Human papillomavirus-based screening at extended intervals missed fewer cervical precancers than cytology in the HPV For Cervical Cancer (HPV FOCAL) trial.
Human papillomavirus-based screening at extended intervals missed fewer cervical precancers than cytology in the HPV For Cervical Cancer (HPV FOCAL) trial.
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在HPV用于宫颈癌（HPV FOCAL）试验中，与细胞学检查相比，以人乳头瘤病毒为基础的筛查在延长的时间间隔内遗漏的宫颈癌前病变较少。
DOI：
10.1002/ijc.34039
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发表时间：
2022-09-15
影响因子：
6.4
通讯作者：
Ogilvie, Gina
中科院分区：
文献类型：
--
作者：
Gottschlich, Anna;Gondara, Lovedeep;Smith, Laurie W.;Cook, Darrel;Martin, Ruth Elwood;Lee, Marette;Peacock, Stuart;Proctor, Lily;Stuart, Gavin;Krajden, Mel;Franco, Eduardo L.;van Niekerk, Dirk;Ogilvie, Gina
虽然建议每隔2至3年使用细胞学进行宫颈筛查，但鉴于基于人乳头瘤病毒（HPV）的筛查检测癌前病变的敏感性增加，建议每隔4至5年进行一次基于HPV的筛查。随着有组织的宫颈筛查计划从细胞学过渡到HPV筛查，间隔时间延长，人们担心癌症会在筛查之间被遗漏。HPV FOCAL试验的参与者每隔24个月接受细胞学检查（细胞学组）或每隔48个月接受基于HPV的筛查（HPV组）;两组在退出时接受联合检测（细胞学和HPV检测）。我们调查了联合检验的结果，以确定患有宫颈上皮内瘤变2级或更高（CIN 2+）的参与者，如果他们只进行了各自的初步筛查，他们将不会检测到癌前病变。在细胞学组中，25/62例（40.3%）确定的CIN 2+在初次筛选时缺失（即，细胞学正常/HPV检测阳性），所有25例患者在既往24个月筛选时细胞学正常。在HPV组中，3例CIN 2+（3/49，6.1%）在初次筛查时漏诊（即HPV检测阴性/细胞学异常）。这3例漏诊中有1例的细胞学检查结果为低级别，在试验之外也不会进行阴道镜检查。多轮细胞学检查未检测到一轮基于HPV的筛查所检测到的某些癌前病变。在我们的人群中，即使在较短的筛查间隔，细胞学检查也比HPV筛查遗漏了更多的CIN 2+。这缓解了对实施基于HPV的延长间隔筛查计划后漏诊的担忧。我们建议政策制定者考虑从细胞学转向基于HPV的宫颈筛查。 有什么新消息吗？ 在筛查项目中，基于人乳头瘤病毒（HPV）的宫颈癌检测比细胞学检查更敏感。然而，人们一直担心，以4至5年为间隔的HPV宫颈筛查可能会错过以2至3年为间隔的细胞学检测的癌症。这是第一项在初次细胞学或HPV筛查后4年使用联合检测的研究，以识别仅通过细胞学或HPV筛查遗漏的癌前病变。与每4年一次的HPV筛查相比，每2年一次的细胞学筛查漏诊的癌前病变数量是每4年一次的8倍以上，这支持了从细胞学筛查到HPV宫颈筛查的扩展转变。
While cervix screening using cytology is recommended at 2‐ to 3‐year intervals, given the increased sensitivity of human papillomavirus (HPV)‐based screening to detect precancer, HPV‐based screening is recommended every 4‐ to 5‐years. As organized cervix screening programs transition from cytology to HPV‐based screening with extended intervals, there is some concern that cancers will be missed between screens. Participants in HPV FOr CervicAL Cancer (HPV FOCAL) trial received cytology (Cytology Arm) at 24‐month intervals or HPV‐based screening (HPV Arm) at 48‐month intervals; both arms received co‐testing (cytology and HPV testing) at exit. We investigated the results of the co‐test to identify participants with cervical intraepithelial neoplasia grade 2 or higher (CIN2+) who would not have had their precancer detected if they had only their arm's respective primary screen. In the Cytology Arm, 25/62 (40.3%) identified CIN2+s were missed by primary screen (ie, normal cytology/positive HPV test) and all 25 had normal cytology at the prior 24‐month screen. In the HPV arm, three CIN2+s (3/49, 6.1%) were missed by primary screen (ie, negative HPV test/abnormal cytology). One of these three misses had low‐grade cytology findings and would also not have been referred to colposcopy outside of the trial. Multiple rounds of cytology did not detect some precancerous lesions detected with one round of HPV‐based screening. In our population, cytology missed more CIN2+, even at shorter screening intervals, than HPV‐based screening. This assuages concerns about missed detection postimplementation of an extended interval HPV‐based screening program. We recommend that policymakers consider a shift from cytology to HPV‐based cervix screening. What's new? Human papillomavirus (HPV)‐based testing for cervical cancer is more sensitive than cytology in screening programs. However, there is persisting concern that HPV‐based cervix screening at 4‐ to 5‐year intervals could miss cancers otherwise detected by cytology at 2‐ to 3‐year intervals. This is the first study to use co‐testing 4 years after primary cytology‐ or HPV‐based screening to identify precancers that would be missed by cytology‐ or HPV‐based screening alone. Over eight times more precancers were missed by cytology‐based screening every 2 years compared to HPV‐based screening every 4 years, supporting an extended shift from cytology to HPV‐based cervix screening.
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DOI：
10.1016/s1701-2163(15)30255-3
发表时间：
2015-05-01
影响因子：
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作者：
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通讯作者：
Ogilvie, Gina