A cross‐sectional study exploring triage of human papillomavirus (HPV)‐positive women by visual assessment, manual and computer‐interpreted cytology, and HPV‐16/18‐45 genotyping in Cameroon. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Vassilakos, Pierre; Wisniak, Ania; Catarino, Rosa; Foguem, Eveline Tincho; Balli, Christine; Saiji, Essia; Tille, Jean‐Christophe; Kenfack, Bruno; Petignat, Patrick
• Is Part Of: International journal of gynecological cancer. Volume 31:Issue 6(2021)
• Publication Date: 2021-06
• Subjects: cervical cancer -- pathology; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2020-002302
• Languages: English
• ISSNs: 1048-891X

Abstract

ABSTRACT : Background : High‐risk human papillomavirus (HPV)‐positive women require triage to identify those at higher risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). We aimed to compare visual assessment of the cervix, manual cytology and automated cytology as triage tests to screen HPV‐positive women, and to assess over‐treatment rates after visual assessment and over‐referral rates to colposcopy after cytology. Methods : The present cross‐sectional study is nested in a large prospective screening trial in Cameroon. Evaluations of the tests have been conducted individually and in combination with HPV‐16/HPV‐18/45 genotyping. For the evaluation of over‐treatment and colposcopic over‐referral, we simulated two screening scenarios: (1) one‐visit scenario (test‐triage‐and‐treatment); and (2) two‐visit scenario (test‐triage‐and‐colposcopy). Results : 1582 women with a median age of 40 years (IQR 35‐45) performed self‐sampling for HPV testing, of which 294 (18.6%) were HPV‐positive, and 12.2% had CIN2+. Sensitivities for CIN2+ detection were 77.1% for visual assessment, 80.0% for manual cytology, and 84.8% for automated cytology. Sensitivity of combined tests was higher compared with single tests. The highest sensitivity was obtained by the combination of genotyping and automated cytology (91.2%). In the one‐visit scenario, the over‐treatment rate was 83.9% in referred women, with a ratio of 6.2 treated women per CIN2+. In the two‐visit scenario, the lowest over‐referral rate would have been under manual cytology (45.0%), with a ratio of 1.8 referred women per CIN2+. Single and combined triage strategies by automated cytology gave rise to over‐referral rates of 69.2% and 76.7%, respectively, and a ratio of 3.2 and 4.3 referred women per CIN2+, respectively. Discussion : Triage of HPV‐positive women using a combination of genotyping and automated cytology for CIN2+ detection may provide public benefits in low‐ and middle‐income countries.