Kimon Chatzistamatiou1, Theodoros Moysiadis2, Viktoria Moschaki3, Nikolaos Panteleris4, Theodoros Agorastos5. 1. 2nd Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki, 49 Konstantinoupoleos St, 54642 Thessaloniki, Greece; 4th Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki, 49 Konstantinoupoleos St, 54642 Thessaloniki, Greece. Electronic address: kimon.chatzistamatiou@gmail.com. 2. Institute of Applied Biosciences, Centre for Research & Technology - Hellas, 57001 Thessaloniki, Greece. 3. 2nd Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki, 49 Konstantinoupoleos St, 54642 Thessaloniki, Greece; 3rd Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki, 49 Konstantinoupoleos St, 54642 Thessaloniki, Greece; 4th Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki, 49 Konstantinoupoleos St, 54642 Thessaloniki, Greece. 4. 2nd Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki, 49 Konstantinoupoleos St, 54642 Thessaloniki, Greece. 5. 4th Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki, 49 Konstantinoupoleos St, 54642 Thessaloniki, Greece.
Abstract
OBJECTIVES: The objective of the present study was to identify the most effective cervical cancer screening algorithm incorporating different combinations of cytology, HPV testing and genotyping. METHODS: Women 25-55years old recruited for the "HERMES" (HEllenic Real life Multicentric cErvical Screening) study were screened in terms of cytology and high-risk (hr) HPV testing with HPV 16/18 genotyping. Women positive for cytology or/and hrHPV were referred for colposcopy, biopsy and treatment. Ten screening algorithms based on different combinations of cytology, HPV testing and HPV 16/18 genotyping were investigated in terms of diagnostic accuracy. RESULTS: Three clusters of algorithms were formed according to the balance between effectiveness and harm caused by screening. The cluster showing the best balance included two algorithms based on co-testing and two based on HPV primary screening with HPV 16/18 genotyping. Among these, hrHPV testing with HPV 16/18 genotyping and reflex cytology (atypical squamous cells of undetermined significance - ASCUS threshold) presented the optimal combination of sensitivity (82.9%) and specificity relative to cytology alone (0.99) with 1.26 false positive rate relative to cytology alone. CONCLUSION: HPV testing with HPV 16/18 genotyping, referring HPV 16/18 positive women directly to colposcopy, and hrHPV (non 16/18) positive women to reflex cytology (ASCUS threshold), as a triage method to colposcopy, reflects the best equilibrium between screening effectiveness and harm. Algorithms, based on cytology as initial screening method, on co-testing or HPV primary without genotyping, and on HPV primary with genotyping but without cytology triage, are not supported according to the present analysis.
OBJECTIVES: The objective of the present study was to identify the most effective cervical cancer screening algorithm incorporating different combinations of cytology, HPV testing and genotyping. METHODS:Women 25-55years old recruited for the "HERMES" (HEllenic Real life Multicentric cErvical Screening) study were screened in terms of cytology and high-risk (hr) HPV testing with HPV 16/18 genotyping. Women positive for cytology or/and hrHPV were referred for colposcopy, biopsy and treatment. Ten screening algorithms based on different combinations of cytology, HPV testing and HPV 16/18 genotyping were investigated in terms of diagnostic accuracy. RESULTS: Three clusters of algorithms were formed according to the balance between effectiveness and harm caused by screening. The cluster showing the best balance included two algorithms based on co-testing and two based on HPV primary screening with HPV 16/18 genotyping. Among these, hrHPV testing with HPV 16/18 genotyping and reflex cytology (atypical squamous cells of undetermined significance - ASCUS threshold) presented the optimal combination of sensitivity (82.9%) and specificity relative to cytology alone (0.99) with 1.26 false positive rate relative to cytology alone. CONCLUSION: HPV testing with HPV 16/18 genotyping, referring HPV 16/18 positive women directly to colposcopy, and hrHPV (non 16/18) positive women to reflex cytology (ASCUS threshold), as a triage method to colposcopy, reflects the best equilibrium between screening effectiveness and harm. Algorithms, based on cytology as initial screening method, on co-testing or HPV primary without genotyping, and on HPV primary with genotyping but without cytology triage, are not supported according to the present analysis.
Authors: Kate T Simms; Michaela Hall; Megan A Smith; Jie-Bin Lew; Suzanne Hughes; Susan Yuill; Ian Hammond; Marion Saville; Karen Canfell Journal: PLoS One Date: 2017-01-17 Impact factor: 3.240
Authors: L Golfetto; E V Alves; T R Martins; T C M Sincero; J B S Castro; C Dannebrock; J G Oliveira; J E Levi; A S C Onofre; M L Bazzo Journal: Braz J Med Biol Res Date: 2018-03-26 Impact factor: 2.590
Authors: Leticia Torres-Ibarra; Jack Cuzick; Attila T Lorincz; Donna Spiegelman; Eduardo Lazcano-Ponce; Eduardo L Franco; Anna Barbara Moscicki; Salaheddin M Mahmud; Cosette M Wheeler; Berenice Rivera-Paredez; Rubí Hernández-López; Leith León-Maldonado; Jorge Salmerón Journal: JAMA Netw Open Date: 2019-11-01
Authors: J E Salazar-Campos; A González-Enciso; R Díaz-Molina; M E Lara-Hernández; J Coronel-Martínez; C Pérez-Plasencia; D Cantú de León Journal: J Cytol Date: 2018 Jul-Sep Impact factor: 1.000