Effectiveness of a two-stage strategy with HPV testing followed by visual inspection with acetic acid for cervical cancer screening in a low-income setting
Effectiveness of a two-stage strategy with HPV testing followed by visual inspection with acetic acid for cervical cancer screening in a low-income setting
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DOI：
10.1002/ijc.29250
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发表时间：
2015-03-15
影响因子：
6.4
通讯作者：
Petignat, Patrick
中科院分区：
文献类型：
--
作者：
Tebeu, Pierre-Marie;Fokom-Domgue, Joel;Petignat, Patrick
世界卫生组织最近提倡一种两阶段策略，即人乳头瘤病毒（HPV）检测，然后用醋酸（VIA）目视检查子宫颈，作为宫颈癌筛查的合适选择。然而，其准确性从未在初级筛查的背景下直接评估。为了评估在低收入环境中对自我获取的样本（自我HPV）进行HPV检测并随后进行VIA（顺序检测）的有效性，我们在喀麦隆的两个城市周边地区招募了540名年龄在30至65岁之间的女性。合资格的妇女获得有关子宫颈癌及如何进行自我抽样的咨询。HPV阳性和HPV阴性妇女的随机样本被召回进行VIA和活检。疾病定义为宫颈上皮内瘤变2级或更严重（CIN2+）。在调整验证偏倚后，测定VIA、自hpv和序列检测的性能。HPV患病率为27.0%。VIA阳性12.9%，患病率5%。VIA对CIN2+的敏感性和特异性分别为36.4%[95%可信区间（CI）： 15.2-64.6%]和90.4% （95% CI: 85.4-93.7%）。自体hpv的敏感性[100.0% (95% CI: 79.6-100.0%)]比序贯检测[33.3% (95% CI: 15.2-58.3%)]高66%。同时，自体hpv特异性[74.5% (95% CI: 70.6 ~ 78.1%)]比序贯检测[96.7% (95% CI: 94.8 ~ 97.9%)]低22%。两阶段的筛查策略，自hpv随后VIA提高了宫颈癌筛查的特异性，但代价是失去了重要的敏感性。需要改进VIA性能的方法或其他工具来提高HPV检测的阳性预测值。有什么新鲜事吗?世界卫生组织专家制定的指南提出了一种宫颈癌筛查策略，即人乳头瘤病毒（HPV）检测后，用乙酸（VIA）目视检查。但对于该战略的准确性，以及其有效性是否超过了威盛所需的资源，问题仍然存在。在这项研究中，在喀麦隆参加筛查活动的妇女中，在HPV阳性结果后被召回进行VIA检查，发现VIA敏感性低，但特异性高。敏感性的丧失可能是不可接受的，特别是对于低收入环境和大规模筛查项目。
The World Health Organization recently advocated a two-stage strategy with human papillomavirus (HPV) testing followed by visual inspection of the cervix with acetic acid (VIA) as a suitable option for cervical cancer screening. However, its accuracy has never been directly assessed in the context of primary screening. To evaluate effectiveness of HPV testing on self-obtained specimens (self-HPV) followed by VIA (sequential testing) in a low-income setting, we recruited 540 women aged between 30 and 65 years in two Cameroonian periurban areas. Eligible women were counseled about cervical cancer and how to perform self-sampling. HPV positive and a random sample of HPV-negative women were called back for VIA and biopsy. Disease was defined by interpretation of cervical intraepithelial neoplasia Grade 2 or worse (CIN2+). Performances of VIA, self-HPV and sequential testing were determined after adjustment for verification bias. HPV prevalence was 27.0%. VIA positivity was 12.9% and disease prevalence was 5%. Sensitivity and specificity of VIA for CIN2+ were 36.4% [95% confidence interval (CI): 15.2-64.6%] and 90.4% (95% CI: 85.4-93.7%), respectively. Sensitivity of self-HPV [100.0% (95% CI: 79.6-100.0%)] was 66% higher than that of sequential testing [33.3% (95% CI: 15.2-58.3%)]. Meanwhile, specificity of self-HPV [74.5% (95% CI: 70.6-78.1%)] was 22% lower than that of sequential testing [96.7% (95% CI: 94.8-97.9%)]. A two-stage screening strategy with self-HPV followed by VIA improves specificity of cervical cancer screening, but at the cost of an important loss of sensitivity. Ways to improve VIA performance or other tools are needed to increase positive predictive value of HPV testing.What's New? Guidelines developed by experts at the World Health Organization propose a cervical cancer screening strategy whereby human papillomavirus (HPV) testing is followed by visual inspection with acetic acid (VIA). But questions remain about the accuracy of the strategy and whether its effectiveness outweighs the resources needed for VIA. In this study, among women enrolled in a screening campaign in Cameroon who were called back for VIA after a positive HPV result, VIA was found to have low sensitivity but high specificity. The loss of sensitivity may be unacceptable, particularly for low-income settings and mass screening programs.