Detection Of Cervical Intraepithelial Neoplasia Research Articles

PAX1 and SOX1 gene methylation as a detection and triage method for cervical intraepithelial neoplasia diagnosis.

Methylation assays have demonstrated potential as dependable and high-precision approaches for identifying or triaging individuals with cervical cancer (CA) or cervical intraepithelial neoplasia (CIN). Our investigation aimed to assess the efficacy of diagnosis and triage of the PAX1/SOX1 methylation panel in detecting CIN or CA. A total of 461 patients with abnormal high-risk human papillomavirus (hrHPV) or cytology test results were recruited for this study. Each patient underwent an assortment of assessments comprising cytology test, hrHPV test, colposcopy examination, and PAX1 and SOX1 methylation test. The extent of methylation of both genes demonstrates a positive correlation with the severity of CIN lesions and CA. To determine the correlation for patients with CIN2 or worse (CIN2+), the area under curve (AUC) was 0.821 (95%CI 0.782-0.853) for PAX1 and 0.800 (95%CI 0.766-0.838) for SOX1, while for CIN3 or worse (CIN3+),0.881 (95%CI 0.839-0.908) for PAX1 and 0.867 (95% 0.830-0.901) for SOX1. The PAX1/SOX1 methylation marker panel performed sensitivity and specificity of 77.16% and 91.67% for CIN2+, 84.76% and 90.50% for CIN3+, respectively. Regarding triaging hrHPV+ patients, the PAX1/SOX1 methylation test only referred 11.83% of the patients who are unnecessary for coloscopy examination, which is comparatively lower than cytology， thereby signifying a promising triage strategy for hr-HPV positive women. Furthermore, we observed that the positive PAX1/SOX1 methylation test result for untreated CIN1 or less patients would result in a higher likelihood of progression upon a 24-month follow-up visit. The present investigation demonstrates that the PAX1/SOX1 methylation marker panel exhibits a favorable diagnostic performance in CIN detection and holds the potential to be employed for individual CIN tests or hrHPV-positive triage.

Cytological DNA methylation for cervical cancer screening: a validation set.

In a previous training set with a case-controlled design, cutoff values for host EPB41L3 and JAM3 gene methylation were obtained for the detection of cervical intraepithelial neoplasia (CIN) 2 or more severe lesions (CIN2+). This validation trial was conducted to evaluate the role of DNA methylation in screening for CIN2+ by cervical cytology among unselected participants. From June 1, 2019, to September 1, 2019, in our study center, we collected liquid-based samples from cervical swabs for methylation assays and hrHPV testing in eligible patients. The primary endpoint was the diagnostic accuracy of DNA methylation and hrHPV genotyping for CIN2+ according to confirmed histology results. Among 307 participants, compared with hrHPV testing, the methylation assay for CIN2+ had lower sensitivity (68.7% versus 86.1%, p=0.002) but higher specificity (96.7% versus 0.696, p<0.001). The methylation assay also had favorable sensitivity and specificity in patients with negative hrHPV testing (56.3% and 96.9%) and in patients with cervical adenocarcinoma (73.7% and 92.7%). DNA methylation had higher specificity than the hrHPV assay (100.0% versus 44.4%, p<0.001) for identifying residual CIN2+ in patients without residual lesions. Positive cervical DNA methylation was associated with a diagnostic probability of endometrial carcinoma (odds ratio 15.5 [95% confidence interval 4.1-58.6]) but not of ovarian epithelial carcinoma (1.4 [0.3-6.5]). The host EPB41L3 and JAM3 gene methylation assay in cervical cytology had favorable diagnostic accuracy for CIN2+ and was highly specific for residual CIN2+ lesions The methylation assay is a promising triage tool in hrHPV+ women, or even an independent tool for cervical cancer screening. The methylation status in cervical cytology could also serve as a prognostic biomarker. Its role in detecting endometrial carcinomas is worthy of further exploration.

Clinical impact of age‑specific distribution of combination patterns of cytology and high‑risk HPV status on cervical intraepithelial neoplasia grade 2 or more.

To the best of our knowledge, the present study is the first to elucidate the significance of cytology and high-risk human papillomavirus (hrHPV) status in different age groups for the detection of cervical intraepithelial neoplasia (CIN)2, CIN3 and squamous cell carcinoma (SCC). There were 12 combinations based on cytology and hrHPV status [cytology: Atypical squamous cells (ASC) of undetermined significance, low-grade squamous intraepithelial lesion, ASC not excluding high-grade squamous intraepithelial lesion (HSIL) and HSIL; hrHPV status: HPV16/18-positive (16/18+), hrHPV positive for subtypes other than 16/18 (others+) and hrHPV-negative (hrHPV-)]. All patients were categorized into four groups based on age (18-29, 30-39, 40-49 and ≥50 years). For patients with CIN2, CIN3 and SCC (CIN2+) (n=107), the distribution of cytology and hrHPV was investigated in each age group. In addition, for all patients (n=446), the occurrence of CIN2+ in each of the 12 combinations was investigated in each age group. In the 18-29-year age group, the most common combination was HSIL and 16/18+, followed by HSIL and others+, which accounted for 73% of CIN2+ cases. The occurrence of HSIL and 16/18+ decreased with increasing age, and no cases occurred in the 50-year age group. In the 18-29-year age group, all patients with HSIL and 16/18+ were diagnosed with CIN2+. CIN2+ was predominantly detected in patients with HSIL in the 18-29-year age group, as well as hrHPV- and others+. This definite distinction was not observed in any other age group. For CIN2+, the distribution patterns of cytology and hrHPV status combinations varied significantly among different age groups. Accordingly, the clinical impact of the combination of cytological findings and hrHPV status can vary among age groups.

Risk stratification of HPV-positive results using extended genotyping and cytology: Data from the baseline phase of the Onclarity trial

BackgroundOptimizing the balance between colposcopy referrals and the detection of high-grade cervical intraepithelial neoplasia (CIN) during cervical cancer screening requires robust triage strategies. We evaluated the performance of extended HPV genotyping (xGT), in combination with cytology triage, and compared it to previously published performance data for high-grade CIN detection by HPV16/18 primary screening in combination with p16/Ki-67 dual staining (DS). Methods and materialsThe baseline phase of the Onclarity trial enrolled 33,858 individuals, yielding 2978 HPV-positive participants. Risk values for ≥CIN3 were determined for Onclarity result groupings corresponding to HPV16, not HPV16 but HPV18 or 31, not HPV16/18/31 but HPV33/58 or 52, not HPV16/18/31/33/58/52 but HPV35/39/68 or 45 or 51 or 56/59/66 across all cytology categories. Published data from the IMPACT trial for HPV16/18 plus DS was utilized as a comparator during ROC analyses. ResultsThere were 163 ≥ CIN3 cases detected. The ≥CIN3 risk stratum hierarchy (% risk of ≥CIN3) that resulted from this analysis included: >LSIL (39.4%); HPV16, ≤LSIL (13.3%); HPV18/31, ≤LSIL (5.9%); HPV33/58/52/45, ASC-US/LSIL (2.4%); HPV33/58/52, NILM (2.1%); HPV35/39/68/51/56/59/66, ASC-US/LSIL (0.9%); and HPV45/35/39/68/51/56/59/66, NILM (0.6%). For ≥CIN3 ROC analysis, the optimal cutoff for sensitivity versus specificity was approximated between not HPV16 but HPV18 or 31, any cytology (≥CIN3 sensitivity = 85.9% and colposcopy-to- ≥ CIN3 = 7.4) and not HPV16/18/31 but HPV33/58/52, NILM (≥CIN3 sensitivity = 94.5% and colposcopy-to- ≥CIN3 = 10.8). HPV16/18 with DS triage showed a sensitivity of 94.3%, with a colposcopy-to- ≥ CIN3 ratio of 11.4. ConclusionsxGT performed similarly compared to HPV primary screening plus DS for detection of high-grade CIN. xGT provides results that stratify risk in a flexible and reliable manner for colposcopy risk thresholds set by different guidelines or organizations.

A Descriptive Study of Different Methods of Cervical Cancer Screening among Ever-Married Women in 35-Year and 45-Year Cohorts in Kalutara District, Sri Lanka.

Screening for cervical cancer in Sri Lankan females with Pap smears (conventional cytology) has shown no marked reduction in cervical cancer incidence over the past two decades. The study aims to compare the efficacy of Pap smear, with other screening tools such as Liquid Based Cytology (LBC) and Human Papilloma Virus/deoxyribonucleic acid (HPV/DNA) (using cobas 4800) in detection of underlying cervical intraepithelial neoplasia (CIN) and cervical cancer among 35 and 45 year old ever married women in Kalutara districtin Sri Lanka. Women from 35-year cohort and 45-year cohort were selected from all Public Health Midwife areas (n=413) in Kalutara district by random sampling. Pap smear, LBC, and HPV/DNA specimen were collected s from women who attended the Well Woman Clinics (WWC) . Women with positive results from any method were confirmed by colposcopy. Results: Of the, 510 and 502 women in the 35-year cohort and 45-year cohort, respectively, included in the analysis, nine women among 35-year cohort (1.8%) and 7 women among 45-year cohort (1.4%) had cytological abnormality (positive results) with Pap smears. Thirteen women among 35-year cohort (2.5%) and 10 women among 45-year cohort (2%) age groups had cytological abnormality (positive results) with Liquid Based Cytology reports. Total of 32 women among 35-year cohort (6.2%) and 24 women among 45-year cohort (4.8%) were positive for HPV/DNA test. Of the women tested positive on screening, colposcopy revealed that HPV/DNA method was superior to Pap and LBC for detecting CIN while the results of latter two were comparable. The CIN detection rate by colposcopy was high with HPV/DNA screening with cobas 4800, whereas the detection rate by LBC was insignificantly higher than Pap smears.

Cytology compared with Hybrid Capture 2 human papilloma virus cervical cancer screening in HIV positive and HIV negative South African women

ObjectivesCervical cancer is preventable and caused by persistent infection with oncogenic human papilloma virus (HPV) types. HPV screening is more sensitive and is the preferred screening test. HPV screening data...

High-risk HPV testing vs liquid-based cytology for cervical cancer screening among 25- to 30-year-old women: A historical cohort study.

High-risk human papilloma virus (hrHPV) DNA testing is more sensitive than cytology screening, achieving greater protection against cervical cancer. Controversy exists regarding the preferred screening method for women 25-30 years of age. At this age, infection with HPV is common and usually transient. Consequently, hrHPV screening in this age group is fraught with high false-positive screening results, leading to more colposcopies and unnecessary treatments with the potential for harm. In the present study, we aimed to compare the results of two screening methods in relation to high-grade cervical intraepithelial lesion detection rate in the young age group of 25-30 years. Retrospective information on cervical cytology, hrHPV testing, colposcopy referrals and histologic results, from one screening round, were retrieved from the Maccabi HealthCare Health Maintenance Organization centralized database during the study period from March 1, 2017 to April 1, 2019 for 25- to 30-year-old women. Screening with hrHPV testing for types 16, 18 and 12 other hrHPV types was compared with the conventional PAP liquid-based cytology (LBC) test. Odds ratio (OR) of detection with 95% confidence interval (CI) was calculated for cervical intraepithelial neoplasia (CIN) grade 3 or higher (CIN 3+). During the study period, 42 244 women 25-30 years old underwent cervical cancer screening; of them, 20 997 were screened with LBC between March 1, 2017 and March 1, 2018 and compared with 21 247 who were screened with hrHPV between April 1, 2018 and April 1, 2019. Testing for hrHPV resulted in a higher colposcopy referral rate compared with primary LBC screening: 9.8% vs 7.8%, respectively; (OR 1.28; 95% CI 1.2-1.37; p< 0.001). Screening with hrHPV led to significantly higher detection of CIN 3+ lesions (OR 1.4; 95% CI 1.2-1.6; p< 0.001) compared with LBC. HPV infections with non-16/18 hrHPV (other hrHPV) were the most prevalent (84.8%). In women 25-30 years old, primary hrHPV screening was associated with a higher detection rate of CIN 3+ compared with cytology screening and should be considered for primary screening in this age group.

Validation of ASCL1 and LHX8 Methylation Analysis as Primary Cervical Cancer Screening Strategy in South African Women with Human Immunodeficiency Virus.

Compared with women who are human immunodeficiency virus (HIV) negative, women with human immunodeficiency virus (WWH) have a higher human papillomavirus (HPV) prevalence and increased cervical cancer risk, emphasizing the need for effective cervical cancer screening in this population. The present study aimed to validate methylation markers ASCL1 and LHX8 for primary screening in a South African cohort of WWH. In this post hoc analysis within the DIAgnosis in Vaccine And Cervical Cancer Screen (DiaVACCS) study, a South African observational multicenter cohort study, cervical scrape samples from 411 HIV-positive women were analyzed for hypermethylation of ASCL1 and LHX8 genes, HPV DNA, and cytology. Sensitivities, specificities, and positive and negative predictive values of primary methylation-based, HPV-based and cytology-based screening were calculated for the detection of cervical intraepithelial neoplasia of grade 3 or higher. Single markers ASCL1 and LHX8 resulted in a good performance for the detection of cervical intraepithelial neoplasia of grade 3 or higher, with sensitivities of 85.9% (95% confidence interval [CI], 78.2%-93.6%) and 89.7% (83.0%-96.5%), respectively, and specificities of 72.9% (67.3%-78.5%) and 75.0% (69.5%-80.5%). Combining markers ASCL1 and LHX8 resulted in a lower sensitivity compared with HPV testing (84.6% vs 93.6%, respectively; ratio, 0.90 [95% CI, .82-.99]) and a higher specificity (86.7% vs 78.3%; ratio 1.11 [1.02-1.20]) and reduced the referral rate from 46.8% to 33.4%. ASCL1/LHX8 methylation had a significantly higher sensitivity than cytology (threshold, high-grade intraepithelial squamous lesion or worse), (84.6% vs 74.0%, respectively; ratio, 1.16 [95% CI, 1.01-1.32]) and similar specificity (86.7% vs 91.0%; ratio, 0.95 [.90-1.003]). Our results validate the accuracy of ASCL1/LHX8 methylation analysis for primary screening in WWH, which offers a full-molecular alternative to cytology- or HPV-based screening, without the need for additional triage testing.

Evaluation of Visual Inspection after Acetic Acid/Cervicography as an Alternative to Colposcopy for Detection of Cervical Intraepithelial Neoplasia

Evaluation of Visual Inspection after Acetic Acid/Cervicography as an Alternative to Colposcopy for Detection of Cervical Intraepithelial Neoplasia

Diagnosis of Cervical Intraepithelial Neoplasia and Invasive Cervical Carcinoma by Cervical Biopsy under Colposcopy and Analysis of Factors Influencing.

Objective To explore the diagnosis of cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (ICC) by cervical biopsy under colposcopy and analyze the factors influencing the detection. Methods The clinical data of 134 CIN confirmed by colposcopy biopsy in our hospital from June 2018 to October 2019 and subsequent LEEP treatment were analyzed retrospectively. All patients were diagnosed pathologically after the operation. The diagnosis of CIN by cervical biopsy under colposcopy was observed. The influencing factors of CIN and ICC detected by colposcopy biopsy were analyzed by the pathological results of loop electrosurgical excision procedure (LEEP) as the gold standard. Results After LEEP, the number of the no intraepithelial or malignant lesions (NILM) or ICC were higher than that of colposcopy biopsy, and CIN-III was lower than that of colposcopy biopsy, the differences were all statistically significant (P < 0.05). Among the 134 patients, the coincidence rate between colposcopy biopsy and LEEP examination results was 79.10% (106/134), and postoperative pathological findings showed that there were 13 cases (9.70%) with the pathological upgrade and 19 cases (14.18%) with pathological decrease. Multivariate logistic analysis showed that the image quality of colposcopy image, atypical blood vessels, biopsy sampling method, and visible lesion area of the cervix were the independent influencing factors for the detection of CIN and ICC by colposcopy biopsy (P < 0.05). Conclusion CIN and ICC can be diagnosed by colposcopy cervical biopsy and postoperative histopathology. However, there are still some missed and misdiagnosed cervical biopsies under colposcopy, and the combined detection of the two can further ensure the diagnosis rate. The clinical registration number is E2018091.

Encoder-Weighted W-Net for Unsupervised Segmentation of Cervix Region in Colposcopy Images.

Simple SummaryThe cervix region segmentation significantly affects the accuracy of diagnosis when analyzing colposcopy. Detecting the cervix region requires manual, intensive, and time-consuming labor from a trained gynecologist. In this paper, we propose a deep learning-based automatic cervix region segmentation method that enables the extraction of the region of interest from colposcopy images in an unsupervised manner. The segmentation performance with a Dice coefficient improved from 0.612 to 0.710 by applying the proposed loss function and encoder-weighted learning scheme and showed the best performance among all the compared methods. The automatically detected cervix region can improve the performance of image-based interpretation and diagnosis by suggesting where the clinicians should focus during colposcopy analysis.Cervical cancer can be prevented and treated better if it is diagnosed early. Colposcopy, a way of clinically looking at the cervix region, is an efficient method for cervical cancer screening and its early detection. The cervix region segmentation significantly affects the performance of computer-aided diagnostics using a colposcopy, particularly cervical intraepithelial neoplasia (CIN) classification. However, there are few studies of cervix segmentation in colposcopy, and no studies of fully unsupervised cervix region detection without image pre- and post-processing. In this study, we propose a deep learning-based unsupervised method to identify cervix regions without pre- and post-processing. A new loss function and a novel scheduling scheme for the baseline W-Net are proposed for fully unsupervised cervix region segmentation in colposcopy. The experimental results showed that the proposed method achieved the best performance in the cervix segmentation with a Dice coefficient of 0.71 with less computational cost. The proposed method produced cervix segmentation masks with more reduction in outliers and can be applied before CIN detection or other diagnoses to improve diagnostic performance. Our results demonstrate that the proposed method not only assists medical specialists in diagnosis in practical situations but also shows the potential of an unsupervised segmentation approach in colposcopy.

Randomized Implementation of a Primary Human Papillomavirus Testing-based Cervical Cancer Screening Protocol for Women 34 to 69 Years in Norway.

Cervical cancer screening programs are facing a programmatic shift where screening protocol based on human papillomavirus testing (HPV-Screening protocol) is replacing the liquid-based cytology (LBC-Screening protocol). For safe technology transfer within the nationwide screening programme in Norway, HPV-Screening protocol was implemented randomized to compare the real-world effectiveness of HPV-Screening protocol and LBC-Screening protocol at the first screening round. Among 302,295 women ages 34 to 69 years scheduled to attend screening from February 2015 to June 2017, 157,447 attended. A total of 77,207 were randomly allocated to the HPV-Screening protocol and 80,240 were allocated to the LBC-Screening protocol. All women were followed up for 18 months. The HPV-Screening protocol resulted in a relative increase of 60% in the detection of cervical intraepithelial neoplasia (CIN) grade 2 or worse [risk ratio (RR) = 1.6, 95% confidence interval (CI) = 1.5-1.7], 40% in CIN grade 3 or worse (RR = 1.4, 95% CI = 1.3-1.6), 40% in cancer (RR = 1.4, 95% CI = 1.0-2.1), and 60% in colposcopy referrals (RR = 1.6, 95% CI = 1.5-1.6) compared with LBC-Screening. The performance of both protocols was age dependent, being more effective in women ages under 50 years. The HPV-Screening protocol was well accepted by women in Norway and detected more CIN2, CIN3, and cancers compared with the LBC-Screening protocol. A randomized implementation of the HPV-Screening protocol with real-world assessment enabled a gradual, quality assured, and safe technology transition. HPV-based screening protocol may further be improved by using HPV genotyping and age-specific referral algorithms.

Accuracy of Naked Eye Visual Inspection in Early Detection of Cervical Intraepithelial Neoplasia at Zagazig University Hospitals

Accuracy of Naked Eye Visual Inspection in Early Detection of Cervical Intraepithelial Neoplasia at Zagazig University Hospitals

230 The detection of cervical intraepithelial neoplasia by electrical impedance spectroscopy in woman reffered to colposcopy due to lgsil in cervical cytology (PRELIMINARY RESULTS)

Introduction: Cancer of the cervix remains the second most common cancer among women worldwide and poses a major threat to women’s health throughout the world. Women with abnormal cervical smears undergo colposcopy as part of a diagnostic and treatment pathway. Unfortunately colposcopic impression, is not perfect. The addition of colposcopically directed biopsies does not necessarily improve diagnostic accuracy. Electrical impedance spectroscopy (EIS) has been evaluated in a wide range of clinical trials and appears to provide a potentially promising cervical control tool with similar sensitivity and specificity to previous and potential trials.

CIN Extension at Colposcopy: Relation to Treatment and Blood Parameters.

To determine the colposcopic lesion size that predicts the presence of residual lesion in patients with cervical intraepithelial neoplasia (CIN) 2/3, to aid gynaecologists in selecting conservative management. Data from 51 patients with low- and high-grade squamous intraepithelial lesions were evaluated. Colposcopic images were captured and lesion areas were calculated. Polymerase chain reaction (PCR) for human papillomavirus was performed. Laboratory parameters were evaluated. Receiver operating characteristic (ROC) curves were used to obtain cut-off values for lesion area. The performance of PCR in the detection of high-grade CIN was assessed. A flowchart was created to compare the costs of related procedures in the Brazilian health system. For CIN 2/3 treated with excisional surgery, the best cut-off value for lesion area below which no residual lesion was present was 21019 pixels2 (58.87 mm2). The cut-off value that predicted compromised surgical margins was 155577.65 pixels2 (435.75 mm2). Among all patients with CIN, lesion area correlated inversely with neutrophil/lymphocyte ratio (NLR; r=-0.446, P=0.001), platelet/lymphocyte ratio (PLR; r=-0.438, P=0.001), and absolute number of leukocytes (r=-0.351, P=0.011). Conservative clinical management with semi-annual clinical follow-up was found to reduce direct costs to the Brazilian Health System by R $909.82 (US $169.42). CIN reflects systemic alteration, leading to altered NLRs, PLRs, and absolute numbers of leukocytes. Patients with high-grade CIN and colposcopic lesion areas <21019pixels2 could benefit from conservative management, which would result in cost savings for the Brazilian health system.

Age-specific effectiveness of primary human papillomavirus screening versus cytology in a cervical cancer screening program: a nationwide cross-sectional study.

BackgroundPrimary human papillomavirus (HPV) screening is recommended for the detection of cervical intraepithelial neoplasia (CIN) in the general population; however, the triage for HPV‐positive women remains a challenge. This study aimed to evaluate the age‐specific effectiveness of primary HPV screening versus primary cytology screening for identifying optimal strategies for women of different ages.MethodsThe dataset of the prevalence round screening was derived from the National Cervical Cancer Screening Program in China. Primary cervical screening protocols included cytology only, HPV testing with cytology triage, and HPV testing with HPV‐16/18 genotyping plus cytology triage. The primary outcomes were age‐specific detection rate, colposcopy referral rate and positive predictive value (PPV) for CIN2+. Multivariate Poisson regression was used to evaluate the relative effectiveness of HPV testing and cytology according to age groups. The I2 statistic with a random‐effect model was used to test the heterogeneity in relative effectiveness of HPV testing versus cytology between age groups.ResultsThis study included 1,160,981 women. HPV testing with HPV‐16/18 genotyping plus cytology triage significantly increased the CIN2+ detection by 36% (rate ratio [RR]: 1.36, 95% confidential interval [CI] 1.21–1.54) for women aged 35‐44 years and by 34% (RR: 1.34, 95% CI 1.20‐1.51) for women aged 45‐54 years compared with cytology only. HPV testing with cytology triage had similar CIN2+ detection rate compared with cytology only. The PPVs were substantially increased for both HPV testing groups. Among women aged 55‐64 years old, HPV testing with HPV‐16/18 genotyping plus cytology triage increased the colposcopy referral rate by 19% (RR 1.19, 95% CI 1.10‐1.29) compared with cytology only, but did not increase the CIN2+ detection (1.09, 0.91–1.30). The effectiveness of HPV testing with cytology triage did not change in older women. The between‐age‐group heterogeneity in the effectiveness was statistically significant for HPV testing with HPV‐16/18 genotyping plus cytology triage versus cytology only.ConclusionsOur results suggested that the effectiveness of primary HPV screening with different triage strategies differed among age groups. HPV testing with HPV‐16/18 genotyping plus cytology triage could be used for women aged 35‐54 years to detect more lesions, and HPV testing with cytology triage could balance the CIN2+ detection and the number of colposcopies for women aged 55‐64 years. Longitudinal data including both prevalence and incidence screening rounds are warranted to assess age‐specific triage strategies.

Young immigrant women and cervical cancer screening: participation and lesions detected at the first screening round.

to evaluate if the country of origin affects participation and outcomes of cervical cancer screening. retrospective cohort study. all Italian and foreign women resident in the Veneto region (North-Eastern Italy) who were born between 1986 and 1992 and who had been invited for the first time through the screening programme between 2011 and 2017 were identified and included in the survey. participation to screening was calculated along with the detection of Cervical Intraepithelial Neoplasia (CIN) grade 2 or 3 and of carcinoma, by citizenship. 96,105 (77.5%) Italians and 27,958 (22.5%) foreign women were included. Overall, the adjusted participation was 53.3%, with large differences among the geographical study areas. The value was highest for Italian women (56.4%), while women with other citizenships showed lower attendance: 45.5% for Eastern Europe, 44.8% for Sub Saharan Africa, 40.0% for Northern Africa, 38.5% for Central and Southern America, and 36.5% for Asia. The detection of CIN2+ was higher for women from Central and Southern America (23.0‰) or from Eastern Europe (17.9‰), while it was lower for those from Italy (11.9‰), Northern Africa (7.5‰), Sub-Saharan Africa (6.6‰), and from Asia (2.5‰) (p<0.001). cervical screening programmes should identify and face the barriers to participation of foreign women. This is particularly important for women from geographic areas with a high prevalence of disease, such as Central and Southern America and Eastern Europe.

A Performance Evaluation of an Optoelectronic Cervical Screening Device in Comparison to Cytology and HPV DNA Testing

Objective: An optoelectronic screening device (OESD) is evaluated for the detection of cervical intra-epithelial neoplasia (CIN) 2+ lesions in comparison to Liquid Based Cytology (LBC) and high-risk HPV DNA (hrHPV) testing. Methods: In total 506 consecutive women referred because of abnormal cervical cytology or a positive high-risk HPV test, had an examination using OESD, LBC, and hrHPV testing. They were screened in 4 colposcopy clinics in New South Wales, Australia. In a retrospective audit, results were compared to the gold standard of colposcopy and biopsies if required. Sensitivity, specificity, area under the receiver operating characteristic (ROC)-curves, and differences using McNemar tests were calculated. All results were available for comparison on 474 patients. Results: The sensitivity to detect CIN II+ lesions by OESD, LBC and hrHPV-testing was 0.72, 0.81, and 0.88, and the specificity was 0.71, 0.95, and 0.76 respectively. The age- and previous-treatment adjusted area under the ROC curve for OESD was 0.83, for LBC 0.94, and for hrHPV testing 0.89. McNemar’s tests showed no significant difference in sensitivity between OESD and LBC (p = 0.26), and no significant difference in specificity between OESD and hrHPV-testing (p = 1.0) amongst patients without previous treatment. Conclusions: The optoelectronic screening device demonstrated comparable sensitivity to high quality cytology conducted in a hospital clinical setting. Specificity was comparable to hrHPV-testing in an approximate primary screening setting. OESD has the advantage of producing an immediate result and being easy to use without need of laboratory equipment. This device can potentially become an important tool in the prevention of cervical cancer, particularly in developing countries and resource-limited settings.

Self-sampling as the principal modality for population based cervical screening: Five-year follow-up of the PaVDaG study.

Self‐sampling provides a powerful means to engage women in cervical screening. In the original Papillomavirus Dumfries and Galloway study (PaVDaG), we demonstrated cross‐sectional similarity of high‐risk human papillomavirus (Hr‐HPV) testing on self‐taken vaginal vs clinician‐taken samples for the detection of cervical intraepithelial neoplasia 2 or worse (CIN2+). Few data exist on the longitudinal performance of self‐sampling; we present longitudinal outcomes of PaVDaG. Routinely screened women provided a self‐taken and a clinician‐collected sample. Ninety‐one percent of 5136 women from the original cohort completed a further screening round. Sensitivity, specificity, positive predictive value and complement of the negative predictive value of the Hr‐HPV test on self‐samples for detection of CIN2+ and CIN3+ up‐to 5 years after testing were determined. Additionally, clinical accuracy of Hr‐HPV testing on vaginal and clinician‐collected samples was assessed. A total of 183 CIN2+ and 102 CIN3+ lesions were diagnosed during follow‐up. Risk of CIN2+ and CIN3+ following an Hr‐HPV negative self‐sample was 0.6% and 0.2%, respectively, for up to 5 years after testing. The relative sensitivity for CIN3+ and specificity for ≤CIN1 of Hr‐HPV testing on self‐taken specimens was slightly lower vs clinician‐collected samples: 0.95 (95% CI: 0.90‐0.99; P McN = .0625) and 0.98 (95% CI: 0.95‐1.00; P McN = <.0000), respectively. The low risk of CIN2+ in women with Hr‐HPV—self‐sample(s) suggests, that the 3 to 5‐year recall interval implemented in several cervical screening settings, based on clinician‐taken samples, may be safe for self‐samples. Future assessment will show if “universal” 5‐year screening is appropriate for programs based on self‐sampling.

Analysis of related factors for cervical intraepithelial neoplasia Ⅱ+ detection in grade 1 abnormal colposcopic finding of cervix

Objective: To screen out high risk factors of cervical intraepithelial neoplasia (CIN) of grade Ⅱ or worse (CIN Ⅱ+) by analyzing related factors for CIN Ⅱ+ detection in grade 1 abnormal colposcopic finding (G1) of cervix and provide reference for individual management of colposcopic performance. Methods: A retrospective study was performed on patients who were reffered to colposcopy for abnormal results of cervical cancer screening and only had G1 colposcopic findings of cervix at the First Affiliated Hospital of Nanjing Medical University, from April 2017 to January 2021. The factors influencing the detection of CIN Ⅱ+ were analyzed by univariate and multivariate analysis. Results: (1) A total of 403 patients were included in this study whose median age was 38 years old (range: 22-67 years old), and utimately 108 had high-grade squamous intraepithelial lesion, 1 had adenocarcinoma in situ and 1 had adenocarcinoma. The overall detection rate of CIN Ⅱ+ was 27.3% (110/403). (2) Univariate analysis showed that the detection rate of CIN Ⅱ+, in patients ≥50 years old was higher than that in patients <50 years old (38.3% vs 25.4%; χ²=4.328, P=0.037), and in HPV 16 positive cases was higher than that in non-HPV 16 positive cases (41.8% vs 21.8%; χ²=16.080, P<0.01); as the cytological severity (χ²=6.775, P=0.009) and the number of involving quadrants (χ²=31.117, P<0.01) increased, the risk of CIN Ⅱ+ detection increased; but the types of colpolscopic signs were not related to detection of CIN Ⅱ+(χ²=0.323, P=0.851). Multivariable analysis showed that the age of ≥50 years old (OR=2.504, 95%CI: 1.299-4.830, P=0.006), HPV 16 positive type (OR=3.353, 95%CI: 2.004-5.608, P<0.01) and the increase of involving quadrants (OR=1.899, 95%CI: 1.518-2.376, P<0.01) were independent risk factors. (3) The detection rate of CIN Ⅱ+ was highest in the women with HPV 16 positive type and four quadrants of G1 (73.7%), while lowest in the women with non-HPV 16 positive type and one quadrant of G1 (10.4%). Conclusions: The age of ≥50 years old, HPV 16 positive type and the increase of involving quadrants are independent risk factors of detecting CIN Ⅱ+ in G1 colposcopic findings. So the key point of the individual management of G1 groups with different risk stratification is to adequately biopsy in high-risk group to avoid miss diagnosis of CIN Ⅱ+.