Outcomes in Women With Cytology Showing Atypical Squamous Cells of Undetermined Significance With vs Without Human Papillomavirus Testing

被引:14
作者
Cuzick, Jack [1 ]
Myers, Orrin [2 ]
Lee, Ji-Hyun [2 ]
Shi, Yang [3 ]
Gage, Julia C. [4 ]
Hunt, William C. [5 ]
Robertson, Michael [5 ]
Wheeler, Cosette M. [5 ,6 ]
机构
[1] Queen Mary Univ London, Wolfson Inst Prevent Med, Ctr Canc Prevent, London, England
[2] Univ New Mexico, Hlth Sci Ctr, Dept Internal Med, Div Epidemiol Biostat & Prevent Med, 1816 Sigma Chi Rd NE,Mail Stop Code MSC02-1670, Albuquerque, NM 87131 USA
[3] Univ New Mexico, Ctr Comprehens Canc, 1816 Sigma Chi Rd NE,Mail Stop Code MSC02-1670, Albuquerque, NM 87131 USA
[4] NCI, Div Canc Epidemiol & Genet, NIH, US Dept HHS, Bethesda, MD 20892 USA
[5] Univ New Mexico, Hlth Sci Ctr, Dept Pathol, 1816 Sigma Chi Rd NE,Mail Stop Code MSC02-1670, Albuquerque, NM 87131 USA
[6] Univ New Mexico, Hlth Sci Ctr, Dept Obstet & Gynecol, 1816 Sigma Chi Rd NE,Mail Stop Code MSC02-1670, Albuquerque, NM 87131 USA
关键词
CERVICAL PRECANCER; RISK; METHYLATION; GUIDELINES; HPV16; DNA;
D O I
10.1001/jamaoncol.2017.1040
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
IMPORTANCE Little is known about the long-term yield of high-grade cervical intraepithelial neoplasia (CIN) and the influence on biopsy and treatment rates of human papillomavirus (HPV) triage of cytology showing atypical squamous cells of undetermined significance (hereafter ASC-US cytology). OBJECTIVE To examine 5-year outcomes after ASC-US cytology with vs without HPV testing. DESIGN, SETTING, AND PARTICIPANTS In this observational study, all cervical cytology and HPV testing reports from January 1, 2007, to December 31, 2012, were obtained for women throughout New Mexico and linked to pathology reports. The dates of the analysis were May 4, 2015, to January 13, 2017. MAIN OUTCOMES AND MEASURES Influence of HPV testing on disease yield, time to histologically confirmed disease, and biopsy or loop electrosurgical excision procedure rates. RESULTS A total of 457 317 women (mean [SD] age, 39.8 [12.5] years) with a screening test were recorded between 2008 and 2012, and 20 677 (4.5%) of the first cytology results per woman were reported as ASC-US. CIN grade 3 or more severe (CIN3+) lesions were detected in 2.49% of women with HPV testing vs 2.15% of women without HPV testing (P = .23). Time to CIN3+ detection was much shorter in those with HPV testing vs those without testing (median, 103 vs 393 days; P < .001). CIN grade 1 was detected in 11.6% of women with HPV testing vs 6.6% without testing (relative risk, 1.76; 95% CI, 1.56-2.00; P < .001). Loop electrosurgical excision procedure rates within 5 years were 20.0% higher in those who underwent HPV testing, resulting in more CIN2+ and CIN3+ detection. CONCLUSIONS AND RELEVANCE Human papillomavirus testing led to faster and more complete diagnosis of cervical disease, but 55.8% more biopsies and 20.0% more loop electrosurgical excision procedures were performed. In those tested, virtually all high-grade disease occurred in the 43.1% of women who were HPV positive, allowing clinical resources to be focused on women who need them most. These data provide essential information for cervical screening guidelines and public health policy.
引用
收藏
页码:1327 / 1334
页数:8
相关论文
共 13 条
[1]   Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions [J].
Arbyn, Marc ;
Roelens, Jolien ;
Simoens, Cindy ;
Buntinx, Frank ;
Paraskevaidis, Evangelos ;
Martin-Hirsch, Pierre P. L. ;
Prendiville, Walter J. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2013, (03)
[2]   HPV33 DNA methylation measurement improves cervical pre-cancer risk estimation of an HPV16, HPV18, HPV31 and EPB41L3 methylation classifier [J].
Brentnall, Adam R. ;
Vasiljevic, Natasa ;
Scibior-Bentkowska, Dorota ;
Cadman, Louise ;
Austin, Janet ;
Cuzick, Jack ;
Lorincz, Attila T. .
CANCER BIOMARKERS, 2015, 15 (05) :669-675
[3]   Human papillomavirus type 16 infections and 2-year absolute risk of cervical precancer in women with equivocal or mild cytologic abnormalities [J].
Castle, PE ;
Solomon, D ;
Schiffman, M ;
Wheeler, CM .
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2005, 97 (14) :1066-1071
[4]   Human papillomavirus testing 2007-2012: Co-testing and triage utilization and impact on subsequent clinical management [J].
Cuzick, Jack ;
Myers, Orrin ;
Hunt, William C. ;
Saslow, Debbie ;
Castle, Philip E. ;
Kinney, Walter ;
Waxman, Alan ;
Robertson, Michael ;
Wheeler, Cosette M. .
INTERNATIONAL JOURNAL OF CANCER, 2015, 136 (12) :2854-2863
[5]   A Population-Based Evaluation of Cervical Screening in the United States: 2008-2011 [J].
Cuzick, Jack ;
Myers, Orrin ;
Hunt, William C. ;
Robertson, Michael ;
Joste, Nancy E. ;
Castle, Philip E. ;
Benard, Vicki B. ;
Wheeler, Cosette M. .
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, 2014, 23 (05) :765-773
[6]   Individual detection of 14 high risk human papilloma virus genotypes by the PapType test for the prediction of high grade cervical lesions [J].
Cuzick, Jack ;
Ho, Linda ;
Terry, George ;
Kleeman, Michelle ;
Giddings, Michael ;
Austin, Janet ;
Cadman, Louise ;
Ashdown-Barr, Lesley ;
Costa, Maria J. ;
Szarewski, Anne .
JOURNAL OF CLINICAL VIROLOGY, 2014, 60 (01) :44-49
[7]   Cost-effectiveness of alternative triage strategies for atypical squamous cells of undetermined significance [J].
Kim, JJ ;
Wright, TC ;
Goldie, SJ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 287 (18) :2382-2390
[8]   Evaluating cytology for the detection of invasive cervical cancer [J].
Landy, R. ;
Castanon, A. ;
Hamilton, W. ;
Lim, A. W. W. ;
Dudding, N. ;
Hollingworth, A. ;
Sasieni, P. D. .
CYTOPATHOLOGY, 2016, 27 (03) :201-209
[9]   2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors [J].
Massad, L. Stewart ;
Einstein, Mark H. ;
Huh, Warner K. ;
Katki, Hormuzd A. ;
Kinney, Walter K. ;
Schiffman, Mark ;
Solomon, Diane ;
Wentzensen, Nicolas ;
Lawson, Herschel W. .
OBSTETRICS AND GYNECOLOGY, 2013, 121 (04) :829-846
[10]   Elevated methylation of HPV16 DNA is associated with the development of high grade cervical intraepithelial neoplasia [J].
Mirabello, Lisa ;
Schiffman, Mark ;
Ghosh, Arpita ;
Rodriguez, Ana C. ;
Vasiljevic, Natasa ;
Wentzensen, Nicolas ;
Herrero, Rolando ;
Hildesheim, Allan ;
Wacholder, Sholom ;
Scibior-Bentkowska, Dorota ;
Burk, Robert D. ;
Lorincz, Attila T. .
INTERNATIONAL JOURNAL OF CANCER, 2013, 132 (06) :1412-1422