Human papillomavirus DNA detection in the management of women with twice mildly abnormal cytological smears

Ho, Linda; Terry, George; Londesborough, P.; Cuzick, Jack; Lorenzato, Felipe Rinald Barbosa; Singer, Albert

doi:10.1002/jmv.10257

Cited by 14 publications

(23 citation statements)

References 14 publications

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“…However, an estimate of excess risk among hrHPV negative women with BMD cytology is expected within the next few years when, e.g., the ongoing Dutch POBASCAM screening study and Swedish screening study are expected to yield final results. 1,36 In our study 54/105 women (51%) were hrHPV positive at baseline of whom 19 (35%) had a histologically confirmed high-grade 20 In contrast, a previous study by our group demonstrated a prevalence of 10%. 19 In that study however, about half of the women were referred after 1 BMD smear in contrast to our current study where women were referred after 2 BMD smears in 6 months.…”

Section: Discussioncontrasting

confidence: 69%

“…This corresponds with the findings of other studies. 17,20,28 In our study, the negative predictive value (NPV) of hrHPV testing for having high-grade CIN was 98% at baseline for women with a repeated BMD smear, and 100% after 6 and 12 months follow-up. This suggests that hrHPV negative women, despite a persistent BMD cytology, are not at risk for high-grade CIN.…”

Section: Discussionmentioning

confidence: 54%

“…15,17,23 Several studies have used different classifications of mildly abnormal cytology. 17,[19][20]23,[30][31][32] Cuzick et al included women with borderline cytology and negative cytology but were hrHPV positive (HART study). 23 The ALTS study describes triage in women with ASCUS and LSIL cytology (ALTS Group).…”

Section: Discussionmentioning

confidence: 99%

“…This is in agreement with the findings of previous studies. 6,17,19,20,23,[30][31][32] Approximately half of these women cleared hrHPV in 12 months and none of them developed a high-grade CIN during this time. Fourteen percent developed high-grade CIN after 12 months (all were persistently hrHPV positive), without an observed development of (micro)invasive carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, triage with hrHPV testing may improve the selection of women at risk for development of cervical cancer and consequently the management of women with BMD smears. 15,[19][20][21][22][23] This would not only have the advantage of improving the efficiency of the screening program through fewer referrals but also would reduce unnecessary anxiety among the majority of women with BMD who are not at risk for high-grade CIN. 3,5,24 In this prospective study, triage with hrHPV testing was performed in the follow-up of women referred with a repeated BMD established in the screening program.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

Bais

Rebolj

Snijders

et al. 2005

Intl Journal of Cancer

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In the Netherlands 2% of cervical smears in the cervical cancer screening program are read as borderline or mildly dyskaryotic cytology (BMD smear). Only in about 10% of these women a highgrade CIN lesion (CIN II-III) is present; therefore referral is for the majority unnecessary. In our study triage with high-risk HPV (hrHPV) testing was used to identify women at risk for development of high-grade CIN lesions after a repeat BMD smear. A ''wait-and-see'' period was incorporated allowing clearance of HPV and regression of the lesion. Women with a low-grade lesion, irrespective of their HPV status, were monitored at 12 months; women with a high-grade lesion were monitored at 6 and 12 months. Fifty-one of the 105 women (49%) were hrHPV negative at baseline; none of them showed progression of the lesion within the first year of follow-up (NPV 100%). High-grade CIN was present in 1 patient who was HPV negative at baseline (2%); she demonstrated regression after 12 months. Nineteen of the hrHPV positive women (35%) demonstrated a high-grade CIN lesion at baseline and 3 cleared hrHPV after 6 months, with a subsequent regression of CIN. Ten women remained hrHPV positive with persistence of high-grade CIN and were eventually treated. At baseline, 35 hrHPV positive women demonstrated a low-grade lesion, 19 remained hrHPV positive after 12 months and 5 developed high-grade CIN. Sixteen out of the 35 cleared the hrHPV infection without progression of the lesion. In conclusion, triage, using hrHPV testing for women with persistent BMD cytology, can select women who are not at risk for development of high-grade CIN. We recommend return to the screening program without referral for colposcopic examination if hrHPV is absent. For hrHPV positive women, a repeat hrHPV test after another 6 months is suggested. Referral is only required if persistence of hrHPV is established. ' 2005 Wiley-Liss, Inc.Key words: HPV; triage; borderline or mild dyskaryosis; guidelinesIn the Dutch population-based cervical cancer-screening program, women between 30 and 60 years of age undergo a cytological smear every 5th year. Recent surveys showed that about 2% of these smears contained borderline or mildly dyskaryotic (BMD) changes. 1,2 According to current screening guidelines, in these cases cytology is repeated after 6 months and (if negative) after 12 months. When cytology is persistently abnormal, women are referred to the gynaecologist where colposcopic examination is performed and a biopsy is taken for histological examination. When histology shows no or low-grade dysplasia ( CIN I) women will be kept under cytological surveillance without immediate treatment. High-grade dysplasia (CIN II-III) or a worse lesion will be treated. Only 10% of women with a single BMD smear show a high-grade CIN lesion. [3][4][5][6] Consequently, there is a need for an improved risk assessment of women with BMD.Infection with high-risk HPV (hrHPV) has been established as an important etiological factor in the carcinogenesis of cervical cancer. 7,8 Persistence of hr...

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

Bais

Rebolj

Snijders

et al. 2005

Intl Journal of Cancer

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Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions

Arbyn

Roelens

Simoens

et al. 2013

Cochrane Database of Systematic Reviews

110

156

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Human papillomavirus triage of women with persistent borderline or mildly dyskaryotic smears: Comparison of costs and side effects of three alternative strategies

Bais

Ballegooijen

Boer

et al. 2007

Intl Journal of Cancer

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The conventional direct referral to colposcopy of persistent borderline or mildly dyskaryotic (BMD) smears in cervical cancer screening leads to considerable unnecessary referrals and associated anxiety and costs. This may be improved by including testing for oncogenic human papillomavirus (HPV) in the triage. We assessed costs and side effects (referrals, treatments and time in follow-up) for 3 possible HPV triage strategies (immediate HPV testing, a 6-month delay in HPV testing, a 2-stage combination of both) and compared them with the conventional strategy. The assessments are based on recent Dutch data from various national databases and trials. We estimated that the referral rate could be reduced by 49, 58 and 58% with immediate, delayed and 2-stage HPV testing, respectively. As a consequence, the average length of follow-up, as well as average costs, also decrease. Therefore, we advocate including HPV testing before referring to colposcopy. Among the 3 HPV strategies, analysis of additional aspects favors implementation of immediate HPV testing. ' 2007 Wiley-Liss, Inc.Key words: borderline and mild dyskaryosis; human papillomavirus; triage; cost; side effects Cytology-based cervical cancer screening prevents deaths by treating preinvasive (cervical intraepithelial neoplasia, CIN) and early invasive disease. Low-grade abnormalities described as borderline and mild dyskaryosis (BMD) are the most common type of cytologic abnormalities, ranging in frequency from below 2% in the Netherlands to above 6% in Finland.1 In several countries, it is currently recommended to follow-up these women with a Pap smear in 6 months. [2][3][4] Women are then referred for a colposcopy if the BMD abnormality does not normalize. 3 In the Netherlands, about one third of the women with BMD primary screening smears is eventually referred, 1 most often because of BMD persistence and less often because of cytological progression. 5This diagnostic policy of following-up BMD smears induces a considerable amount of side effects in terms of a high number of referrals and a long follow-up period with associated costs and psychologic consequences. About 60-90% of women with BMD persistence have no high-grade lesion that needs to be treated. 6-13The burden on women and the health care could be reduced if the subgroup at high risk for a significant lesion were identified.It has been consistently shown in the literature that detection of an infection with one of the high-risk human papillomavirus types (HPV) can be used for a risk stratification of women with lowgrade abnormal smears.14,15 An infection with HPV is a necessary factor in the development of invasive cervical cancer. 16 Because no histological progression is seen in women who spontaneously clear the HPV infection, 17 women without a detectable HPV infection do not need further follow-up. That could be the case in 40-60% of women with persistent BMD smears.7-13 The discussion about the optimal strategy and time points of incorporating HPV testing into triage of women with BMD smear...

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Human papillomavirus DNA detection in the management of women with twice mildly abnormal cytological smears

Cited by 14 publications

References 14 publications

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions

Human papillomavirus triage of women with persistent borderline or mildly dyskaryotic smears: Comparison of costs and side effects of three alternative strategies

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