A comparison of HPV DNA testing and liquid based cytology over three rounds of primary cervical screening: Extended follow up in the ARTISTIC trial
A comparison of HPV DNA testing and liquid based cytology over three rounds of primary cervical screening: Extended follow up in the ARTISTIC trial
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DOI：
10.1016/j.ejca.2011.01.008
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发表时间：
2011-04-01
影响因子：
8.4
通讯作者：
Peto, Julian
中科院分区：
文献类型：
--
作者：
Kitchener, Henry C.;Gilham, Clare;Peto, Julian
背景：与细胞学检查相比，HPV检测的额外敏感性可以延长宫颈筛查间隔。我们希望确定，通过进一步（第三）轮筛选的ARTISTIC试验中，提供了一个负的基线HPV筛查相比，细胞学超过6 years period.Methods：CIN 2或更糟（CIN 2+）和CIN 3或更糟（CIN 3+）的累积率与基线HPV状态和细胞学的保护。使用Hybrid Capture 2（Qiagen）检测高危型HPV，并使用线性阵列（Roche）和Papillocheck（Greiner）检测进行基因分型。结果：第3轮包括8，873名妇女，其中6，337人在第1轮和第2轮进行了筛查，2，536人自第1轮以来没有进行筛查。中位随访时间为72.7个月。总的来说，3轮的CIN 2+累积率为3.88%（95%CI 3.59%，4.17%）;第1轮为2.39%，第2轮为0.78%，第3轮为0.74%。基线状态的累积发生率为20.53%（95%CI 19.04%，22.08%）细胞学异常，20.12%（95%CI 18.68%，21.61%），细胞学阴性为1.41%（95%CI 1.19%，1.65%），HPV检测阴性为0.87%（95%CI 0.70%，1.06%）。50岁以上HPV阴性妇女累积感染率为0.16%（95%CI 0.07%，0.34%）。HPV阳性/细胞学阴性的女性在6年内的累积CIN 2+率为7.73%（95%CI 6.29%，9.36%），是总体率的两倍。解释：HPV阴性检测在三轮内比正常细胞学检测具有更大的保护作用。ARTISTIC扩展的结果表明，如果HPV检测取代细胞学作为主要筛查检测，则筛查间隔可延长至6年。(C)2011爱思唯尔有限公司保留所有权利。
Background: The additional sensitivity of HPV testing compared with cytology could permit extended cervical screening intervals. We wished to determine, through a further (third) round of screening in the ARTISTIC trial, the protection provided by a negative baseline HPV screen compared with that of cytology over a 6 year period.Methods: Cumulative rates of CIN2 or worse (CIN2+) and CIN3 or worse (CIN3+) were correlated with baseline HPV status and cytology. HPV was detected using the Hybrid Capture 2 (Qiagen) assay for high risk types and genotyped using the Linear Array (Roche) and Papillocheck (Greiner) assays. LBC was performed using ThinPrep (Hologic).Findings: Round 3 included 8,873 women of whom 6,337 had been screened in both rounds 1 and 2 and 2,536 had not been screened since round 1. The median duration of follow-up was 72.7 months. The cumulative rate of CIN2+ over three rounds was 3.88% (95%CI 3.59%, 4.17%) overall; 2.39% in round 1, 0.78% in round 2 and 0.74% in round 3. Cumulative rates by baseline status were 20.53% (95%CI 19.04%, 22.08%) for abnormal cytology, 20.12% (95%CI 18.68%, 21.61%) for HPV detection, 1.41% (95%CI 1.19%, 1.65%) for negative cytology and 0.87% (95%CI 0.70%, 1.06%) for a negative HPV test. In HPV negative women aged over 50 the cumulative rate was 0.16% (95%CI 0.07%, 0.34%). Women who were HPV positive/cytology negative at entry had a cumulative CIN2+ rate of 7.73% (95%CI 6.29%, 9.36%) over 6 years, twice the overall rate.Interpretation: A negative HPV test was significantly more protective than normal cytology over three rounds. The findings of this extension of ARTISTIC suggest that the screening interval could be extended to 6 years if HPV testing replaced cytology as the primary screening test. (C) 2011 Elsevier Ltd. All rights reserved.