Impact of variations in triage cytology interpretation on human papillomavirus–based cervical screening and implications for screening algorithms

Guglielmo Ronco, Marco Zappa, Silvia Franceschi, Sara Tunesi, Adele Caprioglio, Massimo Confortini, Annarosa Del Mistro, Francesca M. Carozzi, Nereo Segnan, Manuel Zorzi, Paolo Giorgi Rossi, Fabio Falcini, Anna Gillio-Tos, Pamela Giubilato, Luigi Pasquale, Giovanna Luciano, E. Polla, P. Dalla Palma, Chiara Fedato, F. ZagoA. Pupo, Ivana Simoncello, M. G. Penon, Lorenza Gallo, Annamaria Del Sole, Luisa Paterlini, Cinzia Campari, A. Iossa, Alessandra Barca, Maria Concetta Tufi, Paola Bellardini, C. Fortunato, Maria C. Minna, A. Macerola, Donatella Caraceni

Research output: Contribution to journalArticle

8 Downloads (Pure)

Abstract

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.

Original languageEnglish
Pages (from-to)148-155
Number of pages8
JournalEuropean Journal of Cancer
Volume68
DOIs
Publication statusPublished - Nov 1 2016

Fingerprint

Colposcopy
Triage
Cell Biology
Referral and Consultation
Proxy
Italy

Keywords

  • Cervical cancer
  • Cytology
  • Human papillomavirus
  • Screening
  • Triage

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Impact of variations in triage cytology interpretation on human papillomavirus–based cervical screening and implications for screening algorithms. / Ronco, Guglielmo; Zappa, Marco; Franceschi, Silvia; Tunesi, Sara; Caprioglio, Adele; Confortini, Massimo; Del Mistro, Annarosa; Carozzi, Francesca M.; Segnan, Nereo; Zorzi, Manuel; Giorgi Rossi, Paolo; Falcini, Fabio; Gillio-Tos, Anna; Giubilato, Pamela; Pasquale, Luigi; Luciano, Giovanna; Polla, E.; Dalla Palma, P.; Fedato, Chiara; Zago, F.; Pupo, A.; Simoncello, Ivana; Penon, M. G.; Gallo, Lorenza; Del Sole, Annamaria; Paterlini, Luisa; Campari, Cinzia; Iossa, A.; Barca, Alessandra; Tufi, Maria Concetta; Bellardini, Paola; Fortunato, C.; Minna, Maria C.; Macerola, A.; Caraceni, Donatella.

In: European Journal of Cancer, Vol. 68, 01.11.2016, p. 148-155.

Research output: Contribution to journalArticle

Ronco, G, Zappa, M, Franceschi, S, Tunesi, S, Caprioglio, A, Confortini, M, Del Mistro, A, Carozzi, FM, Segnan, N, Zorzi, M, Giorgi Rossi, P, Falcini, F, Gillio-Tos, A, Giubilato, P, Pasquale, L, Luciano, G, Polla, E, Dalla Palma, P, Fedato, C, Zago, F, Pupo, A, Simoncello, I, Penon, MG, Gallo, L, Del Sole, A, Paterlini, L, Campari, C, Iossa, A, Barca, A, Tufi, MC, Bellardini, P, Fortunato, C, Minna, MC, Macerola, A & Caraceni, D 2016, 'Impact of variations in triage cytology interpretation on human papillomavirus–based cervical screening and implications for screening algorithms', European Journal of Cancer, vol. 68, pp. 148-155. https://doi.org/10.1016/j.ejca.2016.09.008
Ronco, Guglielmo ; Zappa, Marco ; Franceschi, Silvia ; Tunesi, Sara ; Caprioglio, Adele ; Confortini, Massimo ; Del Mistro, Annarosa ; Carozzi, Francesca M. ; Segnan, Nereo ; Zorzi, Manuel ; Giorgi Rossi, Paolo ; Falcini, Fabio ; Gillio-Tos, Anna ; Giubilato, Pamela ; Pasquale, Luigi ; Luciano, Giovanna ; Polla, E. ; Dalla Palma, P. ; Fedato, Chiara ; Zago, F. ; Pupo, A. ; Simoncello, Ivana ; Penon, M. G. ; Gallo, Lorenza ; Del Sole, Annamaria ; Paterlini, Luisa ; Campari, Cinzia ; Iossa, A. ; Barca, Alessandra ; Tufi, Maria Concetta ; Bellardini, Paola ; Fortunato, C. ; Minna, Maria C. ; Macerola, A. ; Caraceni, Donatella. / Impact of variations in triage cytology interpretation on human papillomavirus–based cervical screening and implications for screening algorithms. In: European Journal of Cancer. 2016 ; Vol. 68. pp. 148-155.
@article{93db3a1dc64742f996abfd0bc34f96a6,
title = "Impact of variations in triage cytology interpretation on human papillomavirus–based cervical screening and implications for screening algorithms",
abstract = "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.",
keywords = "Cervical cancer, Cytology, Human papillomavirus, Screening, Triage",
author = "Guglielmo Ronco and Marco Zappa and Silvia Franceschi and Sara Tunesi and Adele Caprioglio and Massimo Confortini and {Del Mistro}, Annarosa and Carozzi, {Francesca M.} and Nereo Segnan and Manuel Zorzi and {Giorgi Rossi}, Paolo and Fabio Falcini and Anna Gillio-Tos and Pamela Giubilato and Luigi Pasquale and Giovanna Luciano and E. Polla and {Dalla Palma}, P. and Chiara Fedato and F. Zago and A. Pupo and Ivana Simoncello and Penon, {M. G.} and Lorenza Gallo and {Del Sole}, Annamaria and Luisa Paterlini and Cinzia Campari and A. Iossa and Alessandra Barca and Tufi, {Maria Concetta} and Paola Bellardini and C. Fortunato and Minna, {Maria C.} and A. Macerola and Donatella Caraceni",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.ejca.2016.09.008",
language = "English",
volume = "68",
pages = "148--155",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Ltd",

}

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 - Giorgi Rossi, Paolo

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

UR - http://www.scopus.com/inward/record.url?scp=84991699745&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84991699745&partnerID=8YFLogxK

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 -