Reflex cytology for triage of high‐risk human papillomavirus positive self‐sampled material in cervical cancer screening: a prospective cohort study
Objective High‐risk human papillomavirus (HrHPV)‐positive women detected by self‐sampling require an extra visit at the general practitioner for additional cytology testing, but the loss to follow up within this triage is substantial. The aim of this study was to evaluate the clinical utility of ref...
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| Veröffentlicht in: | BJOG : an international journal of obstetrics and gynaecology 2020-12, Vol.127 (13), p.1656-1663 |
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| container_title | BJOG : an international journal of obstetrics and gynaecology |
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| creator | Loopik, DL Melchers, WJG Vedder, JEM Brule, AJC Massuger, LFAG Bekkers, RLM Siebers, AG |
| description | Objective
High‐risk human papillomavirus (HrHPV)‐positive women detected by self‐sampling require an extra visit at the general practitioner for additional cytology testing, but the loss to follow up within this triage is substantial. The aim of this study was to evaluate the clinical utility of reflex cytology on hrHPV‐positive self‐samples for immediate stratification of women who need referral for colposcopy.
Design
A prospective cohort study.
Setting
Two Dutch cervical cancer‐screening laboratories.
Population
1014 screenees who tested hrHPV‐positive on self‐samples between 1 December 2018 and 1 August 2019.
Methods
Self‐samples were directly used for cytological analysis. Cytological and histological outcomes during follow up were obtained from the Dutch Pathology Registry (PALGA).
Main outcome measures
Test performance of reflex cytology on self‐samples was determined for different thresholds and compared with physician‐taken cytology and histological outcomes.
Results
Reflex cytology on self‐samples for detecting abnormal cytology showed a sensitivity of 26.4% (95% CI 21.8–31.3) and specificity of 90.5% (95% CI 87.7–92.8). Of all ≥CIN2 cases, 29.4% (95% CI 22.5–37.1) were detected with reflex cytology on self‐samples. The positive predictive value for detection of ≥CIN2 was higher with cytology on self‐collected samples than on physician‐collected samples. Of women who were lost to follow up, 12.9% were found to have abnormal cytology on their self‐sampled material.
Conclusion
Cytology testing is achievable on hrHPV‐positive self‐samples, could decrease the loss to follow up in screening and is easily implementable in the current clinical practice. Of all hrHPV‐positive women with abnormal cytology on additional physician‐collected samples, 26.4% could have been directly referred for colposcopy if triage with reflex cytology on self‐sampled material had been performed.
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Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy.
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Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy. |
| doi_str_mv | 10.1111/1471-0528.16352 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7689810</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2458496087</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4672-fb463cb020ade42c090ca30d6c9577f18d60433a24d66344c6a905fde527a0233</originalsourceid><addsrcrecordid>eNqFkbuO1DAUhiMEYi9Q0yFLNDTZPb7EyVAgwYqrVloJQW15nJPEixMHOxlIt49AyfPxJHhmlhHQ4MZH9udP5_jPskcUzmha51SUNIeCVWdU8oLdyY4PJ3d3NeTAWXWUncR4DUAlA34_O-KsAClZeZz9-ICNw2_ELJN3vl1I4wOZgtUtEt-Qzrbdz5vvwcbPpJt7PZBRj9Y53-uNDXMko492shskEV2TyKj70WFNej1hsjhiB2IwbKxJtdFDqkk0AXGwQ_uMaDIGH0c0O4fxnQ8TidNcLw-ye412ER_e7qfZp9evPl68zS-v3ry7eHGZGyFLljdrIblZAwNdo2AGVmA0h1qaVVGWDa1qCYJzzUQtJRfCSL2CoqmxYKUGxvlp9nzvHed1j7XBYQraqTHYXodFeW3V3zeD7VTrN6qU1aqikARPbwXBf5kxTqq30aBzekA_R8UEhZIDp1VCn_yDXvs5DGm8RBWVWEmoykSd7ymTviYGbA7NUFDb1NU2Y7XNWO1STy8e_znDgf8dcwKKPfDVOlz-51Mv31_txb8AYQa8Yw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2458496087</pqid></control><display><type>article</type><title>Reflex cytology for triage of high‐risk human papillomavirus positive self‐sampled material in cervical cancer screening: a prospective cohort study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Loopik, DL ; Melchers, WJG ; Vedder, JEM ; Brule, AJC ; Massuger, LFAG ; Bekkers, RLM ; Siebers, AG</creator><creatorcontrib>Loopik, DL ; Melchers, WJG ; Vedder, JEM ; Brule, AJC ; Massuger, LFAG ; Bekkers, RLM ; Siebers, AG</creatorcontrib><description>Objective
High‐risk human papillomavirus (HrHPV)‐positive women detected by self‐sampling require an extra visit at the general practitioner for additional cytology testing, but the loss to follow up within this triage is substantial. The aim of this study was to evaluate the clinical utility of reflex cytology on hrHPV‐positive self‐samples for immediate stratification of women who need referral for colposcopy.
Design
A prospective cohort study.
Setting
Two Dutch cervical cancer‐screening laboratories.
Population
1014 screenees who tested hrHPV‐positive on self‐samples between 1 December 2018 and 1 August 2019.
Methods
Self‐samples were directly used for cytological analysis. Cytological and histological outcomes during follow up were obtained from the Dutch Pathology Registry (PALGA).
Main outcome measures
Test performance of reflex cytology on self‐samples was determined for different thresholds and compared with physician‐taken cytology and histological outcomes.
Results
Reflex cytology on self‐samples for detecting abnormal cytology showed a sensitivity of 26.4% (95% CI 21.8–31.3) and specificity of 90.5% (95% CI 87.7–92.8). Of all ≥CIN2 cases, 29.4% (95% CI 22.5–37.1) were detected with reflex cytology on self‐samples. The positive predictive value for detection of ≥CIN2 was higher with cytology on self‐collected samples than on physician‐collected samples. Of women who were lost to follow up, 12.9% were found to have abnormal cytology on their self‐sampled material.
Conclusion
Cytology testing is achievable on hrHPV‐positive self‐samples, could decrease the loss to follow up in screening and is easily implementable in the current clinical practice. Of all hrHPV‐positive women with abnormal cytology on additional physician‐collected samples, 26.4% could have been directly referred for colposcopy if triage with reflex cytology on self‐sampled material had been performed.
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Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy.
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Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy.</description><identifier>ISSN: 1470-0328</identifier><identifier>EISSN: 1471-0528</identifier><identifier>DOI: 10.1111/1471-0528.16352</identifier><identifier>PMID: 32506627</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Algorithms ; Cancer screening ; Cellular biology ; Cervical cancer ; cervical intraepithelial neoplasia ; Cohort analysis ; Cohort Studies ; Colposcopy ; Cytodiagnosis - methods ; Cytology ; Early Detection of Cancer - methods ; Family physicians ; Female ; Gynaecological Oncology ; Human papillomavirus ; Humans ; Medical referrals ; Medical screening ; Papillomaviridae - isolation & purification ; Papillomavirus Infections - diagnosis ; Prospective Studies ; Referral and Consultation ; screening ; Self Care ; self‐sampling ; Specimen Handling ; triage ; Uterine Cervical Neoplasms - diagnosis ; Uterine Cervical Neoplasms - virology</subject><ispartof>BJOG : an international journal of obstetrics and gynaecology, 2020-12, Vol.127 (13), p.1656-1663</ispartof><rights>2020 The Authors. published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists</rights><rights>2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4672-fb463cb020ade42c090ca30d6c9577f18d60433a24d66344c6a905fde527a0233</citedby><cites>FETCH-LOGICAL-c4672-fb463cb020ade42c090ca30d6c9577f18d60433a24d66344c6a905fde527a0233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1471-0528.16352$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1471-0528.16352$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32506627$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Loopik, DL</creatorcontrib><creatorcontrib>Melchers, WJG</creatorcontrib><creatorcontrib>Vedder, JEM</creatorcontrib><creatorcontrib>Brule, AJC</creatorcontrib><creatorcontrib>Massuger, LFAG</creatorcontrib><creatorcontrib>Bekkers, RLM</creatorcontrib><creatorcontrib>Siebers, AG</creatorcontrib><title>Reflex cytology for triage of high‐risk human papillomavirus positive self‐sampled material in cervical cancer screening: a prospective cohort study</title><title>BJOG : an international journal of obstetrics and gynaecology</title><addtitle>BJOG</addtitle><description>Objective
High‐risk human papillomavirus (HrHPV)‐positive women detected by self‐sampling require an extra visit at the general practitioner for additional cytology testing, but the loss to follow up within this triage is substantial. The aim of this study was to evaluate the clinical utility of reflex cytology on hrHPV‐positive self‐samples for immediate stratification of women who need referral for colposcopy.
Design
A prospective cohort study.
Setting
Two Dutch cervical cancer‐screening laboratories.
Population
1014 screenees who tested hrHPV‐positive on self‐samples between 1 December 2018 and 1 August 2019.
Methods
Self‐samples were directly used for cytological analysis. Cytological and histological outcomes during follow up were obtained from the Dutch Pathology Registry (PALGA).
Main outcome measures
Test performance of reflex cytology on self‐samples was determined for different thresholds and compared with physician‐taken cytology and histological outcomes.
Results
Reflex cytology on self‐samples for detecting abnormal cytology showed a sensitivity of 26.4% (95% CI 21.8–31.3) and specificity of 90.5% (95% CI 87.7–92.8). Of all ≥CIN2 cases, 29.4% (95% CI 22.5–37.1) were detected with reflex cytology on self‐samples. The positive predictive value for detection of ≥CIN2 was higher with cytology on self‐collected samples than on physician‐collected samples. Of women who were lost to follow up, 12.9% were found to have abnormal cytology on their self‐sampled material.
Conclusion
Cytology testing is achievable on hrHPV‐positive self‐samples, could decrease the loss to follow up in screening and is easily implementable in the current clinical practice. Of all hrHPV‐positive women with abnormal cytology on additional physician‐collected samples, 26.4% could have been directly referred for colposcopy if triage with reflex cytology on self‐sampled material had been performed.
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Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy.
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Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Cancer screening</subject><subject>Cellular biology</subject><subject>Cervical cancer</subject><subject>cervical intraepithelial neoplasia</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Colposcopy</subject><subject>Cytodiagnosis - methods</subject><subject>Cytology</subject><subject>Early Detection of Cancer - methods</subject><subject>Family physicians</subject><subject>Female</subject><subject>Gynaecological Oncology</subject><subject>Human papillomavirus</subject><subject>Humans</subject><subject>Medical referrals</subject><subject>Medical screening</subject><subject>Papillomaviridae - isolation & purification</subject><subject>Papillomavirus Infections - diagnosis</subject><subject>Prospective Studies</subject><subject>Referral and Consultation</subject><subject>screening</subject><subject>Self Care</subject><subject>self‐sampling</subject><subject>Specimen Handling</subject><subject>triage</subject><subject>Uterine Cervical Neoplasms - diagnosis</subject><subject>Uterine Cervical Neoplasms - virology</subject><issn>1470-0328</issn><issn>1471-0528</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNqFkbuO1DAUhiMEYi9Q0yFLNDTZPb7EyVAgwYqrVloJQW15nJPEixMHOxlIt49AyfPxJHhmlhHQ4MZH9udP5_jPskcUzmha51SUNIeCVWdU8oLdyY4PJ3d3NeTAWXWUncR4DUAlA34_O-KsAClZeZz9-ICNw2_ELJN3vl1I4wOZgtUtEt-Qzrbdz5vvwcbPpJt7PZBRj9Y53-uNDXMko492shskEV2TyKj70WFNej1hsjhiB2IwbKxJtdFDqkk0AXGwQ_uMaDIGH0c0O4fxnQ8TidNcLw-ye412ER_e7qfZp9evPl68zS-v3ry7eHGZGyFLljdrIblZAwNdo2AGVmA0h1qaVVGWDa1qCYJzzUQtJRfCSL2CoqmxYKUGxvlp9nzvHed1j7XBYQraqTHYXodFeW3V3zeD7VTrN6qU1aqikARPbwXBf5kxTqq30aBzekA_R8UEhZIDp1VCn_yDXvs5DGm8RBWVWEmoykSd7ymTviYGbA7NUFDb1NU2Y7XNWO1STy8e_znDgf8dcwKKPfDVOlz-51Mv31_txb8AYQa8Yw</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Loopik, DL</creator><creator>Melchers, WJG</creator><creator>Vedder, JEM</creator><creator>Brule, AJC</creator><creator>Massuger, LFAG</creator><creator>Bekkers, RLM</creator><creator>Siebers, AG</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons 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>7QP</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202012</creationdate><title>Reflex cytology for triage of high‐risk human papillomavirus positive self‐sampled material in cervical cancer screening: a prospective cohort study</title><author>Loopik, DL ; Melchers, WJG ; Vedder, JEM ; Brule, AJC ; Massuger, LFAG ; Bekkers, RLM ; Siebers, AG</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4672-fb463cb020ade42c090ca30d6c9577f18d60433a24d66344c6a905fde527a0233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>Cancer screening</topic><topic>Cellular biology</topic><topic>Cervical cancer</topic><topic>cervical intraepithelial neoplasia</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Colposcopy</topic><topic>Cytodiagnosis - methods</topic><topic>Cytology</topic><topic>Early Detection of Cancer - methods</topic><topic>Family physicians</topic><topic>Female</topic><topic>Gynaecological Oncology</topic><topic>Human papillomavirus</topic><topic>Humans</topic><topic>Medical referrals</topic><topic>Medical screening</topic><topic>Papillomaviridae - isolation & purification</topic><topic>Papillomavirus Infections - diagnosis</topic><topic>Prospective Studies</topic><topic>Referral and Consultation</topic><topic>screening</topic><topic>Self Care</topic><topic>self‐sampling</topic><topic>Specimen Handling</topic><topic>triage</topic><topic>Uterine Cervical Neoplasms - diagnosis</topic><topic>Uterine Cervical Neoplasms - virology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Loopik, DL</creatorcontrib><creatorcontrib>Melchers, WJG</creatorcontrib><creatorcontrib>Vedder, JEM</creatorcontrib><creatorcontrib>Brule, AJC</creatorcontrib><creatorcontrib>Massuger, LFAG</creatorcontrib><creatorcontrib>Bekkers, RLM</creatorcontrib><creatorcontrib>Siebers, AG</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>Calcium & Calcified Tissue Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Loopik, DL</au><au>Melchers, WJG</au><au>Vedder, JEM</au><au>Brule, AJC</au><au>Massuger, LFAG</au><au>Bekkers, RLM</au><au>Siebers, AG</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reflex cytology for triage of high‐risk human papillomavirus positive self‐sampled material in cervical cancer screening: a prospective cohort study</atitle><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle><addtitle>BJOG</addtitle><date>2020-12</date><risdate>2020</risdate><volume>127</volume><issue>13</issue><spage>1656</spage><epage>1663</epage><pages>1656-1663</pages><issn>1470-0328</issn><eissn>1471-0528</eissn><abstract>Objective
High‐risk human papillomavirus (HrHPV)‐positive women detected by self‐sampling require an extra visit at the general practitioner for additional cytology testing, but the loss to follow up within this triage is substantial. The aim of this study was to evaluate the clinical utility of reflex cytology on hrHPV‐positive self‐samples for immediate stratification of women who need referral for colposcopy.
Design
A prospective cohort study.
Setting
Two Dutch cervical cancer‐screening laboratories.
Population
1014 screenees who tested hrHPV‐positive on self‐samples between 1 December 2018 and 1 August 2019.
Methods
Self‐samples were directly used for cytological analysis. Cytological and histological outcomes during follow up were obtained from the Dutch Pathology Registry (PALGA).
Main outcome measures
Test performance of reflex cytology on self‐samples was determined for different thresholds and compared with physician‐taken cytology and histological outcomes.
Results
Reflex cytology on self‐samples for detecting abnormal cytology showed a sensitivity of 26.4% (95% CI 21.8–31.3) and specificity of 90.5% (95% CI 87.7–92.8). Of all ≥CIN2 cases, 29.4% (95% CI 22.5–37.1) were detected with reflex cytology on self‐samples. The positive predictive value for detection of ≥CIN2 was higher with cytology on self‐collected samples than on physician‐collected samples. Of women who were lost to follow up, 12.9% were found to have abnormal cytology on their self‐sampled material.
Conclusion
Cytology testing is achievable on hrHPV‐positive self‐samples, could decrease the loss to follow up in screening and is easily implementable in the current clinical practice. Of all hrHPV‐positive women with abnormal cytology on additional physician‐collected samples, 26.4% could have been directly referred for colposcopy if triage with reflex cytology on self‐sampled material had been performed.
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Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy.
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Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32506627</pmid><doi>10.1111/1471-0528.16352</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | BJOG : an international journal of obstetrics and gynaecology, 2020-12, Vol.127 (13), p.1656-1663 |
| issn | 1470-0328 1471-0528 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Algorithms Cancer screening Cellular biology Cervical cancer cervical intraepithelial neoplasia Cohort analysis Cohort Studies Colposcopy Cytodiagnosis - methods Cytology Early Detection of Cancer - methods Family physicians Female Gynaecological Oncology Human papillomavirus Humans Medical referrals Medical screening Papillomaviridae - isolation & purification Papillomavirus Infections - diagnosis Prospective Studies Referral and Consultation screening Self Care self‐sampling Specimen Handling triage Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - virology |
| title | Reflex cytology for triage of high‐risk human papillomavirus positive self‐sampled material in cervical cancer screening: a prospective cohort study |
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