Referral population studies underestimate differences between human papillomavirus assays in primary cervical screening.
Cytopathology
; 28(5): 419-428, 2017 Oct.
Article
em En
| MEDLINE
| ID: mdl-28901682
ABSTRACT
OBJECTIVE:
We studied how representative cytologically abnormal women ("referral populations") are with respect to uncovering differences between human papillomavirus (HPV) assays in the primary screening where most women are cytologically normal.METHODS:
A total of 4997 women were tested with SurePath® cytology, and Hybrid Capture 2 (HC2), cobas, CLART and APTIMA HPV assays. Women with positive test results were offered a follow-up. For all detected HPV infections and HPV-positive high-grade cervical intraepithelial neoplasia (≥CIN2), we studied the distributions of assay-specific signal strengths in the baseline samples as documented by the assays' automatically generated reports. We calculated the likelihood of test result discordance as the proportion of HPV-positive samples that were not confirmed by all four assays.RESULTS:
Median signal strengths for HPV infections were weaker in normal than abnormal cytology (P<.001, adjusted for women's age, multiple infections and the reason for taking the sample). For HC2, they were RLU/CO 11.0 (interquartile range, IQR 3.3-52.8) vs 124.2 (IQR 22.8-506.9), respectively; for cobas, Ct 33.5 (IQR 29.6-37.5) vs 26.9 (IQR 23.7-31.3), respectively; for APTIMA, S/CO 10.2 (IQR 5.8-11.3) vs 11.1 (IQR 9.4-15.5), respectively. Similar patterns were observed for HPV-positive ≥CIN2. The four HPV assays more frequently returned discordant test results in normal than in abnormal cytology. Relative frequency of discordance in detecting HPV infections was 0.39 (95% confidence interval 0.33-0.48) for abnormal vs normal cytology.CONCLUSIONS:
These data suggest that referral population studies, by not including sufficient numbers of cytology normal women, underestimate the differences between HPV assays that would become apparent in primary screening.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Displasia do Colo do Útero
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Citodiagnóstico
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Infecções por Papillomavirus
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Detecção Precoce de Câncer
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
/
Screening_studies
Limite:
Adult
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Aged
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Female
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Humans
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Middle aged
/
Pregnancy
Idioma:
En
Revista:
Cytopathology
Assunto da revista:
PATOLOGIA
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Dinamarca