Follow-up of women with cervical cytological abnormalities showing atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion: a nationwide cohort study

Sundström, Karin; Lu, Donghao; Elfström, K. Miriam; Wang, Jiangrong; Andrae, Bengt; Dillner, Joakim; Sparén, Pär

doi:10.1016/j.ajog.2016.07.042

Cited by 22 publications

(16 citation statements)

References 14 publications

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“…Such studies require a rigorous design for each research question. Several previous studies can serve as examples of such detailed investigations, for example, lifetime risk of cervical cancer after treatment of CIN3, long‐term risk after diagnosis of atypical glandular cells (AGC) in screening in relation to the initial biopsy, cancer risk after ASCUS/CIN1 at younger ages with and without immediate biopsy, risk of recurrent CIN2/3 by treatment type for different grade of CIN lesions . It is anticipated that collectively, such studies will help to optimize the management for abnormalities, and consequently improve the effectiveness of the cervical screening program.…”

Section: Discussionmentioning

confidence: 99%

Cervical cancer case–control audit: Results from routine evaluation of a nationwide cervical screening program

Wang

Elfström

Andrae

et al. 2019

Intl Journal of Cancer

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Our study used a refined case–control cervical cancer Audit framework to investigate effectiveness of cervical screening, with measures of three screening failures: irregular‐participation, cervical cancer developed after cytological abnormalities and after normal screening results. The register‐based study included 4,254 cervical cancer cases diagnosed in Sweden during 2002–2011, and 30 population‐based controls per case. We used conditional logistic regression models to examine relative risks of cervical cancer in relation to screening participation and screening results in the past two screening rounds from 6 months before cancer diagnosis. We found that women unscreened in past two screening rounds showed four times increased risk of cervical cancer compared to women screened in time (OR = 4.1, 95% CI = 3.8–4.5), and women unscreened in the previous round but screened in the most recent round also showed a statistically significantly elevated risk (OR = 1.6, 95% CI = 1.5–1.8). Women having abnormality in previous two rounds exhibited higher risk of cervical cancer compared to women screened with normal results, while having normal results in the subsequent round after the abnormality also yielded an increased risk (OR = 4.0, 95% CI = 3.2–5.1). Being screened with only normal results was associated with 89% risk reduction for squamous cell cancer, compared to women unscreened, but only 60% reduction for adenocarcinoma. Our findings emphasize the importance of routine participation in cervical screening and suggest that management of abnormalities, as well as sensitivity of the test, warrants improvement especially for preventing cervical adenocarcinoma. The Audit framework serves as routine evaluation model and the findings benchmark for future evaluation of changes in screening practice.

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Section: Discussionmentioning

confidence: 99%

Cervical cancer case–control audit: Results from routine evaluation of a nationwide cervical screening program

Wang

Elfström

Andrae

et al. 2019

Intl Journal of Cancer

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“…The increase in the rate of positivity as well as the increase of false-negative cases identified by 100% RR, due to the increased detection of atypia and more severe lesions, can be explained by the fact that the population of 2004 was composed predominantly of younger women, i.e., aged ≤35 years, whose atypia and squamous lesions tended to be low-grade and regressed spontaneously [24]. The population of 2013 was composed predominantly of women aged 26-55 years, who presented with atypia and more severe lesions.…”

Section: Discussionmentioning

confidence: 99%

Impact of Implementing 100% Rapid Review as a Quality Control Tool in Cervical Cytology

et al. 2018

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Objective: We aimed to evaluate the impact of implementing 100% rapid review (100% RR) as a quality control tool in cervical smear cytology. Design: A cross-sectional study was conducted in which cytology findings, false-negative results, and quality indicators were evaluated. The variables were analyzed in 2004, the year in which 100% RR was implemented, and again in 2013, i.e., 10 years on. Results: Detection of atypical squamous cells of undetermined significance (ASC-US) increased from 0.90% in 2004 to 2.47% in 2013 by routine screening. Detection of atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) increased from 13.33% in 2004 to 36.27% in 2013 by 100% RR. Detection of high-grade squamous intraepithelial lesion (HSIL) increased from 0.64% in 2004 to 4.29% in 2013 by routine screening, and increased from 0% in 2004 to 19.61% in 2013 by 100% RR. There was a significant increase (p = 0.00001) in the identification of false-negative results of ASC-US, low-grade squamous intraepithelial lesion, ASC-H, HSIL, and atypical glandular cells. All quality indicators had increased in 2013 when compared to 2004 results. Conclusions: Ten years after the implementation of the 100% RR method, improvements were found in the detection of atypia and precursor lesions and in quality indicators.

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“…25,26 In women < 30 years old, ASC-US and LSIL are common and, although they may indicate an underlying CIN 2, the spontaneous regression potential is high. 27 Younger women, in comparison to older women, are more likely to have false-positive cytology and less likely to be tested positive for the hrHPV testing. 28 Therefore, HC2 for hrHPV could improve the triage for colposcopy mainly in women aged 30 years old, the specificity for this age group was significantly higher than repeat cytology and HC2 for hrHPV in women < 30 years old.…”

Section: Discussionmentioning

confidence: 99%

High-risk Human Papillomavirus Testing for Triage of Women with Previous Cytological Abnormalities from the Vale do Ribeira Region

Lorente

Fernandes

Etlinger-Colonelli

et al. 2020

Rev Bras Ginecol Obstet

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Objective To evaluate the performance of the hybrid capture 2 (HC2) high-risk papillomavirus (hrHPV) assay and cytological test in women with previous abnormalities, to detect cervical intraepithelial neoplasia grade 2 or worse (≥ CIN 2). Methods A cytological test and HC2 (Qiagen, Gaithersburg, Maryland, EUA) for hrHPV were conducted in 359 liquid-based (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) samples collected from women from the Vale do Ribeira Region, during July 2013 and September 2015 with previous cytology classified as atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H), and atypical glandular cells (AGC). The histopathological examination was conducted in 179 women. The performance evaluations were calculated using the “exact” Clopper-Pearson 95% confidence interval (CI) test by MEDCALC (Medcalc Software Ltd, Ostend, Belgium). Results The ≥ CIN 2 frequency was 11.7% (21/179). The HC2 for hrHPV and repeat cytology to detect ≥ CIN 2 obtained, respectively, a sensitivity of 90.5% (95%CI = 69.6–98.8) and 90.5%, (95%CI = 69.6–98.8), a specificity of 65.8% (95% CI = 57.9–73.2) and 43.7% (95%CI = 35.8–51.8), a positive predictive value of 26.0% (95% CI = 21.4–31.3) and 17.6%, (95%CI = 14.9–20.6), and a negative predictive value of 98.1% (95%CI = 93.3–99.5) and 97.2% (95% CI = 90.1–99.2). Conclusion Hybrid capture 2 for hrHPV improves the performance of the detection of ≥ CIN 2, without compromising sensitivity, and provides a greater safety margin to return to the triennial screening of women undergoing follow-up due to previous abnormalities, without underlying ≥ CIN 2.

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Follow-up of women with cervical cytological abnormalities showing atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion: a nationwide cohort study

Cited by 22 publications

References 14 publications

Cervical cancer case–control audit: Results from routine evaluation of a nationwide cervical screening program

Cervical cancer case–control audit: Results from routine evaluation of a nationwide cervical screening program

Impact of Implementing 100% Rapid Review as a Quality Control Tool in Cervical Cytology

High-risk Human Papillomavirus Testing for Triage of Women with Previous Cytological Abnormalities from the Vale do Ribeira Region

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