Performance of Different Combination Models of High-Risk HPV Genotyping in Triaging Chinese Women With Atypical Squamous Cells of Undetermined Significance.

Zhen Guo,Pei-Pei Chen,Dong-Mei Zhao,Hong-Min Chen,Man-Man Jia,Xi-Bin Sun,Ling-Yan Ren,Qiong Chen,Shao-Kai Zhang

doi:10.3389/fonc.2019.00202

Abstract

Objective: The purpose of this study was to evaluate the effect of different combination models of high-risk human papilloma viruses (HPV) genotyping in triaging Chinese women with atypical squamous cells of undetermined significance (ASCUS).Methods: We established a screening cohort of 3,997 Chinese women who underwent cervical cytology and HPV genotyping test. Women with ASCUS cytology underwent punch biopsy under colposcopy/endocervical curettage. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different combination models of HR-HPV genotyping calculated that cervical intraepithelial neoplasia 2 or higher (CIN2+) on histology were endpoints.Results: Of the full sample, 393 women had ASCUS. Among ASCUS women with a CIN2 lesion, the prevalence for HPV were 40.0% (type 16), 10.0% (type 18), 0.0% (type 33), 30.0% (type 52), 40.0% (type 58), and 30.0% (other nine types). For ASCUS women with a CIN3 lesion, the prevalence for HPV were 68.4% (type 16), 15.8% (type 18), 10.5% (type 33), 31.6% (type 52), 15.8% (type 58), and 36.8% (other nine types). Combination model including HPV16/18/33/52/58 for predicting CIN2+ lesion in women with ASCUS had relatively higher sensitivity [93.1% (78.0, 98.1)], specificity [75.8% (71.2, 79.9)], PPV [23.5% (16.7, 32.0)], and NPV [99.3% (97.4, 99.8)] than other combination models. Moreover, the referral rate of HPV16/18/33/52/58 (29.3%) was lower than HR-HPV (36.1%).Conclusions: The study demonstrates that specific HR-HPV types HPV16/18/33/52/58 may be an effective strategy in ASCUS triage. This improves the subsequent selection of ASCUS patients.

Highlights

Cervical cancer is the third most common cancer among women worldwide, the second most common cause of cancer death, and causes 300,000 deaths a year [1]
The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different combination models of HR-human papilloma viruses (HPV) genotyping calculated that cervical intraepithelial neoplasia 2 or higher (CIN2+) on histology were endpoints
The study demonstrates that specific HR-HPV types HPV16/18/33/52/58 may be an effective strategy in atypical squamous cells of undetermined significance (ASCUS) triage

Summary

Introduction

Cervical cancer is the third most common cancer among women worldwide, the second most common cause of cancer death, and causes 300,000 deaths a year [1]. The current suggestion for diagnosing cervical lesions involve a “three-step” exanimation: liquid based cytology, colposcopy (which is an observation technique that can identify potential precancerous and cancerous lesions), and histological examination [3]. The 2006 consensus guidelines for the management of women with abnormal cytological smears recommend three approaches for the management of ASCUS: 2 repeat cervical smears taken 6 months apart, reflex HR-HPV DNA testing, and colposcopic examination [8]. These are all safe and effective choices and the approach taken depends on the individual circumstances and resources available

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Results

Conclusion