Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot
BACKGROUND Overcalling of abnormalities has been a concern for using cytology triage after positive high‐risk human papillomavirus (HPV) tests in cervical screening. METHODS The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the Eng...
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| Veröffentlicht in: | Cancer cytopathology 2022-07, Vol.130 (7), p.531-541 |
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| creator | Rebolj, Matejka Mathews, Christopher S. Denton, Karin Appleyard, Tracey‐Louise Cruickshank, Margaret Cuschieri, Kate Ellis, Kay Evans, Chris Frew, Viki Giles, Thomas Gray, Alastair Holbrook, Miles Hunt, Katherine Kitchener, Henry Levine, Tanya McBride, Emily Mesher, David Palmer, Timothy Parker, Janet Rimmer, Elizabeth Rudge Pickard, Hazel Sargent, Alexandra Smith, David Smith, John Soldan, Kate Stubbs, Ruth Tidy, John Tyler, Xenia Waller, Jo |
| description | BACKGROUND
Overcalling of abnormalities has been a concern for using cytology triage after positive high‐risk human papillomavirus (HPV) tests in cervical screening.
METHODS
The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the English HPV pilot. The pilot compared routine implementation of primary cervical screening based on cytology (N = 931,539), where HPV test results were not available before cytology reporting, with that based on HPV testing (N = 403,269), where cytology was only required after positive HPV tests.
RESULTS
Revealed HPV positivity was associated with a higher direct referral to colposcopy after any abnormality (adjusted odds ratio [ORadj], 1.16; 95% confidence interval [CI], 1.14‐1.18). Laboratories with higher direct referral referred fewer persistently HPV‐positive women after early recall. The detection of high‐grade cervical intraepithelial neoplasia (CIN2+) after direct referral increased with an ORadj of 1.17 (95% CI, 1.13‐1.20) for informed versus uninformed cytology. Generally, the positive predictive value (PPV) of colposcopy for CIN2+ remained comparable under both conditions of interpreting cytology. In women 50 to 64 years old with high‐grade dyskaryosis, however, the PPV increased from 71% to 83% after revealing HPV positivity (ORadj, 2.05; 95% CI, 1.43‐2.93).
CONCLUSIONS
Quality‐controlled cervical screening programs can avoid inappropriate overgrading of HPV‐positive cytology.;
These population‐based data show that the interpretation of triage cytology informed by a positive human papillomavirus (HPV) test can contribute to a higher overall detection of high‐grade cervical intraepithelial neoplasia without a concomitant increase in overreferral of low‐risk women. The practices used in England, where the national cervical screening program is quality‐assured using rigorous national standards, may serve as a model for screening settings where revealing HPV positivity has led to overgrading of cytology. |
| doi_str_mv | 10.1002/cncy.22572 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2647212068</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2684529585</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3932-6f801d301be3c93aad1adf2f9d5efcfd68e5951b510357c71a9bd14030aa9cd53</originalsourceid><addsrcrecordid>eNp9kU1P3DAQhq0KVL566Q-oLHGpkBb8sU5iblUEBQlBD6VqT5Fjj3eNsvFiO61y4q_XYRcOHDh5PPPokWZehD5TckoJYWe61-MpY6JkH9A-lXw-Kwpe7bzW7PceOojxgRBalYx-RHtc8LKURbmPnuox-c4vRuz6BGEdIKnkfI-VzV-ssF6qfgE4eXz14xdOEJPrFxnG6-BWKoxYQ_jrtOpw1AGgz9NzfNfG3H0WTYM0mBHb4Fc4LQFf9IvOxSVeu86nI7RrVRfh0_Y9RPeXFz_rq9nN3ffr-tvNTHPJ2aywFaGGE9oC15IrZagylllpBFhtTVGBkIK2ghIuSl1SJVtD54QTpaQ2gh-irxvvOvjHIW_RrFzU0HWqBz_EhhXzfBpGiiqjx2_QBz-EvMhEVXPBpKgm4cmG0sHHGMA224M0lDRTLM0US_McS4a_bJVDuwLzir7kkAG6Af65DsZ3VE19W__ZSP8DtvCaCA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2684529585</pqid></control><display><type>article</type><title>Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Rebolj, Matejka ; Mathews, Christopher S. ; Denton, Karin ; Appleyard, Tracey‐Louise ; Cruickshank, Margaret ; Cuschieri, Kate ; Ellis, Kay ; Evans, Chris ; Frew, Viki ; Giles, Thomas ; Gray, Alastair ; Holbrook, Miles ; Hunt, Katherine ; Kitchener, Henry ; Levine, Tanya ; McBride, Emily ; Mesher, David ; Palmer, Timothy ; Parker, Janet ; Rimmer, Elizabeth ; Rudge Pickard, Hazel ; Sargent, Alexandra ; Smith, David ; Smith, John ; Soldan, Kate ; Stubbs, Ruth ; Tidy, John ; Tyler, Xenia ; Waller, Jo</creator><creatorcontrib>Rebolj, Matejka ; Mathews, Christopher S. ; Denton, Karin ; Appleyard, Tracey‐Louise ; Cruickshank, Margaret ; Cuschieri, Kate ; Ellis, Kay ; Evans, Chris ; Frew, Viki ; Giles, Thomas ; Gray, Alastair ; Holbrook, Miles ; Hunt, Katherine ; Kitchener, Henry ; Levine, Tanya ; McBride, Emily ; Mesher, David ; Palmer, Timothy ; Parker, Janet ; Rimmer, Elizabeth ; Rudge Pickard, Hazel ; Sargent, Alexandra ; Smith, David ; Smith, John ; Soldan, Kate ; Stubbs, Ruth ; Tidy, John ; Tyler, Xenia ; Waller, Jo ; HPV Pilot Steering Group ; for the HPV Pilot Steering Group</creatorcontrib><description>BACKGROUND
Overcalling of abnormalities has been a concern for using cytology triage after positive high‐risk human papillomavirus (HPV) tests in cervical screening.
METHODS
The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the English HPV pilot. The pilot compared routine implementation of primary cervical screening based on cytology (N = 931,539), where HPV test results were not available before cytology reporting, with that based on HPV testing (N = 403,269), where cytology was only required after positive HPV tests.
RESULTS
Revealed HPV positivity was associated with a higher direct referral to colposcopy after any abnormality (adjusted odds ratio [ORadj], 1.16; 95% confidence interval [CI], 1.14‐1.18). Laboratories with higher direct referral referred fewer persistently HPV‐positive women after early recall. The detection of high‐grade cervical intraepithelial neoplasia (CIN2+) after direct referral increased with an ORadj of 1.17 (95% CI, 1.13‐1.20) for informed versus uninformed cytology. Generally, the positive predictive value (PPV) of colposcopy for CIN2+ remained comparable under both conditions of interpreting cytology. In women 50 to 64 years old with high‐grade dyskaryosis, however, the PPV increased from 71% to 83% after revealing HPV positivity (ORadj, 2.05; 95% CI, 1.43‐2.93).
CONCLUSIONS
Quality‐controlled cervical screening programs can avoid inappropriate overgrading of HPV‐positive cytology.;
These population‐based data show that the interpretation of triage cytology informed by a positive human papillomavirus (HPV) test can contribute to a higher overall detection of high‐grade cervical intraepithelial neoplasia without a concomitant increase in overreferral of low‐risk women. The practices used in England, where the national cervical screening program is quality‐assured using rigorous national standards, may serve as a model for screening settings where revealing HPV positivity has led to overgrading of cytology.</description><identifier>ISSN: 1934-662X</identifier><identifier>EISSN: 1934-6638</identifier><identifier>DOI: 10.1002/cncy.22572</identifier><identifier>PMID: 35377967</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Cellular biology ; Cervical cancer ; Colposcopy ; cytology ; Early Detection of Cancer - methods ; Female ; Human papillomavirus ; Humans ; mass screening ; Mass Screening - methods ; Medical screening ; Middle Aged ; Observational studies ; Papillomaviridae ; Papillomavirus Infections ; Pregnancy ; Uterine Cervical Dysplasia ; Uterine Cervical Neoplasms ; Vaginal Smears ; Young Adult</subject><ispartof>Cancer cytopathology, 2022-07, Vol.130 (7), p.531-541</ispartof><rights>2022 The Authors. published by Wiley Periodicals LLC on behalf of American Cancer Society.</rights><rights>2022 The Authors. Cancer Cytopathology published by Wiley Periodicals LLC on behalf of American Cancer Society.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3932-6f801d301be3c93aad1adf2f9d5efcfd68e5951b510357c71a9bd14030aa9cd53</citedby><cites>FETCH-LOGICAL-c3932-6f801d301be3c93aad1adf2f9d5efcfd68e5951b510357c71a9bd14030aa9cd53</cites><orcidid>0000-0001-9597-645X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncy.22572$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncy.22572$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35377967$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rebolj, Matejka</creatorcontrib><creatorcontrib>Mathews, Christopher S.</creatorcontrib><creatorcontrib>Denton, Karin</creatorcontrib><creatorcontrib>Appleyard, Tracey‐Louise</creatorcontrib><creatorcontrib>Cruickshank, Margaret</creatorcontrib><creatorcontrib>Cuschieri, Kate</creatorcontrib><creatorcontrib>Ellis, Kay</creatorcontrib><creatorcontrib>Evans, Chris</creatorcontrib><creatorcontrib>Frew, Viki</creatorcontrib><creatorcontrib>Giles, Thomas</creatorcontrib><creatorcontrib>Gray, Alastair</creatorcontrib><creatorcontrib>Holbrook, Miles</creatorcontrib><creatorcontrib>Hunt, Katherine</creatorcontrib><creatorcontrib>Kitchener, Henry</creatorcontrib><creatorcontrib>Levine, Tanya</creatorcontrib><creatorcontrib>McBride, Emily</creatorcontrib><creatorcontrib>Mesher, David</creatorcontrib><creatorcontrib>Palmer, Timothy</creatorcontrib><creatorcontrib>Parker, Janet</creatorcontrib><creatorcontrib>Rimmer, Elizabeth</creatorcontrib><creatorcontrib>Rudge Pickard, Hazel</creatorcontrib><creatorcontrib>Sargent, Alexandra</creatorcontrib><creatorcontrib>Smith, David</creatorcontrib><creatorcontrib>Smith, John</creatorcontrib><creatorcontrib>Soldan, Kate</creatorcontrib><creatorcontrib>Stubbs, Ruth</creatorcontrib><creatorcontrib>Tidy, John</creatorcontrib><creatorcontrib>Tyler, Xenia</creatorcontrib><creatorcontrib>Waller, Jo</creatorcontrib><creatorcontrib>HPV Pilot Steering Group</creatorcontrib><creatorcontrib>for the HPV Pilot Steering Group</creatorcontrib><title>Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot</title><title>Cancer cytopathology</title><addtitle>Cancer Cytopathol</addtitle><description>BACKGROUND
Overcalling of abnormalities has been a concern for using cytology triage after positive high‐risk human papillomavirus (HPV) tests in cervical screening.
METHODS
The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the English HPV pilot. The pilot compared routine implementation of primary cervical screening based on cytology (N = 931,539), where HPV test results were not available before cytology reporting, with that based on HPV testing (N = 403,269), where cytology was only required after positive HPV tests.
RESULTS
Revealed HPV positivity was associated with a higher direct referral to colposcopy after any abnormality (adjusted odds ratio [ORadj], 1.16; 95% confidence interval [CI], 1.14‐1.18). Laboratories with higher direct referral referred fewer persistently HPV‐positive women after early recall. The detection of high‐grade cervical intraepithelial neoplasia (CIN2+) after direct referral increased with an ORadj of 1.17 (95% CI, 1.13‐1.20) for informed versus uninformed cytology. Generally, the positive predictive value (PPV) of colposcopy for CIN2+ remained comparable under both conditions of interpreting cytology. In women 50 to 64 years old with high‐grade dyskaryosis, however, the PPV increased from 71% to 83% after revealing HPV positivity (ORadj, 2.05; 95% CI, 1.43‐2.93).
CONCLUSIONS
Quality‐controlled cervical screening programs can avoid inappropriate overgrading of HPV‐positive cytology.;
These population‐based data show that the interpretation of triage cytology informed by a positive human papillomavirus (HPV) test can contribute to a higher overall detection of high‐grade cervical intraepithelial neoplasia without a concomitant increase in overreferral of low‐risk women. The practices used in England, where the national cervical screening program is quality‐assured using rigorous national standards, may serve as a model for screening settings where revealing HPV positivity has led to overgrading of cytology.</description><subject>Adult</subject><subject>Cellular biology</subject><subject>Cervical cancer</subject><subject>Colposcopy</subject><subject>cytology</subject><subject>Early Detection of Cancer - methods</subject><subject>Female</subject><subject>Human papillomavirus</subject><subject>Humans</subject><subject>mass screening</subject><subject>Mass Screening - methods</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Papillomaviridae</subject><subject>Papillomavirus Infections</subject><subject>Pregnancy</subject><subject>Uterine Cervical Dysplasia</subject><subject>Uterine Cervical Neoplasms</subject><subject>Vaginal Smears</subject><subject>Young Adult</subject><issn>1934-662X</issn><issn>1934-6638</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp9kU1P3DAQhq0KVL566Q-oLHGpkBb8sU5iblUEBQlBD6VqT5Fjj3eNsvFiO61y4q_XYRcOHDh5PPPokWZehD5TckoJYWe61-MpY6JkH9A-lXw-Kwpe7bzW7PceOojxgRBalYx-RHtc8LKURbmPnuox-c4vRuz6BGEdIKnkfI-VzV-ssF6qfgE4eXz14xdOEJPrFxnG6-BWKoxYQ_jrtOpw1AGgz9NzfNfG3H0WTYM0mBHb4Fc4LQFf9IvOxSVeu86nI7RrVRfh0_Y9RPeXFz_rq9nN3ffr-tvNTHPJ2aywFaGGE9oC15IrZagylllpBFhtTVGBkIK2ghIuSl1SJVtD54QTpaQ2gh-irxvvOvjHIW_RrFzU0HWqBz_EhhXzfBpGiiqjx2_QBz-EvMhEVXPBpKgm4cmG0sHHGMA224M0lDRTLM0US_McS4a_bJVDuwLzir7kkAG6Af65DsZ3VE19W__ZSP8DtvCaCA</recordid><startdate>202207</startdate><enddate>202207</enddate><creator>Rebolj, Matejka</creator><creator>Mathews, Christopher S.</creator><creator>Denton, Karin</creator><creator>Appleyard, Tracey‐Louise</creator><creator>Cruickshank, Margaret</creator><creator>Cuschieri, Kate</creator><creator>Ellis, Kay</creator><creator>Evans, Chris</creator><creator>Frew, Viki</creator><creator>Giles, Thomas</creator><creator>Gray, Alastair</creator><creator>Holbrook, Miles</creator><creator>Hunt, Katherine</creator><creator>Kitchener, Henry</creator><creator>Levine, Tanya</creator><creator>McBride, Emily</creator><creator>Mesher, David</creator><creator>Palmer, Timothy</creator><creator>Parker, Janet</creator><creator>Rimmer, Elizabeth</creator><creator>Rudge Pickard, Hazel</creator><creator>Sargent, Alexandra</creator><creator>Smith, David</creator><creator>Smith, John</creator><creator>Soldan, Kate</creator><creator>Stubbs, Ruth</creator><creator>Tidy, John</creator><creator>Tyler, Xenia</creator><creator>Waller, Jo</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9597-645X</orcidid></search><sort><creationdate>202207</creationdate><title>Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot</title><author>Rebolj, Matejka ; Mathews, Christopher S. ; Denton, Karin ; Appleyard, Tracey‐Louise ; Cruickshank, Margaret ; Cuschieri, Kate ; Ellis, Kay ; Evans, Chris ; Frew, Viki ; Giles, Thomas ; Gray, Alastair ; Holbrook, Miles ; Hunt, Katherine ; Kitchener, Henry ; Levine, Tanya ; McBride, Emily ; Mesher, David ; Palmer, Timothy ; Parker, Janet ; Rimmer, Elizabeth ; Rudge Pickard, Hazel ; Sargent, Alexandra ; Smith, David ; Smith, John ; Soldan, Kate ; Stubbs, Ruth ; Tidy, John ; Tyler, Xenia ; Waller, Jo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3932-6f801d301be3c93aad1adf2f9d5efcfd68e5951b510357c71a9bd14030aa9cd53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Cellular biology</topic><topic>Cervical cancer</topic><topic>Colposcopy</topic><topic>cytology</topic><topic>Early Detection of Cancer - methods</topic><topic>Female</topic><topic>Human papillomavirus</topic><topic>Humans</topic><topic>mass screening</topic><topic>Mass Screening - methods</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Papillomaviridae</topic><topic>Papillomavirus Infections</topic><topic>Pregnancy</topic><topic>Uterine Cervical Dysplasia</topic><topic>Uterine Cervical Neoplasms</topic><topic>Vaginal Smears</topic><topic>Young Adult</topic><toplevel>online_resources</toplevel><creatorcontrib>Rebolj, Matejka</creatorcontrib><creatorcontrib>Mathews, Christopher S.</creatorcontrib><creatorcontrib>Denton, Karin</creatorcontrib><creatorcontrib>Appleyard, Tracey‐Louise</creatorcontrib><creatorcontrib>Cruickshank, Margaret</creatorcontrib><creatorcontrib>Cuschieri, Kate</creatorcontrib><creatorcontrib>Ellis, Kay</creatorcontrib><creatorcontrib>Evans, Chris</creatorcontrib><creatorcontrib>Frew, Viki</creatorcontrib><creatorcontrib>Giles, Thomas</creatorcontrib><creatorcontrib>Gray, Alastair</creatorcontrib><creatorcontrib>Holbrook, Miles</creatorcontrib><creatorcontrib>Hunt, Katherine</creatorcontrib><creatorcontrib>Kitchener, Henry</creatorcontrib><creatorcontrib>Levine, Tanya</creatorcontrib><creatorcontrib>McBride, Emily</creatorcontrib><creatorcontrib>Mesher, David</creatorcontrib><creatorcontrib>Palmer, Timothy</creatorcontrib><creatorcontrib>Parker, Janet</creatorcontrib><creatorcontrib>Rimmer, Elizabeth</creatorcontrib><creatorcontrib>Rudge Pickard, Hazel</creatorcontrib><creatorcontrib>Sargent, Alexandra</creatorcontrib><creatorcontrib>Smith, David</creatorcontrib><creatorcontrib>Smith, John</creatorcontrib><creatorcontrib>Soldan, Kate</creatorcontrib><creatorcontrib>Stubbs, Ruth</creatorcontrib><creatorcontrib>Tidy, John</creatorcontrib><creatorcontrib>Tyler, Xenia</creatorcontrib><creatorcontrib>Waller, Jo</creatorcontrib><creatorcontrib>HPV Pilot Steering Group</creatorcontrib><creatorcontrib>for the HPV Pilot Steering Group</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer cytopathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rebolj, Matejka</au><au>Mathews, Christopher S.</au><au>Denton, Karin</au><au>Appleyard, Tracey‐Louise</au><au>Cruickshank, Margaret</au><au>Cuschieri, Kate</au><au>Ellis, Kay</au><au>Evans, Chris</au><au>Frew, Viki</au><au>Giles, Thomas</au><au>Gray, Alastair</au><au>Holbrook, Miles</au><au>Hunt, Katherine</au><au>Kitchener, Henry</au><au>Levine, Tanya</au><au>McBride, Emily</au><au>Mesher, David</au><au>Palmer, Timothy</au><au>Parker, Janet</au><au>Rimmer, Elizabeth</au><au>Rudge Pickard, Hazel</au><au>Sargent, Alexandra</au><au>Smith, David</au><au>Smith, John</au><au>Soldan, Kate</au><au>Stubbs, Ruth</au><au>Tidy, John</au><au>Tyler, Xenia</au><au>Waller, Jo</au><aucorp>HPV Pilot Steering Group</aucorp><aucorp>for the HPV Pilot Steering Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot</atitle><jtitle>Cancer cytopathology</jtitle><addtitle>Cancer Cytopathol</addtitle><date>2022-07</date><risdate>2022</risdate><volume>130</volume><issue>7</issue><spage>531</spage><epage>541</epage><pages>531-541</pages><issn>1934-662X</issn><eissn>1934-6638</eissn><abstract>BACKGROUND
Overcalling of abnormalities has been a concern for using cytology triage after positive high‐risk human papillomavirus (HPV) tests in cervical screening.
METHODS
The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the English HPV pilot. The pilot compared routine implementation of primary cervical screening based on cytology (N = 931,539), where HPV test results were not available before cytology reporting, with that based on HPV testing (N = 403,269), where cytology was only required after positive HPV tests.
RESULTS
Revealed HPV positivity was associated with a higher direct referral to colposcopy after any abnormality (adjusted odds ratio [ORadj], 1.16; 95% confidence interval [CI], 1.14‐1.18). Laboratories with higher direct referral referred fewer persistently HPV‐positive women after early recall. The detection of high‐grade cervical intraepithelial neoplasia (CIN2+) after direct referral increased with an ORadj of 1.17 (95% CI, 1.13‐1.20) for informed versus uninformed cytology. Generally, the positive predictive value (PPV) of colposcopy for CIN2+ remained comparable under both conditions of interpreting cytology. In women 50 to 64 years old with high‐grade dyskaryosis, however, the PPV increased from 71% to 83% after revealing HPV positivity (ORadj, 2.05; 95% CI, 1.43‐2.93).
CONCLUSIONS
Quality‐controlled cervical screening programs can avoid inappropriate overgrading of HPV‐positive cytology.;
These population‐based data show that the interpretation of triage cytology informed by a positive human papillomavirus (HPV) test can contribute to a higher overall detection of high‐grade cervical intraepithelial neoplasia without a concomitant increase in overreferral of low‐risk women. The practices used in England, where the national cervical screening program is quality‐assured using rigorous national standards, may serve as a model for screening settings where revealing HPV positivity has led to overgrading of cytology.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35377967</pmid><doi>10.1002/cncy.22572</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-9597-645X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Cellular biology Cervical cancer Colposcopy cytology Early Detection of Cancer - methods Female Human papillomavirus Humans mass screening Mass Screening - methods Medical screening Middle Aged Observational studies Papillomaviridae Papillomavirus Infections Pregnancy Uterine Cervical Dysplasia Uterine Cervical Neoplasms Vaginal Smears Young Adult |
| title | Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot |
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