Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-alone or Cotesting Strategies
| Autor: | Gunther Schauberger, Dirk Schriefer, Hans Ikenberg, Charles James Kirkpatrick, Linda A. Liang, Katja Schwarzer, Heinz Kölbl, Thomas Einzmann, Maria Blettner, Kathrin Radde, Sylke Ruth Zeissig, Chris J.L.M. Meijer, Arno Franzen, Stefanie J. Klug |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Epidemiology Population Uterine Cervical Neoplasms Alphapapillomavirus Cervical cancer screening Sensitivity and Specificity Cohort Studies 03 medical and health sciences 0302 clinical medicine Pregnancy Cytology medicine Humans education Papillomaviridae Early Detection of Cancer Vaginal Smears Colposcopy education.field_of_study medicine.diagnostic_test business.industry Obstetrics Papillomavirus Infections Confidence interval 030104 developmental biology Oncology 030220 oncology & carcinogenesis Verification bias Liquid-based cytology Female business Papanicolaou Test Cohort study |
| Zdroj: | Cancer Epidemiology, Biomarkers & Prevention. 30:474-484 |
| ISSN: | 1538-7755 1055-9965 |
| DOI: | 10.1158/1055-9965.epi-20-1003 |
| Popis: | Background: Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study. Methods: The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ≥30 years (n = 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants [ASC-US+ or high-risk HC2 (hrHC2)] and a random 5% sample of screen-negatives were referred to colposcopy. Post hoc HPV genotyping was conducted by GP5+/6+ PCR-EIA with reverse line blotting. Sensitivity, specificity (adjusted for verification bias), and potential harms, including number of colposcopies needed to detect 1 precancerous lesion (NNC), were calculated. Results: In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) were lower than HC2 (95%) and PCR (79%) for CIN2+. Cotesting demonstrated higher sensitivities (HC2 cotesting: 99%; PCR cotesting: 84%), but at the cost of lower specificities (92%–95%) compared with HPV stand-alone (HC2: 95%; PCR: 94%) and cytology (97% or 99%). Cotesting versus HPV stand-alone showed equivalent relative sensitivity [HC2: 1.06, 95% confidence interval (CI), 1.00–1.21; PCR: 1.07, 95% CI, 1.00–1.27]. Relative specificity of Pap cotesting with either HPV test was inferior to stand-alone HPV. LBC cotesting demonstrated equivalent specificity (both tests: 0.99, 95% CI, 0.99–1.00). NNC was highest for Pap cotesting. Conclusions: Cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals. Impact: HPV stand-alone screening offers a better balance of benefits and harms than cotesting. See related commentary by Wentzensen and Clarke, p. 432 |
| Databáze: | OpenAIRE |
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