Long-term observational approach in women with histological diagnosis of cervical low-grade squamous intraepithelial lesion: an Italian multicentric retrospective cohort study

Ciavattini, Andrea; Serri, Matteo; Giuseppe, Jacopo Di; Liverani, Carlo Antonio; Gardella, Barbara; Papiccio, Maria; Carpini, Giovanni Delli; Morini, Stefano; Clemente, Nicolò; Sopracordevole, Francesco

doi:10.1136/bmjopen-2018-024920

Cited by 7 publications

(9 citation statements)

References 23 publications

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“…We showed that the switch to the hrHPV‐based screening programme leads to an increase in the detection rates of low‐grade CIN lesions. Most of the detected low‐grade lesions will not progress 7 . Previous studies on triage strategies have shown that the number of unnecessary referrals to colposcopy could be reduced by the use of genotyping 33 .…”

Section: Discussionmentioning

confidence: 99%

“…Most of the detected low-grade lesions will not progress. 7 Previous studies on triage strategies have shown that the number of unnecessary referrals to colposcopy could be reduced by the use of genotyping. 33 Genotyping is not used in the current Dutch hrHPV-based screening programme but should be considered to reduce the number of colposcopies.…”

Section: Discussionmentioning

confidence: 99%

“…For these women, we will present costs per life years gained and costs per quality‐adjusted life years (QALYs) gained as the main outcome. The number of referrals to a gynaecologist and detected CIN, most of which will not progress to cancer, will be presented, as these are considered to be important harmful effects of screening 6,7 . These results are useful for policymakers of similar countries to decide whether a switch to primary hrHPV screening is beneficial for their country.…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of HPV‐based cervical screening based on first year results in the Netherlands: a modelling study

Jansen

Naber

Aitken

et al. 2020

BJOG

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Objective We aim to compare the cost-effectiveness of the old cytology programme with the new high-risk human papillomavirus (hrHPV) screening programme, using performance indicators from the new Dutch hrHPV screening programme.Design Model-based cost-effectiveness analysis.Setting The Netherlands.Population Dutch 30-year-old unvaccinated females followed up lifelong.Methods We updated the microsimulation screening analysis (MISCAN) model using the most recent epidemiological and screening data from the Netherlands. We simulated both screening programmes, using the screening behaviour and costs observed in each programme. Sensitivity analyses were performed on screening behaviour, utility losses and discount rates.Main outcome measures Cervical cancer incidence and mortality rates, number of screening tests and repeat tests, colposcopy referrals by lesion grade, costs from a societal perspective, qualityadjusted life years (QALYs) gained and cost-effectiveness. ResultsThe new Dutch cervical cancer screening programme decreased the cervical cancer mortality by 4% and the incidence by 1% compared with the old programme. Colposcopy referrals of women without cervical intra-epithelial neoplasia grade 2 or worse, increased by 172%, but 13% more QALYs were still achieved. Total costs were reduced by 21%, mainly due to fewer screening tests. Per QALY gained, the hrHPV programme cost 46% less (€12,225) than the cytology programme (€22,678), and hrHPV-based screening remained more cost-effective in all sensitivity analyses.Conclusions The hrHPV-based screening programme was found to be more effective and cost-effective than the cytology programme. Alternatives for the current triage strategy should be considered to lower the number of unnecessary referrals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of HPV‐based cervical screening based on first year results in the Netherlands: a modelling study

Jansen

Naber

Aitken

et al. 2020

BJOG

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“… 30 However, there is still a part of LSIL that progresses to HSIL. 30 The diagnostic accuracy of traditional colposcopy in detecting HSIL or worse (HSIL+) ranged only from 30 to 70%. 31 The sensitivity of colposcopy diagnosis for high‐grade lesions/carcinoma (HSIL+) was 71.6% in a study from Tianjin, China 8 and 80.9% in a recent study from Chengdu, China.…”

Section: Discussionmentioning

confidence: 99%

Application of EfficientNet‐B0 and GRU‐based deep learning on classifying the colposcopy diagnosis of precancerous cervical lesions

Chen

et al. 2023

Cancer Medicine

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Background: Colposcopy is indispensable for the diagnosis of cervical lesions.However, its diagnosis accuracy for high-grade squamous intraepithelial lesion (HSIL) is at about 50%, and the accuracy is largely dependent on the skill and experience of colposcopists. The advancement in computational power made it possible for the application of artificial intelligence (AI) to clinical problems. Here, we explored the feasibility and accuracy of the application of AI on precancerous and cancerous cervical colposcopic image recognition and classification. Methods:The images were collected from 6002 colposcopy examinations of normal control, low-grade squamous intraepithelial lesion (LSIL), and HSIL. For each patient, the original, Schiller test, and acetic-acid images were all collected.We built a new neural network classification model based on the hybrid algorithm. EfficientNet-b0 was used as the backbone network for the image feature extraction, and GRU(Gate Recurrent Unit)was applied for feature fusion of the three modes examinations (original, acetic acid, and Schiller test). Results:The connected network classifier achieved an accuracy of 90.61% in distinguishing HSIL from normal and LSIL. Furthermore, the model was applied to "Trichotomy", which reached an accuracy of 91.18% in distinguishing the HSIL, LSIL and normal control at the same time. Conclusion:Our results revealed that as shown by the high accuracy of AI in the classification of colposcopic images, AI exhibited great potential to be an effective tool for the accurate diagnosis of cervical disease and for early therapeutic intervention in cervical precancer.

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“…The first, well described and accepted pathway suggests that HSIL develops via LSIL and that LSIL originates in the ectocervical epithelium by high risk human papilloma virus (hrHPV) infection of the basal cell compartment in the squamous epithelium. 24,41,47,48 A second theory states that HSIL is the result of a hrHPV infection of IMM, as concluded from the dual expression of keratin 17 and p16 in atypical squamous lesions with metaplastic features. 6,13,22,43,45 The third pathway involves hrHPV infection of the specific stretch of endocervical, keratin 7-positive cuboidal cells at the SqCJ, producing immediately a HSIL without a low-grade precursor lesion.…”

Section: Discussionmentioning

confidence: 99%

Switches of SOX17 and SOX2 expression in the development of squamous metaplasia and squamous intraepithelial lesions of the uterine cervix

et al. 2020

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Aims The dynamics and topographical distribution of SOX17 and SOX2 expression was studied in the transformation zone (TZ) of the uterine cervix. This TZ is a dynamic area where switches from glandular into squamous epithelium can be recognized, new squamocolumnar junctions are formed, and premalignant lesions originate. SOX17 and SOX2 show mutually exclusive expression patterns in the normal uterine cervix, with SOX2 being exclusively found in squamous epithelium, while SOX17 is detected in endocervical columnar cells and reserve cells. Methods and Results Normal cervices and squamous intraepithelial lesions (SIL) were studied with immunohistochemistry, methylation of SOX17, human papilloma virus (HPV) genotyping, and in situ hybridization. In the TZ squamous metaplasia originating from these reserve cells can still show SOX17 expression, while also remnants of SOX17‐positive immature metaplasia can be recognized in the normal squamous epithelium. SOX17 expression is gradually lost during maturation, resulting in the exclusive expression of SOX2 in the majority of (SIL). This loss of SOX17 expression is independent of methylation of the CpG island in its promotor region. HPV can be detected in SOX17‐positive immature metaplastic regions in the immediate vicinity of SOX2‐positive SIL, suggesting that switches in SOX17 and 2 expression can occur upon HPV infection. Conclusions This switch in expression, and the strong association between the distribution of reserve cells and squamous areas within the columnar epithelium in the TZ, suggests that reserve cell proliferations, next to basal cells in the squamous epithelium, are potential targets for the formation of squamous lesions upon viral infection.

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Long-term observational approach in women with histological diagnosis of cervical low-grade squamous intraepithelial lesion: an Italian multicentric retrospective cohort study

Cited by 7 publications

References 23 publications

Cost‐effectiveness of HPV‐based cervical screening based on first year results in the Netherlands: a modelling study

Cost‐effectiveness of HPV‐based cervical screening based on first year results in the Netherlands: a modelling study

Application of EfficientNet‐B0 and GRU‐based deep learning on classifying the colposcopy diagnosis of precancerous cervical lesions

Switches of SOX17 and SOX2 expression in the development of squamous metaplasia and squamous intraepithelial lesions of the uterine cervix

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