Clinical significance of high-risk HPV-DNA detection combined with TCT in screening and follow-up of cervical lesions / 上海预防医学

ObjectiveTo explore the application value of high-risk HPV-DNA detection combined with TCT in cervical lesion screening and follow-up. MethodsThis study was conducted from February 2019 to February 2021. During this period， 241 subjects who were the patients referred from the primary community hospitals to the center for re-examination of cervical lesions. Of which 80 were patients with cervical intraepithelial neoplasia. Liquid-based cytology （TCT） technology was used to examine the cervical cytological morphology. The second-generation high-throughput sequencing technology and time-of-flight mass spectrometry technology， independently developed by BGI， were used to screen for HPV-DNA typing. At the same time， biopsy sampling was carried out， and the final pathological diagnosis was made. TCT detection and combined HPV-DNA detection were performed on 80 patients to compare the relationship between TCT alone and TCT/HPV-DNA combined test for the diagnosis and prognosis of CIN Ⅱ and CIN Ⅲ. Follow-up was conducted， and the HPV infection and TCT were re-tested. ResultsAmong the 80 cases of cervical intraepithelial neoplasia， 41 cases （51.25%） were between 35 and 44 years old， higher than the other age groups （P<0.001）. Compared with either TCT or HPV-DNA， TCT combined with HPV-DNA had obvious advantages in sensitivity， specificity， positive predictive value， and negative predictive value （P<0.05）. The recurrence rate in CIN Ⅱ and CIN Ⅲ groups was 9.52% and 16.67% respectively after 18 months of the follow-up. ConclusionTCT detection plays a positive role in cervical pre-cancer screening. By combining high-risk HPV-DNA typing and TCT detection， the detection values of sensitivity and specificity are significantly higher， which can improve the accuracy of cervical lesion screening and is of great significance for the follow-up work.

Discussing Cervical Cancer Screening Options: Outcomes to Guide Conversations Between Patients and Providers.

Purpose. In 2018, the US Preventive Services Task Force (USPSTF) endorsed three strategies for cervical cancer screening in women ages 30 to 65: cytology every 3 years, testing for high-risk types of human papillomavirus (hrHPV) every 5 years, and cytology plus hrHPV testing (co-testing) every 5 years. It further recommended that women discuss with health care providers which testing strategy is best for them. To inform such discussions, we used decision analysis to estimate outcomes of screening strategies recommended for women at age 30. Methods. We constructed a Markov decision model using estimates of the natural history of HPV and cervical neoplasia. We evaluated the three USPSTF-endorsed strategies, hrHPV testing every 3 years and no screening. Outcomes included colposcopies with biopsy, false-positive testing (a colposcopy in which no cervical intraepithelial neoplasia grade 2 or worse was found), treatments, cancers, and cancer mortality expressed per 10,000 women over a shorter-than-lifetime horizon (15-year). Results. All strategies resulted in substantially lower cancer and cancer death rates compared with no screening. Strategies with the lowest likelihood of cancer and cancer death generally had higher likelihood of colposcopy and false-positive testing. Conclusions. The screening strategies we evaluated involved tradeoffs in terms of benefits and harms. Because individual women may place different weights on these projected outcomes, the optimal choice for each woman may best be discerned through shared decision making.

NILM Pap slides from women 30 years of age and older with positive high-risk HPV DNA. Focused rescreening prior to report issuance, an enhanced quality control measure.

OBJECTIVES: Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) regulations specify that at least 10% of negative Papanicolaou (Pap) slides be rescreened as a quality control (QC) measure. With incorporation of human papillomavirus (HPV) DNA testing into screening guidelines for women aged 30 years or older, a population of patients exists who are HPV positive as well as negative for intraepithelial lesion or malignancy (NILM). METHODS: In this 9-month retrospective review with follow-up, 26,501 women 30 years of age and older underwent liquid-based Pap screening with concomitant high-risk HPV DNA testing at CellNetix Pathology and Laboratories, Seattle, WA. Of these women, 1,096 (4.1%) were originally interpreted by cytotechnologists as NILM with HPV DNA positivity. RESULTS: On rescreening, 13.9% (152/1,096) of patients were upgraded to atypical squamous cells and higher, with 2.8% being upgraded to low-grade squamous intraepithelial lesion (LSIL) and higher. Historical routine QC measures from the same period showed that 0.3% of cases were upgraded to LSIL and higher, representing a statistically significant increase in the detection of cases with LSIL and higher (χ(2) two-tailed P < .0001). CONCLUSIONS: Focused rescreening of this enriched subpopulation of patients who are NILM and high-risk HPV DNA positive enhances QC. An inherent potential bias in study design is recognized because results of DNA testing were, by definition, known at the time of rescreening result interpretations.