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Colposcopic and histopathologic evaluation of women with HPV persistence exiting an organized screening program.
- Source :
-
American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2020 Mar; Vol. 222 (3), pp. 253.e1-253.e8. Date of Electronic Publication: 2019 Oct 01. - Publication Year :
- 2020
-
Abstract
- Background: Human papillomavirus-based screening has a higher sensitivity for precursors of cervical cancer compared with cytology-based screening. However, more evidence is needed on optimal management of human papillomavirus-positive women.<br />Objective: The objective of the study was to compare the risk of histopathologically confirmed cervical intraepithelial lesions grade 2 or worse after 1 and 3 years of human papillomavirus persistence, respectively, and evaluate the clinical management of human papillomavirus-positive women in the 56-60 year age group.<br />Study Design: This was a randomized health care policy offering human papillomavirus screening to 50% of resident women aged 56-60 years in the Stockholm/Gotland region of Sweden during January 2012 through May 2014. Women who were human papillomavirus positive/cytology negative at baseline were referred for a repeat test after 1 or 3 years. In case of human papillomavirus persistence, women were referred for colposcopy, including biopsies and endocervical sampling.<br />Results: The human papillomavirus prevalence was 5.5% (405 women of 7325 attending). Among the 405 human papillomavirus-positive women, 313 were reflex test cytology negative at baseline and were referred for a repeat human papillomavirus test, 176 women after 1 year and 137 women after 3 years. After 1 year, 91 of 176 (52%) were persistently human papillomavirus positive and after 3 years 55 of 137 (40%) (P = .042). In repeat cytology, 10 of the 91 (12%) were positive after 1 year and 15 of 55 (33%) after 3 years (P = .005). The attendance rates for colposcopy were similar: 82 of 91 (90%) in the 1 year group and 45 of 55 (82%) in the 3 year group. All women attending colposcopy were postmenopausal, and endocervical sampling and punch biopsies were performed to facilitate colposcopic management, with a positive predictive value of 43-50% and 28-31%, respectively. Histopathologically confirmed cervical intraepithelial lesions grade 2 or worse was found in 19 of 82 women (23%) and 9 of 45 women (20%) in the 1 year and 3 year groups, respectively, and registry linkage follow-up found no cancers in either group. Human papillomavirus genotyping was predictive of cervical intraepithelial lesions grade 2 or worse, and human papillomavirus 16 was the most common genotype at human papillomavirus persistence, occurring in 18% of the cases in the 1 year group and 20% in the 3 year group.<br />Conclusion: It was safe to postpone repeat human papillomavirus tests for 3 years in postmenopausal women attending the organized cervical screening program. There was a high risk for cervical intraepithelial lesions grade 2 or worse at follow-up and noteworthy yields from human papillomavirus genotyping as well as endocervical sampling and random biopsies in the absence of visible colposcopic lesions.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Biopsy
Conization statistics & numerical data
Early Detection of Cancer
Female
Follow-Up Studies
Genotype
Humans
Hysterectomy statistics & numerical data
Middle Aged
Papillomaviridae genetics
Predictive Value of Tests
Random Allocation
Referral and Consultation
Sweden epidemiology
Uterine Cervical Neoplasms epidemiology
Uterine Cervical Neoplasms surgery
Uterine Cervical Dysplasia epidemiology
Uterine Cervical Dysplasia surgery
Colposcopy
Papillomavirus Infections epidemiology
Uterine Cervical Neoplasms pathology
Uterine Cervical Dysplasia pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6868
- Volume :
- 222
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- American journal of obstetrics and gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 31585095
- Full Text :
- https://doi.org/10.1016/j.ajog.2019.09.039