Liquid-based cytology for primary cervical cancer screening: a multi-centre study

Monsonégo, Joseph; Autillo‐Touati, Amapola; Bergeron, Christine; Dachez, Roger; Liaras, J; Saurel, J; Zerat, Laurent; Chatelain, Pierre; Mottot, C

doi:10.1054/bjoc.2000.1588

Cited by 104 publications

(92 citation statements)

References 24 publications

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“…34 However, this prevalence is slightly higher than in other settings, 38 probably due in part to the high proportion (25%) of young women in our cohort; also, technical difficulties with Thinprep could have contributed to the higher rate of ASC-US and LSIL in the first and adjudicated cytology, respectively. 8 The HPV DNA assay was much more sensitive (by >25%Pt) than LBC but slightly less specific [by $5%Pt], in agreement to that reported in other trials. [11][12][13][14]38,39 AHPV, however, was much more sensitive than LBC (by >25%Pt) but had a similar specificity.…”

Section: Early Detection and Diagnosissupporting

confidence: 87%

Evaluation of oncogenic human papillomavirus RNA and DNA tests with liquid‐based cytology in primary cervical cancer screening: The FASE study

Monsonégo

Hudgens

Zerat³

et al. 2010

Intl Journal of Cancer

129

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The APTIMA V R HPV Assay (AHPV) allows detection of 14 high-risk human papillomavirus (HPV) RNA types in cervical specimens. Until present, the assay has been compared to HPV DNA tests only in triage settings. Herein, we compare AHPV with a DNA assay (Hybrid Capture V R 2; HC2) and liquid-based cytology (LBC; using PreservCyt V R ThinPrep liquid Pap) in a screening setting (French APTIMA screening evaluation [FASE] study). Women (N 5 5,006) aged 20-65 were screened by gynecologists in 17 private practices in Paris, France. One cervical specimen was collected and tested with LBC, AHPV and HC2 assays. Women were referred to colposcopy if they were ASC-US1 in LBC or HPV positive in either HPV assay. To control for verification bias, a random group (14%) with normal LBC and dually HPV negative tests underwent colposcopy. Data from 4,429 women were analyzed. Sensitivity, specificity and predictive values were calculated for the three tests. AHPV and HC2 were highly sensitive for CIN21 (92.0% and 96.7%) and CIN31 (95.7% and 95.3%) detection and much more sensitive than LBC (69.1% for CIN21 and 73.3% for CIN31). Specificity of AHPV was higher than that of HC2, but similar to that of LBC (p < 0.001). Combining LBC with either HPV test slightly increased sensitivity but compromised specificity. AHPV assay is both specific and sensitive for the detection of high-grade precancerous lesions and may be considered as an option for routine cervical cancer screening for women over 20 years of age.Invasive cervical cancer (ICC) is the second most frequent female cancer worldwide, 1 with an estimation of 493,000 cases annually. ICC incidence and mortality rates have dramatically declined over the past five decades in developed countries, largely due to screening programs based on conventional cervical Papanicolaou (Pap) smears. 2,3 Conventional Pap smear screening, however, has limited sensitivity, positive predictive value (PPV) and reproducibility, which limits its use for primary screening. 3,4-7 Liquid-based cytology (LBC) has been shown to be more sensitive than conventional

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Section: Early Detection and Diagnosissupporting

confidence: 87%

Evaluation of oncogenic human papillomavirus RNA and DNA tests with liquid‐based cytology in primary cervical cancer screening: The FASE study

Monsonégo

Hudgens

Zerat³

et al. 2010

Intl Journal of Cancer

129

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“…The use of the same cervical specimens collected for liquid-based cytology and HPV detection certainly reduces the discrepancies between the results of cytology and HPV testing for the detection of HGSIL. However, the higher sensitivity of liquid-based cytology for the detection of HGSIL observed in our study and reported in the literature 15,35 remains lower than the sensitivity of HPV testing.…”

Section: Discussioncontrasting

confidence: 69%

“…14 HC-II is a non radioactive, easy to perform, relatively rapid (5 hr of handling), liquid hybridization assay designed to detect 18 HPV types divided into high-risk (types 16,18,31,33,35,39,45, 51, 52, 56, 58, 59 and 68) and low-risk (types 6, 11, 42, 43 and 44) groups. The first studies have been particularly promising, showing a good agreement with PCR results, with a detection of HR-HPV DNA in more than 90% of high grade SIL (HGSIL).…”

mentioning

confidence: 99%

Recurrent human papillomavirus infection detected with the hybrid capture II assay selects women with normal cervical smears at risk for developing high grade cervical lesions: A longitudinal study of 3,091 women

Bory

Cucherousset

Lee

et al. 2002

Intl Journal of Cancer

115

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Key words: hybrid capture; human papillomavirus; cervical intraepithelial neoplasia; cytologic screeningHigh-risk human papillomaviruses (HR-HPV) have now been conclusively demonstrated to be the causative agents of cervical cancer. 1-3 Indeed, it has been reported that 99.7% of all cervical squamous cell carcinomas contain HR-HPV. 4 Infections with HR-HPV are associated with a relative risk of between 8 and 11 for the development of squamous intraepithelial lesions (SIL) 5 and only low-grade SIL that contain HR-HPVs progress to high-grade disease. 6 While most authors agree that moderate and severe dysplasias should be managed regardless of HPV type as most of them contain HR-HPV, HPV testing may be useful for triaging women with a cytological diagnosis of atypical squamous cells of undetermined significance (ASCUS) in their cervical smears and for the follow-up of women treated for CIN. [7][8][9][10][11][12][13] In the same way, there is an increasing interest in using HR-HPV DNA detection either alone or in addition to the classic cytological examination as a method for primary screening for cervical preneoplastic and neoplastic lesions.Six years ago, a commercial HPV detection test, Hybrid Capture-II (HC-II), was introduced. 14 HC-II is a non radioactive, easy to perform, relatively rapid (5 hr of handling), liquid hybridization assay designed to detect 18 HPV types divided into high-risk (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68) and low-risk (types 6, 11, 42, 43 and 44) groups. The first studies have been particularly promising, showing a good agreement with PCR results, with a detection of HR-HPV DNA in more than 90% of high grade SIL (HGSIL). [15][16][17][18][19] This test has been proposed to be used routinely on large series of women to improve the sensitivity and negative predictive value of cytological screening for SIL. Although the sensitivity of this test is higher than that of cytology, its specificity remains low. This is largely explained by the numerous transient HR-HPV infections and the high prevalence of HR-HPV infection in women with normal smears. For example, in our study that explored the use of this assay for primary screening of 7,932 women explored in primary screening with this assay, we found that a total of 773 women (11.9%) out of 7,339 women with smears within normal limits presented with an HR-HPV infection. 15 Numerous studies in the literature using Polymerase Chain Reaction (PCR) for the detection of HR-HPV have emphasized that the persistence of HR-HPV infection is significantly associated with progressive disease. 20 -24 Moreover a high viral load may be considered as a risk factor and preferentially observed in potentially progressive and high-grade lesions. [25][26][27][28] This parameter can be semi-quantitatively evaluated by the relative light unit values provided by the HC-II assay. Thus, the detection of a recurrent HR-HPV infection with a baseline high viral load may be a useful discriminating test to select the population of women at risk for...

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“…Nonetheless, cervical cytology has recently been rethought and set aside for its low sensitivity because frequent retesting is required after a cytologic testing report (7). In addition, controversial concerns focused on the cost-effectiveness arose when HPV testing was used as the primary means of cervical cancer screening, especially in regions with scarce resources and fragile infrastructures (8-11).Previous studies reported that liquid-based, thin-layer cytology is more accurate than conventional cervical cytology and has a potential to optimize the effectiveness of primary cervical cancer screening (12)(13)(14). Nevertheless, although the frequency of false-negative reports has decreased after using the liquid-based cytologic testing, the sensitivity of cervical cancer screening still can be improved with the development of new approaches such as DNA ploidy image cytometry based on the same specimen (15,16).…”

mentioning

confidence: 99%

“…Previous studies reported that liquid-based, thin-layer cytology is more accurate than conventional cervical cytology and has a potential to optimize the effectiveness of primary cervical cancer screening (12)(13)(14). Nevertheless, although the frequency of false-negative reports has decreased after using the liquid-based cytologic testing, the sensitivity of cervical cancer screening still can be improved with the development of new approaches such as DNA ploidy image cytometry based on the same specimen (15,16).…”

mentioning

confidence: 99%

DNA Ploidy Cytometry Testing for Cervical Cancer Screening in China (DNACIC Trial): a Prospective Randomized, Controlled Trial

Tong

Shen²,

Wang³

et al. 2009

Clinical Cancer Research

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Purpose: This randomized, controlled trial was designed to determine whether the DNA cytometry testing is superior to the conventional cytologic testing for mass cervical cancer screening. Experimental Design: After approval by the institutional ethics review boards from three separate screening centers, a total of 23,993 Chinese women ages 20 to 65 years were randomly assigned into one of the two groups: a DNA cytometry testing group (11,999 women) and a cytologic testing group (11,994 women). Each woman underwent the other testing after first attending the assigned screening test. Women with positive results after assigned testing additionally underwent colposcopy and human papillomaviruses detections, and those with cervical precancerous or cancerous lesions received appropriate treatment. Sensitivity and specificity estimates were adjusted for verification bias. Analyses were by intention to treat and per protocol ways. Results: In the cytometric DNA testing group, cervical cancer was diagnosed in 40 subjects, compared with 24 subjects in the cytologic testing group [hazard ratio for the detection of advanced cancer in the DNA cytometry testing group, 0.42; 95% confidence interval (CI), 0.27-0.60]. The sensitivity of the DNA cytometry testing for cervical cancer was 91.7% (95% CI, 64.3-95.8), whereas the sensitivity of cytologic testing was 44.5% (95% CI, 25.2-61.3; P = 0.008). The specificity was 54.1% (95% CI, 31.6-69.0) for DNA cytometry testing and 70.6% (95% CI, 46.8-82.5; P = 0.003) for cytologic testing. The sensitivity of both tests used together was 100%, and the specificity was 91.8%. A total of 187 subjects reported mild to severe adverse events after treatment with positive results in 319 women. Conclusions: Our results highlight the benefit of the DNA cytometry testing strategy in mass cervical cancer screening with greater sensitivity and positive predicted value than the conventional cytologic testing in developing settings. (Clin Cancer Res 2009;15(20):6438-45) Cervical cancer remains the leading cause of cancer death among women in low-resource countries. Approximately 320,000 of cervical cancer cases are diagnosed in the developing world every year, of which takes over 80% of all the cases of cervical cancer that are diagnosed annually worldwide (1). As thus, how the cervical cancer is sieved through effective methods during mass population screening is an essential question for global researchers investigating the effectiveness October 14, 2009; DOI: 10.1158/1078-0432.CCR-09-1689 and accuracy of currently available means-particularly for predicting the emergence of the cancer after a single round of screening.Cervical cytologic testing with the Bethesda System has proved to be one of the most successful examples of cancer screening over the simple Papanicolaou (Pap) smear test and has resulted in significant decreases in incidence and mortality from cervical cancer (2). Besides, numerous studies recommended that human papillomavirus (HPV) testing is an appropriate method when...

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Liquid-based cytology for primary cervical cancer screening: a multi-centre study

Cited by 104 publications

References 24 publications

Evaluation of oncogenic human papillomavirus RNA and DNA tests with liquid‐based cytology in primary cervical cancer screening: The FASE study

Evaluation of oncogenic human papillomavirus RNA and DNA tests with liquid‐based cytology in primary cervical cancer screening: The FASE study

Recurrent human papillomavirus infection detected with the hybrid capture II assay selects women with normal cervical smears at risk for developing high grade cervical lesions: A longitudinal study of 3,091 women

DNA Ploidy Cytometry Testing for Cervical Cancer Screening in China (DNACIC Trial): a Prospective Randomized, Controlled Trial

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