Adjunctive testing by cytology, p16/Ki-67 dual-stained cytology or HPV16/18 E6 oncoprotein for the management of HPV16/18 screen-positive women.

Autor: Torres-Ibarra L; Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico., Lorincz AT; Wolfson Institute of Preventive Medicine Centre for Cancer Prevention, Queen Mary University, London, UK., Wheeler CM; New Mexico Comprehensive Cancer Center, Center for HPV Prevention, University of New Mexico, Albuquerque, New Mexico, USA., Cuzick J; Wolfson Institute of Preventive Medicine Centre for Cancer Prevention, Queen Mary University, London, UK., Hernández-López R; Health Plan Analysis Office, Technical Deputy Management of Health Plan, Health Plan Administration Management, General Administration, Bank of Mexico, Mexico ty, Mexico., Spiegelman D; Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA., León-Maldonado L; CONACYT-Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico., Rivera-Paredez B; Faculty of Medine, Research Center on Policies, Population and Health, National Autonomous University of Mexico, Mexico City, Mexico., Méndez-Hernández P; Departamento de Calidad y Educación en Salud, Secretaria de Salud Tlaxcala, Santa Ana Chiautempan, Tlaxcala, Mexico.; Facultad de Ciencias de la Salud, Universidad Autónoma de Tlaxcala, Zacatelco, Tlaxcala, Mexico., Lazcano-Ponce E; School of Public Health of Mexico, National Institute of Public Health, Cuernavaca, Mexico., Salmerón J; Faculty of Medine, Research Center on Policies, Population and Health, National Autonomous University of Mexico, Mexico City, Mexico.
Jazyk: angličtina
Zdroj: International journal of cancer [Int J Cancer] 2021 May 01; Vol. 148 (9), pp. 2264-2273. Date of Electronic Publication: 2020 Dec 22.
DOI: 10.1002/ijc.33414
Abstrakt: High-risk human papillomavirus type 16/18 (HPV16/18) genotyping is unable to accurately discriminate nonprogressive infections from those that will progress to cervical cancer. Our study aimed to assesses if additional testing either with liquid-based cytology (LBC) or the putative progression markers p16/Ki-67 and HPV16/18 E6 oncoprotein (E6) can improve the efficiency of HPV16/18 genotyping for triaging high-risk HPV (hrHPV)-positive women through better cancer risk stratification. Women attending colposcopy after positive HPV16/18 genotyping results within the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA) hrHPV-based screening study in Tlaxcala, Mexico, underwent further testing with LBC, p16/Ki-67 dual-stained (DS) cytology and E6. We calculated measures of test performance for detecting histologically confirmed cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and grade 3 or higher (CIN3+). A number of 475 (64.3%) of 739 HPV16/18-positive women had complete results for all tests. Triage positivity rates were 14.1%, 18.5% and 24.4%, for LBC, E6 and DS, respectively. Compared with LBC, DS had higher sensitivity (24.4% vs 60.0%) although lower specificity (87.0% vs 79.3%) for CIN3+ (P < .001), whereas E6 had a sensitivity of 37.8% and a specificity of 83.5%. No invasive cancer was missed by DS or E6, but 75% were in normal cytology. DS test was associated with nearly 75% reduction of colposcopy referrals compared with the direct referral of all HPV16/18-positive women, giving the least number of colposcopies (n = 4.3) per CIN3+ detected. We show that adjunctive testing of HPV16/18-positive women with DS may greatly reduce unnecessary colposcopy referrals within HPV-based screening employing HPV16/18 genotyping while retaining acceptable sensitivity for CIN2+ and CIN3+.
(© 2020 UICC.)
Databáze: MEDLINE
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