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Impact of variations in triage cytology interpretation on human papillomavirus-based cervical screening and implications for screening algorithms.
Impact of variations in triage cytology interpretation on human papillomavirus-based cervical screening and implications for screening algorithms.
- Source :
-
European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2016 Nov; Vol. 68, pp. 148-155. Date of Electronic Publication: 2016 Oct 15. - Publication Year :
- 2016
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Abstract
- Background: Women positive to human papillomavirus (HPV+) testing at cervical screening need triage, typically cytology and immediate colposcopy in case of atypical squamous cells of undetermined significance (ASCUS) or worse (ASCUS+) or, in cytology-normal HPV+ women, HPV test repeat after 1 year and colposcopy referral if still HPV+. Our hypothesis was that substantial variations in triage positivity and sensitivity may produce little variation in overall referral to colposcopy and on sensitivity of the entire screening process.<br />Methods: Centre- and age-aggregated data from 72,869 women aged 35-64 years were derived from 10 organised screening programmes which have piloted HPV screening in Italy since 2012. Overall colposcopy referral was evaluated as a function of immediate colposcopy referral and overall CIN2+ detection as a function of the proportion of all CIN2+ detected by immediate referral (a proxy of cytology's sensitivity). We fitted additive regression models, adjusted for centre, age, compliance to HPV retesting and to colposcopy, by generalised estimation equations.<br />Results: The proportion of HPV+ women directly referred to colposcopy varied across programmes (20-57%; average 37%) and so did CIN2+ detection (49-94%; average 77%). Overall, 63% (range 41-75%) of HPV+ were referred to colposcopy either immediately or at HPV repeat. An absolute 10% increase in immediate colposcopy referral resulted in 4.2% (95% CI: 3.3-5.1%) increase in overall referral. An absolute 10% increase in cytology's sensitivity resulted in a 1.1% (95% CI: 0.1-2.0%) increase in overall CIN2+ detection.<br />Conclusions: Repeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged.<br /> (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Subjects :
- Adult
Atypical Squamous Cells of the Cervix virology
Colposcopy statistics & numerical data
Female
Humans
Italy
Middle Aged
Papanicolaou Test
Papillomavirus Infections pathology
Papillomavirus Infections virology
Referral and Consultation statistics & numerical data
Sensitivity and Specificity
Uterine Cervical Neoplasms pathology
Uterine Cervical Neoplasms virology
Vaginal Smears
Uterine Cervical Dysplasia pathology
Uterine Cervical Dysplasia virology
Algorithms
Atypical Squamous Cells of the Cervix pathology
Early Detection of Cancer methods
Papillomavirus Infections diagnosis
Triage methods
Uterine Cervical Neoplasms diagnosis
Uterine Cervical Dysplasia diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0852
- Volume :
- 68
- Database :
- MEDLINE
- Journal :
- European journal of cancer (Oxford, England : 1990)
- Publication Type :
- Academic Journal
- Accession number :
- 27755998
- Full Text :
- https://doi.org/10.1016/j.ejca.2016.09.008