Influence of Prior Knowledge of Human Papillomavirus Status on the Performance of Cytology Screening

Martins, Toni Ricardo; Longatto‐Filho, Adhemar; Cohen, Diane; Viscondi, Juliana Yukari Kodaira; Fuza, Luiz Mario; Cury, Lise; Villa, Luisa L.; Levi, José Eduardo; Eluf-Neto, José

doi:10.1093/ajcp/aqx163

Cited by 7 publications

(11 citation statements)

References 24 publications

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“…Our evaluation of 12 referral algorithms showed that the use of 16/18 HPV genotyping and cytologic triage for the other Hr-HPVs provided the best balance between sensitivity and specificity, number of tests, and colposcopies required for detection of CIN2 þ . A positive side-effect of adopting HPV as the primary screening tool is the improvement in cytologic diagnosis achieved when the observer is aware of the HPV status of the patient (29). The substantial improvement in cytology performance when HPV status is known suggests that further evaluation of cytologic triage must use this approach, in contrast to this study where blind reading was adopted.…”

Section: Discussionmentioning

confidence: 68%

High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, São Paulo, Brazil

Levi

Martins

Longatto‐Filho

et al. 2019

Cancer Prevention Research

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Every year there are approximately 16,000 new cases of cervical cancer in Brazil. Novel screening technologies may reduce this number by expanding the population coverage but also by improving the detection rate of precursor lesions. We aimed to evaluate human papillomaviruses (HPV)-DNA testing in the context of routine cervical cancer screening in the public health system of the city of São Paulo, Brazil. Women participating in the primary screening program were invited to enroll. Liquid-based cytology samples were collected and cytology and Hr-HPV DNA testing were performed in parallel. Cytologists were blind to HPV results. Women older than 24 years with a positive high-risk HPV test and/or cytology class ! ASC-US were referred to colposcopy. From December 2014 to December 2016, 16,102 women joined the study. High-risk human papilloma-virus (HR HPV) DNA prevalence was 14.9%, whereas cytologic abnormalities were found in 7.2% of the women. Per protocol, 1,592 Hr-HPV þ women, in addition to 72 patients with cytologic classification > lowgrade squamous intraepithelial lesion (LSIL) were referred. A total of 80 cervical intraepithelial neoplasia (CIN2 þ) cases were diagnosed, 79 were Hr-HPV DNA þ and 18 had normal cytology. Hr-HPV DNA detected a significant number of patients with premalignant lesions missed by cytology and all 16 CIN3 þ cases were Hr-HPV DNA þ. HPV genotyping may be useful in the management of Hr-HPV þ women, reducing the burden of colposcopic referral for those harboring genotypes with a weaker association to CIN3 þ. Use of HPV-DNA testing was shown to be feasible and advantageous over current cytologic screening in the public health system.

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Section: Discussionmentioning

confidence: 68%

High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, São Paulo, Brazil

Levi

Martins

Longatto‐Filho

et al. 2019

Cancer Prevention Research

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“…29,30 On the premise of equal risk management, genotyping information may be another factor affecting cervical cancer screening methods. 11,31 A growing number of reports suggest that hrHPV genotypic risk stratification is an effective way to optimize the identification of high-grade diseases while reducing unnecessary colposcopy referrals. 28,32 Onclarity genotyping utilization may contribute to improved cervical cancer screening and management in China.…”

Section: Discussionmentioning

confidence: 99%

“…The primers for the 14 HPV genotypes are designed to target a region of 79 to 137 bases in the E6/E7 genes, whereas the IC primers amplify a 75-base region in the human β-globin gene; a positive β-globin result verifies the presence of human cells in the collection vial. The assay consists of three PCR assay tubes (G1, G2, and G3) and four optical channels for the detection of the 14 HPV genotypes (16,18,31,45, 51, and 52 as single genotypes, and the remaining eight genotypes in three groups of 33/58, 56/59/66, and 35/39/68) and the IC. 3,15 The cobas HPV test is a fully automated assay for the detection of 14 high-risk (hr) HPV genotypes from cervical specimens collected in a liquid-based cytology medium using real-time PCR amplification of the L1 gene and TaqMan ® ("Taqman"; Halethorpe) probes.…”

Section: Hpv Dna Detectionmentioning

confidence: 99%

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Concordance between the BD Onclarity and Roche cobas assays for detection of HPV DNA in a Chinese population

Wang

Yin

et al. 2022

Journal of Medical Virology

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As cervical cancer screening shifts from cytology to human papillomavirus (HPV) testing, a major issue involves validating more HPV tests. In recent years, some HPV tests are used for clinical performance verification in China. The purpose of this study was to explore whether the BD Onclarity (Becton, Dickinson and Company) HPV assay differs from the Roche cobas (Roche Molecular Systems)HPV assay, as determined using 944 cervical samples, including 588 with sequencing results. In the nucleic acid assay accuracy verification, the assays showed excellent concordance for detection of HPV16 (κ = 0.93, 95% confidence interval [CI]: 0.89-0.97) and HPV18 (κ = 0.90, 95% CI: 0.83-0.97), and very good concordance for the 12 other high-risk types (

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“…In a number of studies, cytological abnormalities were reported more frequently after HPV positivity had been revealed, [3][4][5][6][7][8][9][10][11] demonstrating the potential for an increased colposcopy referral. A few studies also showed that some of the extra cytological abnormalities detected with "informed" cytology were in women who had highgrade cervical intraepithelial neoplasia (CIN2+) detected at colposcopy.…”

Section: Introductionmentioning

confidence: 99%

Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot

Mathews

Denton

2022

Cancer Cytopathology

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BACKGROUND: Overcalling of abnormalities has been a concern for using cytology triage after positive high-risk human papillomavirus (HPV) tests in cervical screening. METHODS: The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the English HPV pilot. The pilot compared routine implementation of primary cervical screening based on cytology (N = 931,539), where HPV test results were not available before cytology reporting, with that based on HPV testing (N = 403,269), where cytology was only required after positive HPV tests. RESULTS:Revealed HPV positivity was associated with a higher direct referral to colposcopy after any abnormality (adjusted odds ratio [OR adj ], 1.16; 95% confidence interval [CI], 1.14-1.18). Laboratories with higher direct referral referred fewer persistently HPV-positive women after early recall. The detection of high-grade cervical intraepithelial neoplasia (CIN2+) after direct referral increased with an OR adj of 1.17 (95% CI, 1.13-1.20) for informed versus uninformed cytology. Generally, the positive predictive value (PPV) of colposcopy for CIN2+ remained comparable under both conditions of interpreting cytology. In women 50 to 64 years old with high-grade dyskaryosis, however, the PPV increased from 71% to 83% after revealing HPV positivity (OR adj , 2.05; 95% CI, 1.43-2.93). CONCLUSIONS: Quality-controlled cervical screening programs can avoid inappropriate overgrading of HPV-positive cytology.

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Influence of Prior Knowledge of Human Papillomavirus Status on the Performance of Cytology Screening

Abstract: Our data indicate that cytology interpreted with prior knowledge of the HPV status provides higher sensitivity for CIN 2+ lesions while marginally reducing the overall specificity compared with HPV status blinded cytology.

Cited by 7 publications

References 24 publications

High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, São Paulo, Brazil

High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, São Paulo, Brazil

Concordance between the BD Onclarity and Roche cobas assays for detection of HPV DNA in a Chinese population

Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot

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