Co-Test im Zervixkarzinom-Screening: Die erste Runde

Abstract

BackgroundIn 2020 guidelines for an organized screening program for cervical cancer with changes in primary screening and clinical management of conspicuous findings were introduced in Germany.ObjectiveDue to the data deficit, which stems from the central documentation only beginning after a 9-month delay, the results of the complete first screening round from a routine laboratory are evaluated.MaterialIn 2020 all co-test results of women aged 35 years and over were recorded in a pathology practice. The cytological control findings, human papillomavirus (HPV) tests, colposcopy and histological findings were documented.ResultsIn the primary screening a co-test was carried out for 63,615 women. Cytology findings requiring clarification by colposcopy (groups IIp–V of the Munich nomenclature III) were found in 1.96% and the HPV positive rate was 5.82% (1.28% HPV 16, 0.42% HPV 18). When cytologically negative and HPV positive women were examined by the required co-test 12 months later, these findings persisted in 40.6%, in 19.7% positive cytology findings were found. For 973 of the 1378 women positive for co-test, the results of colposcopy are known: 10.2% cervical intraepithelial neoplasia (CIN) 1, 7.8% CIN2, 8.5% CIN3 and 0.21% carcinoma. Of the 1081 women with positive cytology findings in primary screening 979 underwent colposcopy and 19.9% CIN1, 17% CIN2, 25.1% CIN3, 0.41% adenocarcinoma in situ (AIS) and 1.43% invasive carcinoma were diagnosed. Referral for colposcopy solely on persistent positive HPV test yielded CIN3 in 3.6% and for low-risk cytology a total of 6.6%.ConclusionOur data indicate an unfavorable benefit-cost ratio for negative and low-risk cytology. The central program evaluation will show to what extent algorithms should be adapted.