Benefit of double‐reading cytology smears as a triage strategy among high‐risk human papillomavirus–positive women in Mexico

Ramírez-Palacios, Paula; Chen, Aiyu; Flores, Yvonne N.; Crespi, Catherine M.; Lazcano‐Ponce, Eduardo; Alvarez-Escobedo, Daniel; Torres‐Ibarra, Leticia; Rivera‐Paredez, Berenice; León‐Maldonado, Leith; Hernández‐López, Rubí; Mendiola-Pastrana, Indira Rocío; Méndez‐Hernández, Pablo; Cuzick, Jack; Carmona, Enrique J.; Figueroa, Héctor; Montiel-Cordero, Fernando; Meneses-León, Joacim; Rao, Jianyu; Salmerón, Jorge; Investigators, Frida Study

doi:10.1002/cncy.22303

Cited by 4 publications

(3 citation statements)

References 38 publications

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“…A study conducted in Mexico reported that 3,914 women with positive high-risk HPV were triaged with liquid-based cytology. The study detected a 20.9% increase in HSIL+ cases when double reading was done ( 62 ).…”

Section: Recent Developments In Screening Methodsmentioning

confidence: 93%

Cervical cancer, geographical inequalities, prevention and barriers in resource depleted countries (Review)

2022

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Cervical cancer (CC) remains a current global issue, with >90% of cervical cancer cases being attributed to human papilloma virus (HPV). The highest burden of cervical cancer is reported in resource-depleted geographical areas with a high incidence of HPV infection. Recent developments in primary prevention include vaccinations against specific strains of HPV and the psychoeducation of the public. Yet, despite the availability of vaccinations, there is high incidence of both HPV and cervical cancer in developing countries, which is attributed to a multitude of barriers including inaccessibility to expensive vaccines. With regards to secondary prevention, progress is actively being made to develop more effective methods of screening and to specifically address the needs of low-income countries. In the past few years, more novel screening methods, such as self-assessment kits, immunohistochemistry and methylation marker analysis, have been developed. Barriers to screening in resource-depleted countries include limited financial resources and infrastructure to develop screening programmes, a lack of screening programmes that are accessible to populations, inadequate training of healthcare teams and stigma related to medical examinations performed as part of screening. Developing primary and secondary prevention programs, as well as addressing the barriers involved in countries with low socioeconomic levels, can drastically reduce morbidity and mortality rates associated with cervical cancer, thus reducing the burden associated with this gynaecological malignancy. Contents1. Introduction 2. Epidemiology and geographical inequalities in the burden of CC 3. Primary prevention and barriers faced by developing countries 4. Vaccinations 5. Psychoeducation 6. Secondary prevention and challenges faced by developing countries 7. Recent developments in screening methods 8. Barriers to screening in low resource countries and strategies for improvement 9. Conclusion

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Section: Recent Developments In Screening Methodsmentioning

confidence: 93%

Cervical cancer, geographical inequalities, prevention and barriers in resource depleted countries (Review)

2022

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“…A double reading of these slides was employed to adjudicate the cytological result, as previously described 22 . For all cytological examinations, both the cytotechnologists and the cytopathologist were aware that specimens were hrHPV positives, but they were blinded to HPV16/18 result.…”

Section: Methodsmentioning

confidence: 99%

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

Torres‐Ibarra

Lörincz

Wheeler

et al. 2020

Intl Journal of Cancer

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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+.

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“…Previous studies have documented greater acceptability of the SeCUS and an increase in the participation of women who do not regularly attend screening programs, and SeCUS is a low-cost procedure [ 8 , 11 , 15 ]. This finding supports the proposal that the SeCUS may be regarded as an acceptable alternative for collecting primary samples for cervical cancer screening, thereby increasing screening coverage for women who resist cervical sample collection [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Performance of urine samples compared to cervical samples for detection of precancer lesions among HPV-positive women attending colposcopy clinic in Mexico City

Meneses-León,

Hernández-Salazar,

Torres-Ibarra

et al. 2024

Cancer Causes Control

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Background High-risk human papillomavirus (hrHPV) detection in self-collected urine samples (SeCUS) may be a promising alternative for cervical cancer screening because of its greater acceptability, as long as it can offer comparable sensitivity to clinician-collected cervical samples (CCoS) for detecting precancer lesions. Objective To evaluate the performance of the SeCUS compared to that of the CCoS for cervical intraepithelial neoplasia grade 3 (CIN3) detection among hrHPV-positive women receiving colposcopy in Mexico City using different specific extended HPV typing procedures: HPV16/18, HPV16/18/35/39/68 or HPV16/18/35/39/68/31. Methods From March 2017 to August 2018, 4,158 female users of the cervical cancer screening program at Tlalpan Sanitary Jurisdiction in Mexico City were invited to participate in the FRIDA-Tlalpan study. All participants provided ≥ 30 mL of SeCUS, and then a CCoS was obtained with Cervex-Brush®, which was used for hrHPV typing. Participants who tested positive for hrHPV in CCoS were referred for colposcopy for diagnostic confirmation, and all SeCUS of these women were also tested for hrHPV typing. Results In total, 561 hrHPV-positive women were identified by CCoS via colposcopy, and 82.2% of the SeCUS of these women were also hrHPV positive. From both CCoS and SeCUS, 7 cases of CIN3 were detected. Considering HPV16/18 typing, CCoS and SeCUS detected 4 cases of CIN3, but after HPV16/18/35/39/68/31 extension typing, both CCoS and SeCUS detected all 7 of the CIN3 cases among the hrHPV-positive women. Conclusions Using extended hrHPV typing based on HPV16/18/35/39/68/31, our results suggest that the performance of SeCUS may be equivalent to that of CCoS for detecting CIN3 lesions. Although our results are inconclusive, they support the hypothesis that SeCUS may be an attractive alternative worthy of further research.

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Benefit of double‐reading cytology smears as a triage strategy among high‐risk human papillomavirus–positive women in Mexico

Cited by 4 publications

References 38 publications

Cervical cancer, geographical inequalities, prevention and barriers in resource depleted countries (Review)

Cervical cancer, geographical inequalities, prevention and barriers in resource depleted countries (Review)

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

Performance of urine samples compared to cervical samples for detection of precancer lesions among HPV-positive women attending colposcopy clinic in Mexico City

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