Triage of women with ASC-US/LSIL cytology: the added value of implementing an HPV-test
ForfatterMsomphora, Mbachi Ruth
Background: Within the Norwegian cervical cancer screening program women were recommended biopsy after three consecutive smears of minor lesions (ASC-US/LSIL) 6-12 months apart until 2005. In 2005 the recommendations for biopsy changed to the 2nd ASC-US/LSIL, if the HPV-test was positive. In this study we determine the outcomes of secondary cervical cancer screening in two time-periods before (1996-1998) and after (2006-2008) implementation of an HPV test. Methods: This study has a historical prospective design by including in retrospect all screening- and follow-up tests for women aged 25 to 69 years old kept by the Department of Clinical Pathology, University Hospital of North Norway. All women with a first ASC-US/LSIL smear in 1996-98 and 2006-08 were identified and compared on outcomes such as proportion of cases resolved within 42 months of index smear and incidence of CIN2+. The Department of Clinical pathology has used an HPV mRNA test (NorChip PreTect HPV-Proofer) since the autumn of 2005 in secondary cervical cancer screening (triage). Results: Over the years January 1st 1991 and December 31st 2010 UNN laboratory processed 635 287 smears. After exclusion criteria, the study population comprised of 1405 women during 1996-1998 (study group A) and 738 women with a valid HPV-test in triage during 2006-2008 (study group B). In these subsets 16.2% (227/1405) in 1996-98 and 18.8% (139/738) in 2006-08 of the women were eligible for colposcopy/biopsy according to national screening recommendations. In 2006-08, when the HPV mRNA test was applied, the mean time to resolve an ASC-US/LSIL was 9.1 months (range 3-41) relative 23.1 months (range 4-42) in 1996-98 (p<0.001). Significantly more cases were solved in study group B, including HPV-testing at 1st follow-up (82.4%) compared to study group A (53.6%) within 42 months of follow-up. The positive predictive value of CIN2+ 52.0% (64/124) in study group B was significantly higher compared to that of study group A 41.7% (68/163), when there was indication for biopsy according to the screening algorithm over the time-periods. Conclusion: In triage of women with ASC-US/LSIL, the HPV mRNA test significantly reduced the time from the first abnormal cytology until biopsy and had higher predictive values compared with repeat cytology.
ForlagUiT Norges arktiske universitet
UiT The Arctic University of Norway
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