PCR based high risk HPV testing is superior to neural network based screening for predicting incident CIN III in women with normal cytology and borderline changes

Abstract

Background/Aims-To improve the accuracy of conventional cytology in cervical cancer screening, high risk human papillomavirus (HPV) testing and neural network based screening have been developed. This study assessed the power of both techniques to detect women at risk of developing incident CIN III; that is, CIN III detected during the follow up of women with normal cytology and borderline nuclear changes. Methods-A cohort of 2250 women, 34-54 years of age, who attended population based cervical cancer screening from 1988 to 1991 and had normal smears or borderline nuclear changes was followed. All smears were tested for high risk HPV and the smears were rescreened using neural network based screening. The value of neural network based screening for predicting incident CIN III during a mean follow up period of 6.4 years was compared with that of high risk HPV testing. In addition, morphological markers presumed to be related to HPV were correlated with HPV status. Results-Thirteen (0.6%) women had incident CIN III. Both high risk HPV positivity and abnormal cytology were associated with an increased risk for incident CIN III (odds ratio, 240 and 22, respectively) and high risk HPV positivity was associated with abnormal cytology. The sensitivity of high risk HPV testing for predicting incident CIN III was much higher than that of neural network based screening (92% and 46%, respectively). None of the morphological markers assessed, including koilocytosis, was correlated with high risk HPV status. Conclusion-High risk HPV testing is superior to neural network based screening in identifying women at risk of developing CIN III. For women with normal cytology and borderline changes and a negative high risk HPV test, the screening interval can be considerably prolonged. (J Clin Pathol 2000;53:606-611) Keywords: neural network based screening; high risk human papillomavirus testing; CIN III Classic cervical cytology, introduced several decades ago, is an eVective method to reduce the incidence of, and mortality from, cervical cancer.

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

“…Keywords: human papillomavirus; pregnancy; follow-up study; natural history; prevalence Several epidemiological and biological studies have established the important role of infection with high-risk types of human papilloma virus (HPV) for development of cervical cancer and its precursor lesions. In women with or without abnormal cervical smears a positive high-risk HPV test result indicates an increased risk for development of high grade cervical lesions (Ho et al, 1995;Remmink et al, 1995;Rozendaal et al, 1996Rozendaal et al, , 2000Nobbenhuis et al, 1999). Moreover, in nearly all cervical cancers high-risk HPV types have been detected .…”

Extended duration of the detectable stage by adding HPV test in cervical cancer screening

“…The study population, and screening and follow-up results are described in Rozendaal et al (1996Rozendaal et al ( , 2000. Briefly, the smears obtained during routine screening from 1988 to 1991, from a cohort of 2250 women aged 34 -54 years, who were either normal or who showed borderline nuclear changes were tested for a highrisk HPV.…”

“…Using the results of the Rozendaal study, the duration of the HPV infection and the probability that the HPV infection will progress to CIN III were estimated. On the basis of these estimates, it was possible to calculate the cumulative incidence of CIN III within 5 years after the smear was taken; the current screening interval in the Netherlands, per 1000 cytologically negative women and the cumulative incidence of CIN III within 10 years after the smear was taken per 1000 cytologically negative/HPV negative women.Initially, it was assumed that there were no diagnostic errors, that is, the results of the HPV test and the Pap smear as found by Rozendaal et al (2000) reflected the true disease stage of the women. We used this as our reference model.…”

“…An analysis of a longitudinal study suggests that women with a negative Pap smear and a negative HPV test have a strongly reduced risk of developing cervical abnormalities in the years following the test, and that HPV testing lengthens the detectable stage by 2 -5 years, compared to Pap smear detection alone. One of the possible uses of the human papillomavirus test (HPV) is in primary cervical cancer screening in addition to or instead of the current Pap smear (Cuzick et al, 1999a;Cuzick, 2000;Meijer and Walboomers, 2000).…”

“…However, available data can be explored to derive preliminary estimates for parameters that determine the cost-effectiveness of HPV testing. This study investigates the duration of the detectable preclinical stage using the results of Rozendaal et al (2000). For these estimates, the 5-year cumulative incidence of cervical intraepithelial neoplasia (CIN) III after a negative Pap smear, the current screening interval in the Netherlands, is compared with the cumulative incidence within a doubled screening interval of 10 years (Meijer and Walboomers, 2000) in case of a negative Pap smear and a negative HPV test.…”