Evaluation of 14 triage strategies for HPV DNA-positive women in population-based cervical screening

✍ Scribed by Dorien C. Rijkaart; Johannes Berkhof; Folkert J. van Kemenade; Veerle M.H. Coupe; Albertus T. Hesselink; Lawrence Rozendaal; Danielle A.M. Heideman; Ren H. Verheijen; Saskia Bulk; Wim M. Verweij; Peter J.F. Snijders; Chris J.L.M. Meijer

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: French
• Weight: 335 KB
• Volume: 130
• Category: Article
• ISSN: 0020-7136
• DOI: 10.1002/ijc.26056

✦ Synopsis

Abstract

High‐risk human papillomavirus (hrHPV) testing has a higher sensitivity but lower specificity than cytology for detection of high‐grade intraepithelial neoplasia (CIN). To avoid over‐referral to colposcopy and overtreatment, hrHPV‐positive women require triage testing and/or followup. A total of 25,658 women (30–60 years) enrolled in a population‐based cohort study had an adequate baseline Pap smear and hrHPV test. The end‐point was cumulative two‐year risk of CIN grade 3 or worse (CIN3+). In a post‐hoc analysis, fourteen triage/followup strategies for hrHPV‐positive women (n = 1,303) were evaluated for colposcopy referral rate, positive (PPV) and negative predictive value (NPV). Five strategies involved triage testing without a repeat test and nine strategies involved triage testing followed by one repeat testing. The tests were cytology, hrHPV, HPV16/18 genotyping and HPV16/18/31/33/45 genotyping. Results were adjusted for women in the cohort study who did not attend repeat testing. Of the strategies without repeat testing, combined cytology and HPV16/18/31/33/45 genotyping gave the highest NPV of 98.9% (95%CI 97.6–99.5%). The corresponding colposcopy referral rate was 58.1% (95%CI 55.4–60.8%). Eight of the nine strategies with retesting had an estimated NPV of at least 98%. Of those, cytology triage followed by cytology at 12 months had a markedly lower colposcopy referral rate of 33.4% (95%CI 30.2–36.7%) than the other strategies. The NPV of the latter strategy was 99.3% (95%CI 98.1–99.8%). Triage hrHPV‐positive women with cytology, followed by repeat cytology testing yielded a high NPV and modest colposcopy referral rate and appear to be the most feasible management strategy.