Use of Automated Analysis of Cervical Cytology for the Detection of High-Grade Squamous Intraepithelial Lesions in Human Papillomavirus-Positive Women: A Future Practice?

Vassilakos, Pierre; Catarino, Rosa; Petignat, Patrick

doi:10.1159/000481909

Cited by 1 publication

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“…3 4 This could be useful in the triage of HPVpositive women as it provides accurate prognostic information without the need of visual assessment. [5][6][7] An alternative to triage is to use HPV-16/18 genotyping as a molecular marker reflecting the underlying carcinogenic process, 8 allowing HPV-16/18-positive women to be directly referred to colposcopy. 9 Finally, the WHO recommends primary screening with HPV testing in low-and middle-income countries if resources are available, followed by visual inspection with acetic acid for triage and immediate treatment if positive.…”

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confidence: 99%

A cross-sectional study exploring triage of human papillomavirus (HPV)-positive women by visual assessment, manual and computer-interpreted cytology, and HPV-16/18–45 genotyping in Cameroon

Vassilakos

Wisniak

Catarino

et al. 2021

Int J Gynecol Cancer

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BackgroundHigh-risk human papillomavirus (HPV)-positive women require triage to identify those at higher risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). We aimed to compare visual assessment of the cervix, manual cytology and automated cytology as triage tests to screen HPV-positive women, and to assess over-treatment rates after visual assessment and over-referral rates to colposcopy after cytology.MethodsThe present cross-sectional study is nested in a large prospective screening trial in Cameroon. Evaluations of the tests have been conducted individually and in combination with HPV-16/HPV-18/45 genotyping. For the evaluation of over-treatment and colposcopic over-referral, we simulated two screening scenarios: (1) one-visit scenario (test-triage-and-treatment); and (2) two-visit scenario (test-triage-and-colposcopy).Results1582 women with a median age of 40 years (IQR 35–45) performed self-sampling for HPV testing, of which 294 (18.6%) were HPV-positive, and 12.2% had CIN2+. Sensitivities for CIN2+ detection were 77.1% for visual assessment, 80.0% for manual cytology, and 84.8% for automated cytology. Sensitivity of combined tests was higher compared with single tests. The highest sensitivity was obtained by the combination of genotyping and automated cytology (91.2%). In the one-visit scenario, the over-treatment rate was 83.9% in referred women, with a ratio of 6.2 treated women per CIN2+. In the two-visit scenario, the lowest over-referral rate would have been under manual cytology (45.0%), with a ratio of 1.8 referred women per CIN2+. Single and combined triage strategies by automated cytology gave rise to over-referral rates of 69.2% and 76.7%, respectively, and a ratio of 3.2 and 4.3 referred women per CIN2+, respectively.DiscussionTriage of HPV-positive women using a combination of genotyping and automated cytology for CIN2+ detection may provide public benefits in low- and middle-income countries.

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