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Detection of human papillomavirus (HPV)E62) and 38.7% (95% CI, 35.7, 41.7), respectively (P < 0.05). In 1,373 women undergoing routine screening (CIN 2؉, n ‫؍‬ 7), both Aptima and HC2 showed 100% sensitivity, and the specificities were 88.3% (95% CI, 86.6, 90.0) and 85.3% (95% CI, 83.5, 87.3), respectively (P < 0.05); for women >30 years of age (n ‫؍‬ 845), the specificities were 93.9% (95% CI, 92.3, 95.5) and 92.1% (95% CI, 90.3, 93.9), respectively (P < 0.05). On the basis of 818 referral cases (CIN 2؉, n ‫؍‬ 235), the sensitivity of Aptima was 94.9% (95% CI, 92.1, 97.7) and that of Proofer was 79.1% (95% CI, 73.9, 84.3), and the specificities were 45.8% (95% CI, 41.8, 49.8) and 75.1% (95% CI, 71.6, 78.6), respectively (P < 0.05). Both Aptima and Proofer showed a higher degree of agreement with LA genotyping than HC2. In conclusion, the Aptima test is as sensitive as HC2 but more specific for detecting CIN 2؉ and can serve as a reliable test for both primary cervical cancer screening and the triage of borderline cytological abnormalities.Persistent infection with oncogenic human papillomavirus (HPV) is the underlying cause of cervical cancer (34, 42), and therefore, testing for oncogenic HPV infection could serve as an accurate means of detecting women at risk for cervical cancer. There are also indications that testing for HPV might be the most effective method of cervical cancer screening in developing countries (32). Moreover, HPV testing would be warranted as a primary screening tool in the era of HPV vaccination (13). Numerous studies have established that testing for HPV DNA is significantly more sensitive than Pap cytology for the detection of high-grade cervical intraepithelial neoplasia (CIN 2) or worse (CIN 2ϩ, i.e., CIN 2, CIN 3, squamous cell carcinoma, endocervical adenocarcinoma in situ, and endocervical adenocarcinoma) (1,4,15,20,27,30) and is recommended in primary cervical cancer screening and for the triage of borderline cytological abnormalities (33,43,44). However, HPV testing lacks specificity due to the ubiquitous and transient nature of HPV infection in women, and therefore, the positive predictive value (PPV) tends to be lower than that obtained by cytology (10, 15). The above observation nonetheless has been based on HPV DNA testing, with most studies utilizing the Hybrid Capture 2 DNA test (HC2; Qiagen) (10, 15). While HC2 is highly sensitive for the detection of 13 high-risk oncogenic types targeted by the test (10,11,15), it is also known to cross-react with untargeted nononcogenic types, thus potentially contributing to a reduction in the test's specificity (5,28,31).The oncogenic process in cervical cancer is initiated and mediated by the upregulation of HPV E6/E7 oncoproteins, and thus, overexpression of these oncoproteins is a marker for an increased risk of cervical cancer (26,38,45). Therefore, detection of E6/E7 oncogene expression could be more specific and a better predictor of cervical cancer risk than the detection of HPV DNA, and E6/E7 oncogenic expression can be detecte...

Human papillomavirus (HPV) DNA testing has a higher clinical sensitivity than cytology for the detection of high-grade cervical intraepithelial neoplasia or worse (CIN 2؉). However, an improvement in specificity would be desirable. As malignant transformation is induced by HPV E6/E7 oncogenes, detection of E6/E7 oncogene activity may improve specificity and be more predictive of cervical cancer risk. The PreTect HPVProofer assay (Proofer; Norchip) detects E6/E7 mRNA transcripts from HPV types 16, 18, 31, 33, and 45 with simultaneous genotype-specific identification. The clinical performance of this assay was assessed in a crosssectional study of women referred for colposcopy in comparison with the Hybrid Capture 2 (HC2; Qiagen) test, which detects DNA of 13 high-risk oncogenic HPV types collectively. Cervical specimens were collected in PreservCyt, and cytology was performed using the ThinPrep method (Hologic). The samples were processed for HPV detection with Proofer and HC2 and genotyping with the Linear Array method (Roche Molecular Systems). Histology-confirmed CIN 2؉ served as the disease endpoint to assess the clinical performance of the tests. A total of 1,551 women were studied, and of these, 402 (25.9%) were diagnosed with CIN 2؉ on histology. The Proofer assay showed a sensitivity of 78.1% (95% confidence interval [CI], 74.1 to 82.1) versus 95.8% (95% CI, 93.8 to 97.8) for HC2 (P < 0.05) and a specificity of 75.5% (95% CI, 73.0 to 78.0) versus 39.6% (95% CI, 36.8 to 42.4), respectively (P < 0.05). The lower sensitivity and higher specificity of Proofer for detection of CIN 2؉ can be attributed to the fact that this test detects the expression of E6/E7 genes beyond a threshold from a limited number of oncogenic HPV types. In conclusion, Proofer is more specific than HC2 in identifying women with CIN 2؉ but has a lower sensitivity.Numerous nonrandomized studies (19), and more recently randomized clinical trials (3,24,31,34), have clearly established that testing for human papillomavirus (HPV) DNA is significantly more sensitive than Pap cytology for detection of high-grade cervical intraepithelial neoplasia (CIN 2 and CIN 3) or worse (CIN 2ϩ; i.e., CIN 2, CIN 3, squamous cell carcinoma, endocervical adenocarcinoma in situ, and endocervical adenocarcinoma). There are also indications that testing for HPV might be the most effective method of cervical cancer screening in developing countries (36). Moreover, HPV testing would be warranted as a primary screening tool in the era of HPV vaccination (14). While the use of HPV testing in primary cervical cancer screening and triage of borderline cytologic abnormalities have been recommended (37,43,44), HPV testing lacks specificity due to the ubiquitous and transient nature of HPV infection in women, and therefore, the positive predictive value (PPV) tends to be lower than that of cytology (11,19). Most studies on primary screening have evaluated HPV DNA detection tests, especially the Hybrid Capture 2 (HC2; Qiagen) test (10,19). HC2 utilizes a full genomic prob...

Minimally invasive approaches result in improved QOL beyond the short-term postoperative period, with benefits noted up to 12 weeks after surgery. This prolonged QOL advantage provides further evidence that MIS should be the standard surgical approach for women with early stage endometrial cancer.

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