträume 0,6/2,7/9,7; 1,9/5,2/14,3; 28,8/32,4/44,0 bzw. 28,5/36,7/52,4 (%). Bei persistierenden Befunden derselben Gruppe steigt das Risiko für CIN2+ und CIN3+ signifikant vom ersten zum zweiten II-p‑, IIID1-, III-p- und IIID2-Befund. Bei den Gruppen II‑p, IIID1 und IIID2 finden sich keine signifikanten Altersunterschiede, bei III-p-Befunden ist das Risiko für Frauen <30 und <35 signifikant größer als für ältere Frauen.
Schlussfolgerung
Die MN III mit 3‑gliedriger Dysplasiegraduierung klassifiziert die zytologischen Befunde risikoorientiert. Ihre Befundgruppen eignen sich als Basis für ein risikoadaptiertes Management, um insbesondere Überdiagnostik und -therapie zu vermeiden.
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Effect of High-Risk Human Papillomavirus but Normal Cytology at Test of Cure on Achieving Colposcopy Standards. J Low Genit Tract Dis 2018; 22:110-114. [DOI: 10.1097/lgt.0000000000000373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wentzensen N, Arbyn M, Berkhof J, Bower M, Canfell K, Einstein M, Farley C, Monsonego J, Franceschi S. Eurogin 2016 Roadmap: how HPV knowledge is changing screening practice. Int J Cancer 2017; 140:2192-2200. [PMID: 28006858 DOI: 10.1002/ijc.30579] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 01/01/2023]
Abstract
Human papillomaviruses (HPVs) are the necessary cause of most cervical cancers, a large proportion of other anogenital cancers, and a subset of oropharyngeal cancers. The knowledge about HPV has led to development of novel HPV-based prevention strategies with important impact on clinical and public health practice. Two complementary reviews have been prepared following the 2015 Eurogin Conference to evaluate how knowledge about HPV is changing practice in HPV infection and disease control through vaccination and screening. This review focuses on screening for cervical and anal cancers in increasingly vaccinated populations. The introduction of HPV vaccines a decade ago has led to reductions in HPV infections and early cancer precursors in countries with wide vaccination coverage. Despite the high efficacy of HPV vaccines, cervical cancer screening will remain important for many decades. Many healthcare systems are considering switching to primary HPV screening, which has higher sensitivity for cervical precancers and allows extending screening intervals. We describe different approaches to implementing HPV-based screening efforts in different healthcare systems with a focus in high-income countries. While the population prevalence for other anogenital cancers is too low for population-based screening, anal cancer incidence is very high in HIV-infected men who have sex with men, warranting consideration of early detection approaches. We summarize the current evidence on HPV-based prevention of anal cancers and highlight important evidence gaps.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology & Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Johannes Berkhof
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Bower
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Einstein
- Department of OB/GYN & Women's Health, Rutgers New Jersey Medical School, Newark, USA
| | - Christopher Farley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Schiffman M, Doorbar J, Wentzensen N, de Sanjosé S, Fakhry C, Monk BJ, Stanley MA, Franceschi S. Carcinogenic human papillomavirus infection. Nat Rev Dis Primers 2016; 2:16086. [PMID: 27905473 DOI: 10.1038/nrdp.2016.86] [Citation(s) in RCA: 496] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infections with human papillomavirus (HPV) are common and transmitted by direct contact. Although the great majority of infections resolve within 2 years, 13 phylogenetically related, sexually transmitted HPV genotypes, notably HPV16, cause - if not controlled immunologically or by screening - virtually all cervical cancers worldwide, a large fraction of other anogenital cancers and an increasing proportion of oropharyngeal cancers. The carcinogenicity of these HPV types results primarily from the activity of the oncoproteins E6 and E7, which impair growth regulatory pathways. Persistent high-risk HPVs can transition from a productive (virion-producing) to an abortive or transforming infection, after which cancer can result after typically slow accumulation of host genetic mutations. However, which precancerous lesions progress and which do not is unclear; the majority of screening-detected precancers are treated, leading to overtreatment. The discovery of HPV as a carcinogen led to the development of effective preventive vaccines and sensitive HPV DNA and RNA tests. Together, vaccination programmes (the ultimate long-term preventive strategy) and screening using HPV tests could dramatically alter the landscape of HPV-related cancers. HPV testing will probably replace cytology-based cervical screening owing to greater reassurance when the test is negative. However, the effective implementation of HPV vaccination and screening globally remains a challenge.
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Affiliation(s)
- Mark Schiffman
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Room 6E544, 9609 Medical Center Drive, Rockville, Maryland 20850, USA
| | - John Doorbar
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Nicolas Wentzensen
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Room 6E544, 9609 Medical Center Drive, Rockville, Maryland 20850, USA
| | - Silvia de Sanjosé
- Catalan Institute of Oncology, IDIBELL, Cancer Epidemiology Research Programme and CIBER Epidemiologia Y Salud Publica, Barcelona, Spain
| | - Carole Fakhry
- Department of Otolaryngology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Bradley J Monk
- Division of Gynecologic Oncology, US Oncology Network, University of Arizona-Phoenix, Phoenix, Arizona, USA
| | | | - Silvia Franceschi
- International Agency for Research on Cancer, Infections and Cancer Epidemiology Group, Lyon, France
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Cuzick J, Ahmad AS, Austin J, Cadman L, Ho L, Terry G, Kleeman M, Ashdown-Barr L, Lyons D, Stoler M, Szarewski A. A comparison of different human papillomavirus tests in PreservCyt versus SurePath in a referral population-PREDICTORS 4. J Clin Virol 2016; 82:145-151. [PMID: 27498250 PMCID: PMC4994427 DOI: 10.1016/j.jcv.2016.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Two transport media, PreservCyt and SurePath, are widely used for cervical cytology screening. There are concerns that they may perform differently for HPV testing. OBJECTIVES A comparison of the performance of six different HPV tests in SurePath and PreservCyt in a referral population using two samples from each woman. The primary goal was to compare the performance of each test in the two media. Comparisons between assays and viral load comparisons between media were secondary aims. STUDY DESIGN Two cervical samples were collected in random order at the same visit in women with abnormal cytology. One sample was placed in 20ml of PreservCyt and the other in 10ml of SurePath. Aliquots were taken for 4 DNA based tests: digene HC2 High-Risk HPV DNA Test, Abbott Realtime, BD Onclarity and Genera PapType, an RNA based test-: Hologic Aptima and a protein test: OncoHealth. RESULTS 630 sample pairs were included in the analyses. For all tests except the protein test sensitivities were in excess of 90% for CIN2+ and 95% for CIN3+ for both media and with no significant differences except for a lower sensitivity for CIN2+ of Aptima in SurePath (93% vs 98%, P=0.005). Specificity for CONCLUSIONS We found similar sensitivity for CIN3+ in PreservCyt and SurePath for 5 nucleic acid tests in the two media in a referral population, but signal strength and positivity rates were lower in SurePath except for the Onclarity test. These results need to be replicated in a screening population.
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Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - Amar S Ahmad
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Janet Austin
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Louise Cadman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Linda Ho
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - George Terry
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Michelle Kleeman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Lesley Ashdown-Barr
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Deirdre Lyons
- Department of Colposcopy, St Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Mark Stoler
- Department of Pathology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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Abstract
BACKGROUND Persistent infections with human papillomaviruses are a necessary cause of cervical carcinomas. The development of HPV-based prevention tools, HPV vaccination and HPV testing, is leading to major changes in cervical cancer prevention programs worldwide. A decade after introduction of HPV vaccination in many countries reductions of HPV infections and cancer precursors have been observed in young women. The focus is now on the integration of new approaches for screening of increasingly vaccinated populations. RESULTS AND CONCLUSIONS A successful cervical cancer prevention program includes primary screening, triage of screen-positives, and colposcopy-biopsy to identify women with cancer precursors who require treatment. The role of primary screening is to identify a small subset of women with increased risk of cervical precancer, while the majority of women can be reassured that their risk is very low. Depending on the primary screening test, additional triage testing is required to decide who should be referred to colposcopy. Currently, there are three major approaches to cervical cancer screening: Cervical cytology, HPV testing, and HPV-cytology co-testing. Several triage tests for HPV-positive women are currently being evaluated, including cytology, HPV genotyping, p16/Ki-67 cytology and various methylation tests. Due to the increasing number of options for cervical cancer screening, it is challenging to keep screening guidelines current and comprehensible. The increasing complexity can lead to confusion among providers and women who participate in screening programs about the best approaches. Precision prevention is a novel approach to cervical cancer screening that integrates individual medical history with test results for unified, risk-based management decisions.
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Schneider A, Rakozy C, Stolte C, Bothur-Schäfer P, Rothe H, Welcker T, Choly N, Roesgen A, Böhmer G. Correlation between VITOM® videocolposcopy and histopathology for pathognomonic grading criteria. Arch Gynecol Obstet 2015; 292:1361-6. [DOI: 10.1007/s00404-015-3798-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/16/2015] [Indexed: 11/28/2022]
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Schiffman M, Wentzensen N. Issues in optimising and standardising the accuracy and utility of the colposcopic examination in the HPV era. Ecancermedicalscience 2015; 9:530. [PMID: 25987899 PMCID: PMC4431398 DOI: 10.3332/ecancer.2015.530] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Indexed: 01/27/2023] Open
Abstract
For this tribute to Mario Sideri, we reviewed some of the current issues in colposcopy, many of which we were researching with him. The review concentrates on the impact of HPV testing on cervical screening, specifically on the practice of colposcopy as the major diagnostic procedure in cervical screening programmes. Topics include the changing population of women referred to colposcopy, evolving views of the colposcopic impression, differing approaches to directed and random biopsy, issues in teaching colposcopy using static images, and the development of colposcopy aids, and simplified visual assessment techniques.
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Affiliation(s)
- Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, USA 9609 Medical Center Drive, Rockville, MD 20850
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, USA 9609 Medical Center Drive, Rockville, MD 20850
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Song Y, Zhao YQ, Zhang X, Liu XY, Li L, Pan QJ, Shen GH, Zhao FH, Chen F, Chen W, Qiao YL. Random biopsy in colposcopy-negative quadrant is not effective in women with positive colposcopy in practice. Cancer Epidemiol 2015; 39:237-41. [PMID: 25684646 DOI: 10.1016/j.canep.2015.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/07/2015] [Accepted: 01/11/2015] [Indexed: 10/24/2022]
Abstract
AIM To assess the efficacy of random biopsy in diagnosing those high-grade squamous intraepithelial lesions or carcinomas (HSIL+) missed by colposcopy-directed biopsy, and to identify the scenarios of cervical cancer screening when random biopsy is necessary. PATIENTS/INTERVENTIONS Data from 1997 women who participated in the Shanxi Province Cervical Cancer Screening Study I (SPOCCS I) were reviewed. Each woman received human papillomavirus (HPV) testing with the second-generation hybrid capture, liquid-based cytology, four-quadrant biopsy and endocervical curettage. The final diagnosis was based on the most severe pathological result obtained. The efficacy of random biopsy and colposcopy-directed biopsy was evaluated on the basis of the final pathological results. RESULTS For women with severe cytological abnormalities (HSIL+) and negative colposcopy, the yield of HSIL+ diagnosed by random biopsy was 25%. On the other hand, the yield of HSIL+ diagnosed by random biopsies in the negative quadrant was no more than 4% when the colposcopy was positive, regardless of the cytological findings. For women with negative HPV, no HSIL+ was found by random biopsy. For women with severe cytological abnormalities (HSIL+) and positive HPV, the yield of HSIL+ diagnosed by random biopsy was 35% when colposcopy was negative. For women with low-grade intraepithelial lesion (LSIL) and positive HPV, the yield of HSIL+ diagnosed by random biopsy was 12.5% when colposcopy was negative. CONCLUSION Random biopsy is not effective in the negative quadrant in women with positive colposcopy, but should be performed in women with cytological HSIL+ but negative colposcopy, or in those with cytological LSIL or HGSL+ and positive HPV but negative colposcopy.
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Affiliation(s)
- Yan Song
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu-Qian Zhao
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xun Zhang
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Xiao-Yang Liu
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ling Li
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qin-Jing Pan
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gui-Hua Shen
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng Chen
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen Chen
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Wentzensen N, Walker JL, Gold MA, Smith KM, Zuna RE, Mathews C, Dunn ST, Zhang R, Moxley K, Bishop E, Tenney M, Nugent E, Graubard BI, Wacholder S, Schiffman M. Multiple biopsies and detection of cervical cancer precursors at colposcopy. J Clin Oncol 2014; 33:83-9. [PMID: 25422481 DOI: 10.1200/jco.2014.55.9948] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Women with abnormal cervical cancer screening results are referred to colposcopy and biopsy for diagnosis of cervical cancer precursors (high-grade squamous intraepithelial lesions [HSILs]). Colposcopy with a single biopsy can miss identification of HSILs. No systematic study has quantified the improved detection of HSIL by taking multiple lesion-directed biopsies. METHODS The Biopsy Study was an observational study of 690 women referred to colposcopy after abnormal cervical cancer screening results. Up to four directed biopsies were taken from distinct acetowhite lesions and ranked by colposcopic impression. A nondirected biopsy of a normal-appearing area was added if fewer than four directed biopsies were taken. HSIL identified by any biopsy was the reference standard of disease used to evaluate the incremental yield and sensitivity of multiple biopsies. RESULTS In the overall population, sensitivities for detecting HSIL increased from 60.6% (95% CI, 54.8% to 66.6%) from a single biopsy to 85.6% (95% CI, 80.3% to 90.2%) after two biopsies and to 95.6% (95% CI, 91.3% to 99.2%) after three biopsies. A significant increase in sensitivity of multiple biopsies was observed in all subgroups. The highest increase in yield of HSIL was observed for women with a high-grade colposcopic impression, HSIL cytology, and human papillomavirus (HPV) type 16 positivity. Only 2% of all HSILs diagnosed in the participants were detected by biopsies of normal-appearing transformation zone. CONCLUSION Collection of additional lesion-directed biopsies during colposcopy increased detection of histologic HSIL, regardless of patient characteristics. Taking additional biopsies when multiple lesions are present should become the standard practice of colposcopic biopsy.
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Affiliation(s)
- Nicolas Wentzensen
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK.
| | - Joan L Walker
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Michael A Gold
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Katie M Smith
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Rosemary E Zuna
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Cara Mathews
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - S Terence Dunn
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Roy Zhang
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Katherine Moxley
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Erin Bishop
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Meaghan Tenney
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Elizabeth Nugent
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Barry I Graubard
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Sholom Wacholder
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Mark Schiffman
- Nicolas Wentzensen, Barry I. Graubard, Sholom Wacholder, and Mark Schiffman, National Cancer Institute, Bethesda, MD; Joan L. Walker, Katie M. Smith, Rosemary E. Zuna, Cara Mathews, S. Terence Dunn, Roy Zhang, Katherine Moxley, Erin Bishop, Meaghan Tenney, and Elizabeth Nugent, University of Oklahoma Health Sciences Center, Oklahoma City; and Michael A. Gold, Tulsa Cancer Institute and University of Oklahoma School of Community Medicine, Tulsa, OK
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The increased detection of cervical intraepithelial neoplasia when using a second biopsy at colposcopy. Gynecol Oncol 2014; 135:201-7. [DOI: 10.1016/j.ygyno.2014.08.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/19/2014] [Accepted: 08/28/2014] [Indexed: 11/22/2022]
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Mesci-Haftaci S, Ankarali H, Caglar M, Yavuzcan A. Reliability of colposcopy in Turkey: correlation with Pap smear and 1-year follow up. Asian Pac J Cancer Prev 2014; 15:7317-20. [PMID: 25227835 DOI: 10.7314/apjcp.2014.15.17.7317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A cytologic reading of a Papanicolaou (pap) smear followed, if the result is positive, by a colposcopic search for abnormal cells is the most common screening method for cervical cancer used worldwide. We aimed to present the correlation of smear and colposcopic findings with 6- to 12-month follow-up results and related factors in women who underwent colposcopy in Turkey. MATERIALS AND METHODS The study population consisted of women who attended the gynecology department and were referred for colposcopic evaluation in 2011-2012. A total of 232 women between ages 17 and 68 years were included. Colposcopy indications were ASCUS and higher lesions at cervical smear, macroscopic suspicious lesions, post-coital bleeding history with suspicious smear, and repeated cervical inflammation. All patients were recalled for 6- to 12-month follow-ups. RESULTS The most common colposcopy indication was ASCUS, and the most common biopsy result was inflammation. Nearly half of the patients returned for the control 6-month follow-up, and almost 20% of patients for a 1-year follow up. CONCLUSIONS Colposcopic biopsy is an effective method in indicated patients but is not sufficient in itself if awareness of the subject is not raised in the population. One of the most important aims of cancer screening programs should be enabling patients in developing countries to take responsibility. Patients must be encouraged to apply to the hospital for better disease control.
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Stewart Massad L, D'Souza G, Darragh TM, Minkoff H, Wright R, Kassaye S, Sanchez-Keeland L, Evans CT. Accuracy of colposcopy in HIV seropositive and seronegative women with abnormal Pap tests. Gynecol Oncol 2014; 135:481-6. [PMID: 25127986 DOI: 10.1016/j.ygyno.2014.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/28/2014] [Accepted: 08/04/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study is to compare colposcopic findings and the accuracy of colposcopic impression in HIV seropositive and seronegative women with abnormal Pap tests. METHODS HIV seropositive and seronegative women in a national cohort study had Pap tests collected every six months, with colposcopy for any abnormal result. Prospectively collected colposcopy and histology findings were analyzed retrospectively using Pearson Chi-square, t-test and Wilcoxon two-sample tests, logistic regression models, and Kappa coefficients. RESULTS After adjusting for age and Pap result, 1618 eligible HIV seropositive women were more likely than 406 seronegative women to have inadequate colposcopic examinations, abnormal colposcopic findings, and large cervical lesions. However, among those with abnormal colposcopy, colposcopic characteristics and lesion size and number did not differ by HIV serostatus. Agreement between colposcopists' impressions and highest grade biopsy diagnoses was fair (kappa coefficient 0.35, 95% C.I. 0.31, 0.38). Agreement did not differ by HIV serostatus and did not improve with multiple biopsies (weighted kappa coefficient 0.35, 95% C.I. 0.32, 0.39) or after including all histology results over two years following colposcopy. CONCLUSION Although HIV seropositive women with abnormal cytology are more likely to have colposcopic abnormality, the performance of colposcopy appears to be similar to that in HIV seronegative women. Biopsy is required to confirm colposcopic impression.
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Affiliation(s)
- L Stewart Massad
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
| | | | - Teresa M Darragh
- Department of Pathology and Obstetrics, University of California, San Francisco, CA, USA; Department of Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Rodney Wright
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Seble Kassaye
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC, USA
| | | | - Charlesnika T Evans
- Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, IL, USA; Department of Veterans Affairs Center of Innovation for Complex Chronic Healthcare, Edward Hines J. VA Hospital, Hines, IL, USA
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Cotton SC, Sharp L, Little J, Gray NM, Walker LG, Whynes DK, Cruickshank ME. A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology. Cytopathology 2014; 26:178-87. [DOI: 10.1111/cyt.12173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- S. C. Cotton
- Obstetrics & Gynaecology; University of Aberdeen; Foresterhill Aberdeen UK
| | - L. Sharp
- National Cancer Registry Ireland; Cork Ireland
| | - J. Little
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON Canada
| | - N. M. Gray
- Centre of Academic Primary Care; University of Aberdeen; Foresterhill Aberdeen UK
| | | | - D. K. Whynes
- School of Economics; University of Nottingham; Nottingham UK
| | - M. E. Cruickshank
- Obstetrics & Gynaecology; University of Aberdeen; Foresterhill Aberdeen UK
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Management of borderline change in endocervical cells: a more dependable approach. Br J Cancer 2014; 111:851-7. [PMID: 24967874 PMCID: PMC4150265 DOI: 10.1038/bjc.2014.340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/18/2014] [Accepted: 05/26/2014] [Indexed: 11/13/2022] Open
Abstract
Background: There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs). The objective of this study is to determine the clinical outcome of women with BNCs, to determine the accuracy of colposcopy and propose a more robust management algorithm. Methods: This is a retrospective review of all BNC referrals between January 2006 and December 2011 at the Northumbria Healthcare Trust. Histological diagnosis was based on high-grade histology (CIN 2 or worse). Any high-grade histology in the first year of follow-up was included in the final diagnosis. Results: Of the 9001 new referrals, 167 women had BNCs. Thirty-seven (22%) were diagnosed with high-grade histology on initial assessment. Sixty women had satisfactory and negative colposcopy, out of which 7 (12%) were detected with high-grade histology/cytology in the first year of follow-up. Overall, 50 high-grade histology (30%), including two invasive carcinomas were detected. Conclusions: Current follow-up of BNCs relies heavily on colposcopic assessment. A significant proportion of women with negative colposcopy was found to have high-grade histology in the first year of follow-up. We propose a more robust management algorithm to lower the probability of missed high-grade histology in this subgroup of women.
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Wilson L, Pawlita M, Castle PE, Waterboer T, Sahasrabuddhe V, Gravitt PE, Schiffman M, Wentzensen N. Seroprevalence of 8 oncogenic human papillomavirus genotypes and acquired immunity against reinfection. J Infect Dis 2014; 210:448-55. [PMID: 24569064 DOI: 10.1093/infdis/jiu104] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Natural human papillomavirus (HPV) antibody titers have shown protection against subsequent HPV infection, but previous studies were restricted to few HPV genotypes. We examined the association of naturally occurring antibodies against 8 carcinogenic HPV types with subsequent infections. METHODS A total of 2302 women enrolled in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study provided blood samples at baseline. Serum samples were tested for antibodies against 8 carcinogenic HPV genotypes (16, 18, 31, 33, 35, 45, 52, and 58) using a multiplex serology assay. We analyzed the relationship between HPV antibodies and HPV infection during 2 years of follow-up among women negative for the specific HPV type at baseline. RESULTS Baseline seroprevalence for HPV16 L1 was associated with decreased risk of DNA positivity for HPV16 (odds ratio, 0.39 [95% confidence interval, .18-.86]) at ≥2 follow-up visits. We observed similar but nonsignificant decreased risks for HPV18 and 31. These findings were restricted to women reporting a new sex partner during follow-up. There was no association between baseline seroprevalence and detection of precancer during follow-up. CONCLUSIONS Seroprevalence conferred protection against subsequent HPV infection for HPV16 and indicated possible protection for 2 other genotypes, suggesting that this effect is common to several HPV genotypes.
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Affiliation(s)
- Lauren Wilson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina
| | | | | | | | - Vikrant Sahasrabuddhe
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda
| | - Patti E Gravitt
- Department of Epidemiology Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, Maryland
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda
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Smith JHF. ABC3 Part I: a review of the guidelines for terminology, classification and management of cervical cytology in England. Cytopathology 2013; 23:353-9. [PMID: 23173804 DOI: 10.1111/cyt.12031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The provision of guidance on cytology reporting and evaluation, first outlined in 1995 with the publication of Achievable Standards, Benchmarks for Reporting, and Criteria for Evaluating Cervical Cytopathology (ABC), and subsequently revised and expanded in a second edition in 2000, has been pivotal to the success of the National Health Service Cervical Screening Programme (NHSCSP), ensuring that standards are upheld, and that rigorous evaluation and quality assurance take place. In the last decade, major changes to the NHSCSP, notably the adoption of revised age ranges and screening intervals for all women in England, implementation of liquid-based cytology and, most recently, the decision to introduce high-risk human papillomavirus (HR-HPV) testing for triage of low-grade and borderline (equivalent to 'atypical') cytological abnormalities and test of cure after treatment of cervical intraepithelial neoplasia (CIN) determined that an updated version of ABC was required. The third edition of ABC recommends adoption, with minor modification, of the revised British Society for Clinical Cytology terminology and provides guidance on the management of abnormal cytology results linked to this terminology taking account of HR-HPV testing. To accommodate these changes, expanded result codes, which are electronic codes used to transfer management information to central computers for follow-up, call and recall of individual women, have been developed. Further guidance on specimen adequacy is also provided. Revised performance indicators are described and explained in a separate article by R. Blanks in this issue of Cytopathology. All the changes in ABC3 are designed to support the mission statement of the NHSCSP that 'the objective of cervical screening is to reduce cervical cancer incidence and mortality by screening with a high sensitivity for the detection of CIN2 or worse, whilst maintaining a high specificity'.
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Affiliation(s)
- J H F Smith
- Department of Histopathology and Cytology, Royal Hallamshire Hospital, Sheffield, UK.
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Tidy JA, Brown BH, Healey TJ, Daayana S, Martin M, Prendiville W, Kitchener HC. Accuracy of detection of high-grade cervical intraepithelial neoplasia using electrical impedance spectroscopy with colposcopy. BJOG 2013; 120:400-10; discussion 410-1. [PMID: 23289897 PMCID: PMC3597993 DOI: 10.1111/1471-0528.12096] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 11/27/2022]
Abstract
Objective To determine if electrical impedance spectroscopy (EIS) improves the diagnostic accuracy of colposcopy when used as an adjunct. Design Prospective, comparative, multi-centre clinical study. Setting Three colposcopy clinics: two in England and one in Ireland. Population Women referred with abnormal cytology. Methods In phase 1, EIS was assessed against colposcopic impression and histopathology of the biopsies taken. In phase 2, a probability index and cut-off value for the detection of high-grade cervical intraepithelial neoplasia (HG–CIN, i.e. grade CIN2+) was derived to indicate sites for biopsy. EIS data collection and analyses were performed in real time and blinded to the clinician. The phase-2 data were analysed using different cut-off values to assess performance of EIS as an adjunct. Main outcome measure Histologically confirmed HG–CIN (CIN2+). Results A total of 474 women were recruited: 214 were eligible for analysis in phase 1, and 215 were eligible in phase 2. The average age was 33.2 years (median age 30.3 years, range 20–64 years) and 48.5% (208/429) had high-grade cytology. Using the cut-off from phase 1 the accuracy of colposcopic impression to detect HG–CIN when using EIS as an adjunct at the time of examination improved the positive predictive value (PPV) from 78.1% (95% CI 67.5–86.4) to 91.5%. Specificity was also increased from 83.5% (95% CI 75.2–89.9) to 95.4%, but sensitivity was significantly reduced from 73.6% (95% CI 63.0–82.5) to 62.1%, and the negative predictive value (NPV) was unchanged. The positive likelihood ratio for colposcopic impression alone was 4.46. This increased to 13.5 when EIS was used as an adjunct. The overall accuracy of colposcopy when used with EIS as an adjunct was assessed by varying the cut-off applied to a combined test index. Using a cut-off set to give the same sensitivity as colposcopy in phase 2, EIS increased the PPV to detect HG–CIN from 53.5% (95% CI 45.0–61.8) to 67%, and specificity increased from 38.5% (95% CI 29.4–48.3) to 65.1%. NPV was not significantly increased. Alternatively, applying a cut-off to give the same specificity as colposcopy alone increased EIS sensitivity from 88.5% (95% CI 79.9–94.4) to 96.6%, and NPV from 80.8% (95% CI 67.5–90.4) to 93.3%. PPV was not significantly increased. The receiver operator characteristic (ROC) to detect HG–CIN had an area under the curve (AUC) of 0.887 (95% CI 0.840–0.934). Conclusions EIS used as an adjunct to colposcopy improves colposcopic performance. The addition of EIS could lead to more appropriate patient management with lower intervention rates.
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Affiliation(s)
- J A Tidy
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, UK.
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Anderson L, O'Rorke M, Jamison J, Wilson R, Gavin A. Prevalence of human papillomavirus in women attending cervical screening in the UK and Ireland: New data from northern Ireland and a systematic review and meta-analysis. J Med Virol 2012; 85:295-308. [DOI: 10.1002/jmv.23459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 11/09/2022]
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Bowring J, Albrow R, Fisher A, Downey G, Cullimore J, Patnick J, Walker PG, Kitchener HC. A prospective study of human papillomavirus (HPV) testing to resolve uncertainty in colposcopy. Cytopathology 2012; 24:309-13. [PMID: 22925374 DOI: 10.1111/j.1365-2303.2012.01003.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE UK colposcopy services are seeing increased workloads, a large proportion of which are follow-up appointments. The English Cervical Screening Programme HPV Special Interest Group identified five subcategories of colposcopy clinic patients who often require prolonged follow-up regimes for low-grade abnormalities. Human papillomavirus (HPV) testing has a high negative predictive value, meaning that HPV-negative women are at very low risk of underlying disease. Our objectives were to quantify the number of HPV-negative women in each study subcategory and to evaluate the number who could potentially be discharged from colposcopy on the basis of their results. METHODS Four colposcopy clinics prospectively identified women according to five categories over 12 months. All women underwent cytological testing and high-risk HPV (hrHPV) testing using the Hybrid Capture 2 test. Management outcomes and decisions based on a knowledge of the HPV status were recorded. RESULTS Data available on 755 women showed that 422/755 (55.9%) and 260/755 (34.4%) had persistent cervical intraepithelial neoplasia grade 1 (CIN1) (Category 1) or a minor abnormality following treatment (Category 2), respectively. In Categories 1 and 2, 51.7% and 60.2%, respectively, were hrHPV negative. The rates with biopsies of CIN2 or worse (CIN2+) across the two categories were 3/355 (0.8%) and 21/291 (7.0%) for hrHPV-negative and hrHPV-positive women, respectively. CONCLUSION The incorporation of hrHPV testing within organized cervical screening programmes has been widely accepted. hrHPV testing for the clinical scenarios outlined in this study detects women who are hrHPV negative and therefore at low risk of underlying disease, potentially reducing anxiety and inconvenience for women and costs to colposcopy services.
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Affiliation(s)
- J Bowring
- Department of Gynaecology, Chelsea and Westminster Hospital, Fulham Road, London, UK School of Cancer and Enabling Sciences, University of Manchester, Manchester, UK Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, UK Department of Gynaecology, Birmingham City Hospital, Birmingham, UK Department of Gynaecology, Great Western Hospital, Swindon, UK NHS Cancer Screening Programmes, Sheffield, UK Department of Gynaecology, Royal Free Hospital, London, UK
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