TY - JOUR
T1 - Impact of variations in triage cytology interpretation on human papillomavirus–based cervical screening and implications for screening algorithms
AU - Ronco, Guglielmo
AU - Zappa, Marco
AU - Franceschi, Silvia
AU - Tunesi, Sara
AU - Caprioglio, Adele
AU - Confortini, Massimo
AU - Del Mistro, Annarosa
AU - Carozzi, Francesca M.
AU - Segnan, Nereo
AU - Zorzi, Manuel
AU - Falcini, Fabio
AU - Gillio-Tos, Anna
AU - Giubilato, Pamela
AU - Pasquale, Luigi
AU - Luciano, Giovanna
AU - Polla, E.
AU - Dalla Palma, P.
AU - Fedato, Chiara
AU - Zago, F.
AU - Pupo, A.
AU - Simoncello, Ivana
AU - Penon, M. G.
AU - Gallo, Lorenza
AU - Del Sole, Annamaria
AU - Paterlini, Luisa
AU - Campari, Cinzia
AU - Iossa, A.
AU - Barca, Alessandra
AU - Tufi, Maria Concetta
AU - Bellardini, Paola
AU - Fortunato, C.
AU - Minna, Maria C.
AU - Macerola, A.
AU - Caraceni, Donatella
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background Women positive to human papillomavirus (HPV+) testing at cervical screening need triage, typically cytology and immediate colposcopy in case of atypical squamous cells of undetermined significance (ASCUS) or worse (ASCUS+) or, in cytology-normal HPV+ women, HPV test repeat after 1 year and colposcopy referral if still HPV+. Our hypothesis was that substantial variations in triage positivity and sensitivity may produce little variation in overall referral to colposcopy and on sensitivity of the entire screening process. Methods Centre- and age-aggregated data from 72,869 women aged 35–64 years were derived from 10 organised screening programmes which have piloted HPV screening in Italy since 2012. Overall colposcopy referral was evaluated as a function of immediate colposcopy referral and overall CIN2+ detection as a function of the proportion of all CIN2+ detected by immediate referral (a proxy of cytology's sensitivity). We fitted additive regression models, adjusted for centre, age, compliance to HPV retesting and to colposcopy, by generalised estimation equations. Results The proportion of HPV+ women directly referred to colposcopy varied across programmes (20–57%; average 37%) and so did CIN2+ detection (49–94%; average 77%). Overall, 63% (range 41–75%) of HPV+ were referred to colposcopy either immediately or at HPV repeat. An absolute 10% increase in immediate colposcopy referral resulted in 4.2% (95% CI: 3.3–5.1%) increase in overall referral. An absolute 10% increase in cytology's sensitivity resulted in a 1.1% (95% CI: 0.1–2.0%) increase in overall CIN2+ detection. Conclusions Repeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged.
AB - Background Women positive to human papillomavirus (HPV+) testing at cervical screening need triage, typically cytology and immediate colposcopy in case of atypical squamous cells of undetermined significance (ASCUS) or worse (ASCUS+) or, in cytology-normal HPV+ women, HPV test repeat after 1 year and colposcopy referral if still HPV+. Our hypothesis was that substantial variations in triage positivity and sensitivity may produce little variation in overall referral to colposcopy and on sensitivity of the entire screening process. Methods Centre- and age-aggregated data from 72,869 women aged 35–64 years were derived from 10 organised screening programmes which have piloted HPV screening in Italy since 2012. Overall colposcopy referral was evaluated as a function of immediate colposcopy referral and overall CIN2+ detection as a function of the proportion of all CIN2+ detected by immediate referral (a proxy of cytology's sensitivity). We fitted additive regression models, adjusted for centre, age, compliance to HPV retesting and to colposcopy, by generalised estimation equations. Results The proportion of HPV+ women directly referred to colposcopy varied across programmes (20–57%; average 37%) and so did CIN2+ detection (49–94%; average 77%). Overall, 63% (range 41–75%) of HPV+ were referred to colposcopy either immediately or at HPV repeat. An absolute 10% increase in immediate colposcopy referral resulted in 4.2% (95% CI: 3.3–5.1%) increase in overall referral. An absolute 10% increase in cytology's sensitivity resulted in a 1.1% (95% CI: 0.1–2.0%) increase in overall CIN2+ detection. Conclusions Repeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged.
KW - Cervical cancer
KW - Cytology
KW - Human papillomavirus
KW - Screening
KW - Triage
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U2 - 10.1016/j.ejca.2016.09.008
DO - 10.1016/j.ejca.2016.09.008
M3 - Article
VL - 68
SP - 148
EP - 155
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
ER -