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Zhang R, Xu W, Yang S, Hu D, Bai L, Xiang R, Zhao X, Nie Y, Shi QL. Prevalence of High-Risk Human Papillomavirus Infection, Associated Risk Factors, and Relationship With Cervical Precancerous Lesions in Perimenopausal and Older Women in an Area With High Cervical Cancer Incidence in China. Cureus 2024; 16:e58081. [PMID: 38616979 PMCID: PMC11009475 DOI: 10.7759/cureus.58081] [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] [Accepted: 04/11/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose This study delves into the epidemiology of high-risk human papillomavirus (HR-HPV) infection and its link to precancerous lesions among perimenopausal (40-59 years) and elderly (60-65 years) women in a Chinese county with a notably high incidence of cervical cancer. By uniquely focusing on these age groups in underdeveloped regions, the research aims to offer novel strategies for the management and prevention of cervical cancer. It seeks to inform targeted interventions and public health policies that could significantly benefit women at heightened risk for HPV, addressing a critical gap in current prevention efforts in economically disadvantaged communities. Methods This observational study was conducted at the Maternal and Child Health and Family Planning Service Centre in Lueyang County, from September 2021 to January 2022. It assessed 2008 women aged 40-65 for HPV screening, with 342 undergoing further cytological examination. The study evaluated the prevalence of HPV infection across different age groups and risk categories. It utilized a questionnaire to collect participants' basic information, health behaviors, and other relevant data to analyze factors influencing HR-HPV infection. Statistical analyses comprised chi-square tests, trend analysis, logistic regression, and multiple imputation techniques to address missing data. Results The prevalence of HR-HPV infection among women aged 40-65 years in Lueyang County was 18.43%. Older women exhibited a higher incidence of HPV infection, abnormal ThinPrep Cytology Test (TCT) results (Shaanxi Fu'an Biotechnology Co. Ltd., Baoji City, China), and low/high-grade squamous intraepithelial lesions (LSIL/HSIL) (P<0.05). The most prevalent HR-HPV genotypes in the overall, perimenopausal, and elderly groups were HPV-52, -53, and -58; HPV-52, -53, and -16; and HPV-58, -52, and -53, respectively. The prevalent HR-HPV genotypes in the abnormal The Bethesda System (TBS) results were HPV-16, -52, -33, -58; -16, -52, -58; and-16, -33, and -52. HPV-16, -18, -33 prevalence increased with increasing lesion severity (P<0.05). In this study, factors affecting HR-HPV in the three age groups were found to be mainly related to sexual behavior and education level, including history of lower genital tract diseases, multiple pregnancies, contraceptive methods without tubal ligation, age at first marriage greater than 18 years, never washing the vulva after sex, abstinence from sex, education level of junior high school or above, and spouse's education level of high school or above. Conclusions These findings suggest that the elevated rate of abnormal TBS in the older age group may be attributed to the higher prevalence of persistent infection-prone HR-HPV genotypes (HPV-58, -52, and-53), multiple infections, and potent oncogenic HR-HPV genotypes (HPV-16 and -33). Additionally, the higher HR-HPV prevalence in older patients may be related to lower education attainment, reduced screening rate, and limited condom usage. Therefore, strategies targeting perimenopausal and older women should prioritize enhancing health awareness, increasing screening rates, and encouraging condom utilization.
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Affiliation(s)
- Ruoyi Zhang
- Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, CHN
| | - Wei Xu
- Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, CHN
| | - Siyuan Yang
- Nursing, School of Nursing, Chongqing Medical University, Chongqing, CHN
| | - Dehua Hu
- Obstetrics and Gynecology, Centre of Lueyang Maternal and Child Health Care Hospital, Shaanxi, CHN
| | - Li Bai
- Obstetrics and Gynecology, Centre of Lueyang Maternal and Child Health Care Hospital, Shaanxi, CHN
| | - Rumei Xiang
- Epidemiology and Health Statistics, College of Public Health, Chongqing Medical University, Chongqing, CHN
| | - Xiaowei Zhao
- Obstetrics and Gynecology, Centre of Lueyang Maternal and Child Health Care Hospital, Shaanxi, CHN
| | - Yuxian Nie
- Biomedical Engineering, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, CHN
| | - Qiu-Ling Shi
- Epidemiology and Health Statistics, College of Public Health, State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, CHN
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Guo Y, Peng Q, Wang Y, Li L, Yi X, Yan B, Zou M, Dai G, Guo P, Ma Q, Wu X. The Application of DNA Ploidy Analysis in Large-Scale Population Screening for Cervical Cancer. Acta Cytol 2021; 65:385-392. [PMID: 34482310 DOI: 10.1159/000518052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the application of DNA ploidy analysis in large-scale population screening for cervical cancer. METHODS From March 2016 to March 2019, eligible subjects were enrolled and recommended to undergo DNA ploidy analysis, the ThinPrep cytology test (TCT), and high-risk human papillomavirus (hrHPV) detection concurrently. Patients with positive results were recommended for colposcopy, and biopsy diagnosis was regarded as the "gold standard." We compared the test efficiencies of the 3 methods and compared the efficiency and accuracy of the TCT in our hospital and the "2-cancer screening" project in Hubei Province during the same period. RESULTS Among 20,574 women, the positive rates of DNA ploidy analysis, cytology, and hrHPV testing were 4.01%, 4.71%, and 16.28%, respectively. The sensitivities of these methods for screening for grade 2+ cervical intraepithelial neoplasia were 0.70, 0.68, and 0.96, and their specificities were 0.79, 0.82, and 0.45, respectively. On comparing DNA ploidy analysis with the TCT, there was no significant difference in the sensitivity, specificity, positive predictive value, negative predictive value, and missed diagnosis rate. In opportunistic screening and the 2-cancer screening project, the positive rates of cytology were 4.71% and 2.87%, respectively. And the efficiency and accuracy of the TCT in opportunistic screening were higher than in the 2-cancer screening project. CONCLUSION Therefore, DNA ploidy analysis, which is of low-cost and does not depend on cytopathologists, can replace cytology and be applied in large-scale population screening for cervical cancer.
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Affiliation(s)
- Yulin Guo
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Qiuzi Peng
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Ying Wang
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Lu Li
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Xiaoyun Yi
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Bin Yan
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Miao Zou
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Guohong Dai
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Peng Guo
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Quanfu Ma
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
| | - Xufeng Wu
- Department of Gynecologic Oncology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
- Cervical Cancer Control Center of Hubei Province, Wuhan, China
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Wang Z, Wang T, Yang J, Wang W, Zhang L, Su X, Wang Z, Zhang H, Song J, Lv W, Wang J, Wang C, Zhao C, Hao M. Diagnostic Yield and Performance of a Large Population-Based Cervical Cancer Screening Program in High-Risk Rural China. J Cancer 2020; 11:4000-4006. [PMID: 32328203 PMCID: PMC7171492 DOI: 10.7150/jca.41472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/27/2020] [Indexed: 12/24/2022] Open
Abstract
Primary cervical cancer screening by liquid-based cytology alone or with adjunctive HPV testing are available worldwide. However, little if any information is available about cervical cancer diagnostic yield of population-based cervical cancer screening in China. In response to it, we conducted a large prospective study on 40,000 women cervical cancer screening within six-month period in rural Shanxi Province, where has been reported as the highest cervical cancer rates in China. A standard cross-sectional survey by self-completed questionnaire was collected and followed by the liquid-based cytology screening. Follow-up biopsy with the diagnosis of cervical intraepithelial neoplasia 2 or higher lesion (CIN2+) were analyzed. Of initial 40,000 women participating in this study, 6.76% (2702/40,000) women had ASC-US or higher cytology screening results with ASC/SIL ratio at 6.14 (2381:388). Among them, 1.96% (782/40,000) women were found CIN lesions (95% CI, 1.68-2.23%) on confirmatory biopsies, including 0.55% (218/40,000) CIN2+ and 19 SCCa (47.5/100,000, 95% CI, 29-74/100,000). Women in Yangqu County had lower ASC/SIL ratio, but higher CIN2+ detection rate in comparison with that of Jiexiu County (6.69 vs. 8.84 and 56.7% vs. 43.9%), which reflects the cervical cancer distribution in different populations and regions. Analysis in age-stratified cytology results indicated women aged 60-65 years had the highest incidence of cytologic abnormality among all the age group; likewise, women aged >50 years were at higher risk in developing cervical high grade dysplasia or cancer than women aged <50 years (0.82% vs. 0.49%). This large-scale cervical cancer screening study provided important references as the instructive for establishing the nation-wide cervical cancer screening strategy.
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Affiliation(s)
- Zhilian Wang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Tiannan Wang
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center. 300 Halket St, Pittsburgh, PA, USA
| | - Jing Yang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei Wang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lili Zhang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoqiang Su
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhe Wang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Haitao Zhang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinghui Song
- Department of Obstetrics and Gynecology, Affiliated Hospital of InnerMongolia Medical University, Huhhot, China
| | - Weiguo Lv
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jintao Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Chen Wang
- Department of Pathology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center. 300 Halket St, Pittsburgh, PA, USA
| | - Min Hao
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, China
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Gu L, Hong Z, Gao H, Qiu L, Di W. Incidence of cervical high-grade squamous intraepithelial lesions and squamous cell carcinoma in women with high-risk human papillomavirus and normal cervical cytology: A retrospective analysis of 1858 cases stratified by age and human papillomavirus genotype. Cytopathology 2019; 30:419-425. [PMID: 31069857 DOI: 10.1111/cyt.12717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To retrospectively analyse the incidence of high-grade squamous intraepithelial lesions (HSILs) and squamous cell carcinoma (SCC) in women of different ages with high-risk (HR) human papillomavirus (HPV) but with normal cytology test results stratified by age and HPV genotype. METHODS In total, 1858 women with HR-HPV infection but with a normal smear who received a colposcopy and biopsy between 2015 and 2016 at our institution were included. The pathological results were retrospectively analysed after stratifying by age and HPV genotype. RESULTS Among the 1858 cases, the HSIL% in women aged 21-29 years (10.54%) was significantly different from that in women aged 40-49 years (19.85%; P < 0.05), whereas there was no significant difference in the HSIL% among women aged 21-29 years and those in the other age groups (P > 0.05). In total, 295 cases had single HPV16 infection. The HSIL% in patients with HPV16/18 infection was >15%, and the 40-49-year age group had the highest percentage at 48.48%. For other HR-HPV infections, the HSIL and SCC incidence rate was 10.41%, and there was no significant difference among the age groups; thus, women with other types of viral infections, regardless of age, should be referred to colposcopy. CONCLUSIONS Although HPV16 is the HPV with the highest risk, other HR-HPV infections can also cause a high percentage of HSILs and SCC in women with normal cytology. Therefore, it is necessary to refer HR-HPV-infected women aged ≥21 years for colposcopy in a timely manner to exclude potential cervical intraepithelial neoplasia and cervical cancer.
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Affiliation(s)
- Liying Gu
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zubei Hong
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hua Gao
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lihua Qiu
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wen Di
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,State Key Laboratory of Oncogenes and Related Genes, School of Medicine, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
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Wu T, Chen X, Zheng B, Li J, Xie F, Ding X, Zeng Z, Zhao C. Previous Papanicolaou and Hybrid Capture 2 human papillomavirus testing results of 5699 women with histologically diagnosed cervical intraepithelial neoplasia 2/3. J Am Soc Cytopathol 2019; 8:206-211. [PMID: 31272603 DOI: 10.1016/j.jasc.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Cervical cancer remains an important public health problem in Chinese women owing to the lack of a national screening program. The aim of the present study was to evaluate human papillomavirus (HPV) and Papanicolaou (Pap) test results preceding the histologic diagnosis of cervical intraepithelial neoplasia 2/3 (CIN2/3) in China's largest College of American Pathologists-certified clinical laboratory. MATERIALS AND METHODS All cases of CIN2/3 histologically diagnosed from January 2011 to August 2016 were retrieved from the pathology department records. The Pap cytology and HPV test results from the 6 months before the CIN2/3 diagnoses were analyzed. RESULTS A total of 5699 patients with histologically diagnosed CIN2/3 had previous Pap and/or HPV Hybrid Capture 2 testing results within the previous 6 months. The average age was 39.5 years (range, 16-82 years). Of these patients, 4288 had Pap test findings (average, 1.5 months) available. The results were high-grade squamous intraepithelial lesion in 44.1%, low-grade squamous intraepithelial lesion in 20.0%, atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, in 16.0%, atypical squamous cells of undetermined significance, in 12.3%, atypical glandular cells in 0.7%, and negative in 6.9%. Of the 5699 patients, 2546 had HPV Hybrid Capture 2 test results (average, 1.4 months) available. Of these, 91.7% had positive results and 8.3% had negative results. Of 1135 patients with both previous Pap and HPV results, 7.1% had negative HPV results and 8.0% had negative Pap results (P = 0.38). Only 21 patients (1.9%) had double negative results. CONCLUSIONS The present study has reported the previous results of HPV testing and Pap cytology for patients with high-grade cervical squamous precursor lesions in a population of women in China who had not undergone intensive previous screening. Both high-risk HPV and Pap cytology had similar negative testing rates for these women, although double negative results were less common. These results support the value of combined testing in the detection of cervical cancer precursors.
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Affiliation(s)
- Tao Wu
- Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China
| | - Xiangbai Chen
- Department of Pathology, Baylor Scott and White Health, College Station, Texas
| | - Baowen Zheng
- Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China
| | - Juan Li
- Department of Pathology, Jinan Maternity and Child Care Hospital, Shandong, China
| | - Fengxiang Xie
- Department of Pathology, KingMed Diagnostics, Jinan, Shandong, China
| | - Xiangdong Ding
- Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China
| | - Zhengyu Zeng
- Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China
| | - Chengquan Zhao
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Xie F, Li Z, Zhang L, Zhang H, Qi D, Zhao D, Zhang X, Wang X, Zhao C. Systemic cervical cytology training and quality control programs can improve the interpretation of Papanicolaou tests. J Am Soc Cytopathol 2018; 8:27-33. [PMID: 30929756 DOI: 10.1016/j.jasc.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is no national cervical screening program or national standards for cervical cytology quality control in China. Since 2013, systematic training and quality control programs were implemented in the Papanicolaou testing process at Jinan KingMed Diagnostics. Pathologists were required to complete 1 year of cytology study in the KingMed Diagnostics Cytology School, including 6 months of a diagnostic course and 6 months of practical training in the clinical laboratory. In this study, we compared the Papanicolaou abnormal reporting rates before and after the implementation systematic training and quality control programs. MATERIALS AND METHODS Systematic cytology training and quality control (QC) programs were implemented in 2013. Results from 997,162 cases of liquid-based cytology (LBC) and 100,066 cases of conventional Papanicolaou smears (CPS) rendered between 2008 and 2015 at Jinan KingMed Diagnostics were collected and analyzed. RESULTS After implementation of training and programs, the abnormal reporting rates of atypical squamous cells of unknown significance (ASC-US), low-grade squamous intraepithelial lesions (LSIL), atypical squamous cells cannot exclude HSIL (ASC-H), atypical glandular cells (AGC), and high-grade squamous intraepithelial lesions (HSIL) in LBC were significantly increased. Similar trends were also observed in CPS reporting, except for ASC-H, squamous cell carcinoma, and AGC, probably due to the small percentages of these categories. CONCLUSIONS The study demonstrates the importance of the formal cytology training and QC programs to ensure standardized and effective cervical cancer screening in undeveloped countries, which account for the largest percentage of the world's annual incidence of cervical cancer and with a largely unscreened population.
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Affiliation(s)
| | - Zaibo Li
- Department of Pathology, Wexner Medical Center at Ohio State University, Columbus, Ohio, USA
| | - Liran Zhang
- Jinan KingMed Diagnostics, Jinan, Shandong, China
| | - Huina Zhang
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Debo Qi
- Jinan KingMed Diagnostics, Jinan, Shandong, China
| | - Dongman Zhao
- Jinan KingMed Diagnostics, Jinan, Shandong, China
| | - Xin Zhang
- Jinan KingMed Diagnostics, Jinan, Shandong, China
| | - Xinguo Wang
- Jinan KingMed Diagnostics, Jinan, Shandong, China
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Tao X, Austin RM, Zhang H, Zhang L, Xiao J, Zhou X, Wang L, Zhao C. Histopathologic follow-up and HPV test results with HSIL Papanicolaou test results in China's largest academic women's hospital. Cancer Cytopathol 2017; 125:947-953. [PMID: 28885778 DOI: 10.1002/cncy.21914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Xiang Tao
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - R. Marshall Austin
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Hao Zhang
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Lihong Zhang
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Jianan Xiao
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Xianrong Zhou
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Li Wang
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Chengquan Zhao
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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Zheng B, Yang H, Li Z, Wei G, You J, Liang X, Zhao C. HPV test results and histological follow-up results of patients with LSIL Cervical Cytology from the Largest CAP-certified laboratory in China. J Cancer 2017; 8:2436-2441. [PMID: 28900480 PMCID: PMC5595072 DOI: 10.7150/jca.19421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/30/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Age-adjusted evaluations have explored the possible utility of (HPV test results in women with LSIL Pap. We investigated HPV test results and histopathologic follow-up results of LSIL patients from China's largest CAP-certified laboratory. METHODS Patients with LSIL between 2011 and 2015 from the Guangzhou Kingmed Diagnostics were retrospectively retrieved and their hrHPV test results and histological follow-up results were collected and analyzed. RESULTS LSIL result was identified in 37,895 cases from 2,206,588 Pap tests (1.7%) including 1,513,265 liquid-based cytology and 693,323 conventional Pap tests. The average of these women was 38.4 years (15-88). The LSIL reporting rate in women <30 years was significantly higher than that in women > 30 years (2.1% vs 1.7%). The age specific reporting LSIL rates declined with increased age. 8,014 of 37,895 (21.2%) women with LSIL cytology also had HC2 HPV test results. 75.8% of women with LSIL Pap tests were hrHPV+ and the HPV+ rates declined with increased age except in patients older than 60 years. Overall histopathologic diagnoses within 6 months after LSIL were identified in 5,987 of 37,895 patients at Guangzhou Kingmed Diagnostics. CIN2/3 was identified in 15.2% patients, CIN1 in 66.9%, negative in 14.9% patients. No invasive carcinoma was found in all patients. Of 8014 patients with LSIL Pap test and HPV testing results, 1727 patients had histological follow-up within 6 months after Pap cytology test and HPV testing. The detection rate of CIN2/3 was significantly higher in patients with positive HPV testing result than that in patients with negative HPV testing result (17.8% vs. 8.1%). Among patients with LSIL/HPV negative tests, CIN2/3 was detected in 1 of 30 (3.3%) women aged 50 years and above, appearing lower than those in women less than 50 years (8.0%, 28/351, P=0.357). CONCLUSION This is the largest histological follow-up study in women with LSIL Pap from China and the data are helpful in establishing a baseline for better understanding the status of cervical screening in China. The 85.1% positive predict value of LSIL Pap cytology for follow-up CIN lesion was within currently recognized benchmark ranges.
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Affiliation(s)
- Baowen Zheng
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Huaitao Yang
- Department of Pathology, University Cincinnati College of Medicine, Cincinnati, OH 45219, USA
| | - Zaibo Li
- Department of Pathology, Wexner Medical Center at Ohio State University, Columbus, OH 43210, USA
| | - Guijian Wei
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Jia You
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Xiaoman Liang
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Zheng B, Austin RM, Liang X, Wei G, You J, Liang Y, Zhao C. Conventional Pap smear cervical cancer screening in 11 rural counties in Hainan Province, China: analysis of Bethesda system reporting rates for 218,195 women (predominantly ages 35-64 years) screened in China's National Cervical Cancer Screening Program in Rural Areas (NCCSPRA). J Am Soc Cytopathol 2017; 6:120-125. [PMID: 31043262 DOI: 10.1016/j.jasc.2017.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Recently the Chinese government has introduced support for cervical screening in rural areas. The College of American Pathologists (CAP)-certified Guangzhou Kingmed Diagnostics laboratory supported rural screening program in Hainan Providence utilizing low-cost conventional Papanicolaou smears (CPS). STUDY DESIGN This was a retrospective study of CPS screening results from 2011 to 2014 in 11 rural counties in Hainan Province. Women, most previously unscreened, volunteered to attend free CPS screening. The targeted population was women aged 35-65 years. RESULTS Among total 218,195 conventional Papanicolaou smears, the reported abnormal rate was 4.4% of all smears, with 0.5% for high-grade squamous intraepithelial lesion (HSIL), 0.9% for low-grade squamous intraepithelial lesion (LSIL), 2.6% for atypical squamous cells of undetermined significance, and 0.3% for atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. Reporting rates for different TBS categories were generally within CAP benchmark ranges, except for low reporting rates for unsatisfactory smears and for atypical glandular cells. Abnormal cytology rates varied among counties. Comparing different age groups, the LSIL rate was significantly higher in women <50 years than in women ≥50 years (1.04% versus 0.64%). The HSIL rate was significantly higher in women ≥40 years than in women <40 years (5.3% versus 0.38%). A total of 2286 women with abnormal Papanicolaou smears had documented colposcopic and histopathologic follow-up. Cervical cancer was diagnosed in 23 of 2286 (1.01%) of screened and biopsied patients. Histopathologic HSIL results were confirmed in 80% of biopsied women with HSIL Papanicolaou tests. CONCLUSIONS CPS offered a low cost method to introduce cervical screening in rural China. The international College of American Pathologists Laboratory Accreditation Program provided laboratory quality control standards not otherwise readily available. Educational training programs have been instituted to address areas identified for quality improvement.
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Affiliation(s)
- Baowen Zheng
- Kingmed Guangzhou Diagnostics, Guangzhou, Guangdong, China
| | - R Marshall Austin
- Department of Pathology, Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xiaoman Liang
- Kingmed Guangzhou Diagnostics, Guangzhou, Guangdong, China
| | - Guijian Wei
- Kingmed Guangzhou Diagnostics, Guangzhou, Guangdong, China
| | - Jia You
- Kingmed Guangzhou Diagnostics, Guangzhou, Guangdong, China
| | - Yaoming Liang
- Kingmed Guangzhou Diagnostics, Guangzhou, Guangdong, China
| | - Chengquan Zhao
- Department of Pathology, Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Wang Z, Wang J, Fan J, Zhao W, Yang X, Wu L, Li D, Ding L, Wang W, Xu J, Stram M, Zhao C, Hao M. Risk factors for cervical intraepithelial neoplasia and cervical cancer in Chinese women: large study in Jiexiu, Shanxi Province, China. J Cancer 2017; 8:924-932. [PMID: 28529603 PMCID: PMC5436243 DOI: 10.7150/jca.17416] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/22/2016] [Indexed: 12/18/2022] Open
Abstract
We aimed to investigate the risk factors for cervical intraepithelial neoplasia (CIN) in Jiexiu, Shanxi Province, China. Twenty thousand eligible married women (age: 18-65 years) were administered with a questionnaire on potential risk factors for CIN and underwent liquid based Pap test. All women with abnormal cytological results underwent colposcopy with biopsy. Based on the biopsy pathology results, women were then assigned to either study group (with CIN) or control group (negative for histological results and volunteered to participate in the follow up study). The women in both study group and control group underwent vaginal microflora detection and dietary survey. The potential risk factors were analyzed by using ordinal logistic regression. Among the 20,000 women ne 1,438 women (7.19%) had cytologic abnormalities and 410 (2.05%) women were diagnosed histologically with CIN lesions, including 317 (1.58%) with CIN1, 93 (0.50%) with CIN2/3and 11 (55/100,000) with squamous cell carcinoma (SCC). The average daily dietary folate intake was significantly lower in the study group (344.61±153.07μg) than in the control group (371.50±166.58μg; P<0.001). Multivariate analysis demonstrated that age of 56-65 years, farming as the husband's occupation, unwashing the vulva after sexual intercourse, and low self-reported folate intake were positively associated with CIN development and might have contribution to the increased CIN incidence in this population. These findings may provide help to develop the strategies to reduce the risk of cervical cancer in China.
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Affiliation(s)
- Zhilian Wang
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jintao Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jinrong Fan
- Jiexiu Family Planning/Women and Children Health Service Center, Jinzhong, China
| | - Weihong Zhao
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lingmei Wu
- Jiexiu Family Planning/Women and Children Health Service Center, Jinzhong, China
| | - Dongyan Li
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ling Ding
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Wei Wang
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Junjie Xu
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Michelle Stram
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center. 300 Halket St, Pittsburgh, PA, 15213, USA
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center. 300 Halket St, Pittsburgh, PA, 15213, USA
| | - Min Hao
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
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11
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Latsuzbaia A, Hebette G, Fischer M, Arbyn M, Weyers S, Vielh P, Schmitt F, Mossong J. Introduction of liquid-based cytology and human papillomavirus testing in cervical cancer screening in Luxembourg. Diagn Cytopathol 2017; 45:384-390. [PMID: 28247516 DOI: 10.1002/dc.23678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2014, liquid-based cytology with HPV triage replaced conventional cytology. The aim of our study was to compare conventional and liquid-based cytology (LBC), estimate the prevalence of abnormal cervical cytology and high risk HPV (hrHPV) infection and their correlation, among screened women in Luxembourg. METHODS Between the first January 2013 and 31st December 2015, 315,868 cervical samples from 150,815 women (mean age 42.2 years) were investigated by the national cytology laboratory. Slides were prepared and screened according to European Guidelines. All cytological results were classified according to the Bethesda 2001 system terminology. RESULTS The prevalence of abnormal cervical lesions was as follows: atypical squamous cells of undetermined significance (ASC-US), 1.3%; low-grade squamous intraepithelial lesion (LSIL), 1.9%; high-grade squamous intraepithelial lesion (HSIL), 0.4%. The detection rate of cytological lesions was significantly higher with LBC than with conventional cytology. Based on 11,838 samples with concomitant cytology and HPV testing, hrHPV was detected in 9.5, 45.3, 70.0, and 92.6% of women with negative cytology, ASC-US, LSIL, and HSIL, respectively. CONCLUSION More cervical lesions were identified using LBC compared to conventional cytology. HrHPV infection was correlated with the severity of intraepithelial lesions. The current findings provide important information to evaluate the prevention of cervical cancer in Luxembourg and for monitoring the future impact of HPV vaccination. Diagn. Cytopathol. 2017;45:384-390. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ardashel Latsuzbaia
- Surveillance and Epidemiology of Infectious Diseases, Laboratoire National de Santé, Dudelange, Luxembourg.,Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Gaëtan Hebette
- Department of Medicine, Laboratoire National de Santé, Dudelange, Luxembourg
| | - Marc Fischer
- Department of Medicine, Laboratoire National de Santé, Dudelange, Luxembourg
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Philippe Vielh
- Department of Medicine, Laboratoire National de Santé, Dudelange, Luxembourg
| | - Fernando Schmitt
- Department of Medicine, Laboratoire National de Santé, Dudelange, Luxembourg
| | - Joël Mossong
- Surveillance and Epidemiology of Infectious Diseases, Laboratoire National de Santé, Dudelange, Luxembourg
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12
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Tao X, Austin RM, Zhang H, Zhang L, Xiao J, Wang L, Zhou X, Zhao C. Pap Test Reporting Rates for Conventional Smear and Liquid-Based Cervical Cytology from the Largest Academic Women's Hospital in China: Analysis of 1,248,785 Pap Test Reports. Acta Cytol 2016; 59:445-51. [PMID: 26789332 DOI: 10.1159/000443679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/28/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The Obstetrics and Gynecology Hospital of Fudan University (OGHFU) in Shanghai is the largest academic women's hospital in China. Between 2009 and 2014, the use of liquid-based cytology (LBC) significantly increased while gradually adopting the Bethesda System (TBS), and in 2012 local regulations mandated that pathologists replace technicians to sign out Pap tests. DESIGN A retrospective OGHFU database search documented all Pap test reports between 2009 and 2014 by specimen type, either LBC or conventional Pap smears (CPS), and final reporting category. A total of 1,224,785 Pap reports were analyzed to document variations in Pap test reporting during a period of major change in cervical screening in China. RESULTS LBC gradually replaced CPS, which declined from over 65% of Pap tests in 2010 to 6.4% in 2014. Of 514,811 Pap reports using the traditional class system, class I (negative) reports accounted for 98.3% of results. With the introduction of TBS reporting, pathologist reviews and substantial replacement of CPS by LBC, the laboratory abnormal Pap test rate increased significantly to almost 5%. CONCLUSIONS Changes in cervical cytology reporting between 2009 and 2014 in China's largest academic women's hospital reflected both increased use of LBC and the introduction of pathologist TBS reporting. Abnormality rates increased significantly and fell within CAP benchmark ranges.
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Affiliation(s)
- Xiang Tao
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, PR China
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