David Mesher1, Anne Szarewski1, Louise Cadman1, Janet Austin1, Lesley Ashdown-Barr1, Linda Ho1, George Terry1, Martin Young2, Mark Stoler3, Christine Bergeron4, Julie McCarthy5, Corrina Wright5, Stuart Liddle6, W P Soutter7, Deirdre Lyons8, Jack Cuzick9. 1. Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK. 2. Cytopathology Department, Royal Free Hospital, London NW3, UK. 3. Department of Pathology, University of Virginia Health System, Virginia 22908, USA. 4. Laboratoire Pasteur-Cerba, 95066 Cergy Pontoise Cedex 9, France. 5. Cytopathology Department, St. Mary's Hospital, Praed Street, London W2 1PG, UK. 6. The Doctors Laboratory, 60 Whitfield Street, London W1T 4EU, UK. 7. Department of Gynaecology, Hammersmith and Queen Charlotte's & Chelsea Hospitals, Du Cane Rd., London W12 0HS, UK. 8. Department of Gynaecology, St. Mary's Hospital, Praed Street, London W2 1PG, UK. 9. Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK. Electronic address: j.cuzick@qmul.ac.uk.
Abstract
AIM: To compare triage strategies using different human papillomavirus (HPV) consensus and genotyping tests and a p16(INK4a) test. METHODS: 1228 women referred with a borderline or single mildly dyskaryotic smear. Samples were taken at colposcopy using PreservCyt. Tests included Hybrid Capture 2, Abbott RealTime PCR, BD HPV, Cobas 4800, PreTect HPV-Proofer, APTIMA and p16(INK4a). Results were based on the worst histology within 9 months. RESULTS: 97/1228 (7.9%) women had CIN3+ (203/1228 (17%) CIN2+). HPV testing alone using Hybrid Capture 2, Abbott RealTime PCR, BD HPV, Cobas 4800 or APTIMA had a sensitivity for CIN3+ ranging from 99.0% to 100.0% and specificity for <CIN2 from 23.3% to 34.7%. p16(INK4a) had a sensitivity of 86.8% and specificity of 50.7%. PreTect HPV-Proofer had a sensitivity of 85.1% and specificity of 73.2%. Testing for HPV type 16 only had sensitivities ranging from 66.0% to 75.5% and specificities from 81.3% to 87.6%. Dual testing with HPV type 16 combined with p16(INK4a) gave a high sensitivity for CIN3+ (78.7% to 98.0%) and specificity for <CIN2 of 58.6% to 81.5%. CONCLUSIONS: Triage with sensitive HPV testing assays can substantially reduce the number of unnecessary referrals in women with low grade cytology with virtually no loss of sensitivity. Even greater gains can be made if p16 and type 16 are used, but some cases of CIN2 will be missed. In both cases short term surveillance will be needed.
AIM: To compare triage strategies using different human papillomavirus (HPV) consensus and genotyping tests and a p16(INK4a) test. METHODS: 1228 women referred with a borderline or single mildly dyskaryotic smear. Samples were taken at colposcopy using PreservCyt. Tests included Hybrid Capture 2, Abbott RealTime PCR, BD HPV, Cobas 4800, PreTect HPV-Proofer, APTIMA and p16(INK4a). Results were based on the worst histology within 9 months. RESULTS: 97/1228 (7.9%) women had CIN3+ (203/1228 (17%) CIN2+). HPV testing alone using Hybrid Capture 2, Abbott RealTime PCR, BD HPV, Cobas 4800 or APTIMA had a sensitivity for CIN3+ ranging from 99.0% to 100.0% and specificity for <CIN2 from 23.3% to 34.7%. p16(INK4a) had a sensitivity of 86.8% and specificity of 50.7%. PreTect HPV-Proofer had a sensitivity of 85.1% and specificity of 73.2%. Testing for HPV type 16 only had sensitivities ranging from 66.0% to 75.5% and specificities from 81.3% to 87.6%. Dual testing with HPV type 16 combined with p16(INK4a) gave a high sensitivity for CIN3+ (78.7% to 98.0%) and specificity for <CIN2 of 58.6% to 81.5%. CONCLUSIONS: Triage with sensitive HPV testing assays can substantially reduce the number of unnecessary referrals in women with low grade cytology with virtually no loss of sensitivity. Even greater gains can be made if p16 and type 16 are used, but some cases of CIN2 will be missed. In both cases short term surveillance will be needed.
Authors: D A M Heideman; A T Hesselink; F J van Kemenade; T Iftner; J Berkhof; F Topal; D Agard; C J L M Meijer; P J F Snijders Journal: J Clin Microbiol Date: 2013-08-28 Impact factor: 5.948
Authors: Frank Karlsen; Margaret Muturi; Cosmas Muyabwa; Lars E Roseng; Serge Bigabwa; Byamungu Chihongola; Lucy Muchiri Journal: J Public Health Afr Date: 2018-12-21
Authors: M H Uijterwaal; B I Witte; F J Van Kemenade; D Rijkaart; R Ridder; J Berkhof; G A M A Balfoort-van der Meij; M C G Bleeker; P J F Snijders; C J L M Meijer Journal: Br J Cancer Date: 2014-02-11 Impact factor: 7.640