Advances in Cervical Screening Technology

Stoler, Mark H.

doi:10.1038/modpathol.3880048

Cited by 64 publications

(50 citation statements)

References 61 publications

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“…However, at the present time, our study gives a global NPV of 99.9% for the development of an HSIL and carcinoma in women with an initial smear within normal limits and a negative HR-HPV test result. The occurrence of cytological abnormalities in 3.2% of our population is also lower than the percentage of 5.3% of abnormal smears reported in the literature in general primary screening (Stoler, 2000) (5.2% in our own laboratory). Moreover, if we consider our own previous results on women with normal smears and a positive HR-HPV test with a follow-up, the PPV for detecting an HSIL is 7.7% for one test and 21.2% for recurrent HR-HPV infection (Bory et al, 2002).…”

Section: Discussioncontrasting

confidence: 71%

Negative human papillomavirus testing in normal smears selects a population at low risk for developing high-grade cervical lesions

et al. 2004

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High-risk human papillomaviruses (HR-HPV) are the necessary cause of cervical carcinomas and there is an increasing interest in using HR-HPV DNA detection in adjunction to cytological examination for primary cervical screening. To determine whether women with a normal smear negative for HR-HPV DNA detection with the Hybrid Capture II assay might represent a low-risk population for developing a high-grade squamous intraepithelial lesion (HSIL), 4401 women have been followed in a period of 12 -72 months (median ¼ 34 months). During this follow-up, four HSIL and one microinvasive carcinoma have been detected in this cohort (three in the cohort of 3526 women 429 years). The global negative predictive value (NPV) of double-negative tests is thus of 99.9% (ninetyfive percent confidence interval (95% CI): 99.8 -100%), whereas cytology alone gives an NPV of 99.2% (95% CI: 98.9 -99.5%). If we obtain a second negative HR-HPV test 1 -2 years after the initial test, the NPV is 100%. The NPV is also of 100% in the cohort of women 449 years. We conclude that all these women could be safely screened at longer intervals between 3 and 5 years. This policy will offset the increased costs induced by an additional HR-HPV testing in primary screening. It is now well established that oncogenic (high-risk) human papillomaviruses (HPV) are a necessary causal factor in the development of cervical intraepithelial and invasive neoplasias (Lorincz et al, 1992; Bosch et al, 1995;Walboomers et al, 1999;Zur Hausen, 2002). Infections with high-risk HPV (HR-HPV) are associated with a relative risk of between 8 and 11 for the development of squamous intraepithelial lesions (SIL) (Gaarenstroom et al, 1994). Moreover, only low-grade SIL (LSIL) containing HR-HPV progress to high-grade SIL (HSIL) (Koutsky et al, 1992). Owing to this, there is an increasing interest in using HPV DNA detection either alone or in addition to classic cytological examination for primary cervical screening (Cuzick et al, 1995(Cuzick et al, , 1999(Cuzick et al, , 2003Meijer et al, 1998;Clavel et al, 1999Clavel et al, , 2001Kuhn et al, 2000;Ratnam et al, 2000;Schiffman et al, 2000;Schneider et al 2000;Kjaer et al, 2002;Petry et al, 2003;Lorincz and Richart, 2003;Sherman et al, 2003). Most authors consider that a positive HPV testing selects a population at high risk for developing an HSIL, while a negative HPV testing has a very good negative predictive value (NPV). Indeed, considering that the mean time from detectable LSIL to preclinical invasive cancer is 12 -13 years (Gustafson and Adami, 1989), Meijer et al (1998) have proposed that women with cytologically normal smears and a negative HR-HPV test could be rescreened every 8 years.Hybrid Capture-II (HC-II), a commercial HPV detection test, (Digene, Gaithersburg, MD, USA) was introduced 7 years ago (Lorincz, 1996). Hybrid Capture-II is a nonradioactive, reproducible, relatively rapid, liquid hybridisation assay in microtiters designed to detect 18 HPV types divided into high-risk (types 16, 18, 31, 33, 35, 39, 45, 51, ...

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Section: Discussioncontrasting

confidence: 71%

Negative human papillomavirus testing in normal smears selects a population at low risk for developing high-grade cervical lesions

et al. 2004

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“…Considering that HPV infection in younger women often spontaneously regress and that the incidence of cervical cancer in women younger than 30 years is very low, numerous authors (Wright et al, 1998;Cuzick et al, 1999;Stoler, 2000) have recommended the use of HPV testing for older women (>30-35 years old). This could improve the specificity and the positive predictive value of the test.…”

Section: Discussionmentioning

confidence: 99%

Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women

et al. 2001

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Summary High-risk human papillomaviruses (HR-HPV) are the necessary cause of cervical carcinomas. To determine whether HPR-HPV DNA detection in primary routine screening could represent a sensitive and reliable technique for the detection of high-grade squamous intraepithelial lesions (HGSIL), laboratory analysis using 2 cytologic techniques (conventional and liquid-based), HPV testing with Hybrid Capture II assay (HC-II), followed by colposcopic examination of women with abnormal cervical finding and/or persistent HR-HPV infection, was conducted in 7932 women who had routine cervical examination. The sensitivity of HPV testing for detecting a histologically proven HGSIL was 100%, higher than that of conventional (68.1%) and liquid-based (87.8%) cytology. The low specificities of 85.6% and 87.3% of HPV testing slightly increased to 88.4% and 90.1% if HPV testing was reserved for woman >30 years old. The quantitative approach provided by the HC-II assay for the assessment of the viral load was not reliable for predicting HGSIL in normal smears. HR-HPV testing could be proposed in primary screening in association with cytology. With conventional cytology it significantly improves the detection of HGSIL. With the use of the same cervical scrape for HPV testing and liquid-based cytology, HR-HPV testing would allow to select positive samples treated in a second time for cytology which gives a good specificity.

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“…The human papilloma viruses (HPV) are a group of epitheliotropic small DNA viruses that have been strongly linked to the etiology of human anogenital cancer, particularly cervical cancer (Mansur and Androphy, 1993;Zur-Hausen and de Villiers, 1994;Stoler, 2000). Indeed, 99.7% of invasive cervical carcinomas worldwide contain and express DNA from HPV (Walboomers et al, 1999;Herrington, 1999), with HPV-16 and 18 being the types most frequently found in these tumors.…”

Section: Introductionmentioning

confidence: 99%

Oncogenes and tumor angiogenesis: the HPV-16 E6 oncoprotein activates the vascular endothelial growth factor (VEGF) gene promoter in a p53 independent manner

et al. 2000

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Advances in Cervical Screening Technology

Cited by 64 publications

References 61 publications

Negative human papillomavirus testing in normal smears selects a population at low risk for developing high-grade cervical lesions

Negative human papillomavirus testing in normal smears selects a population at low risk for developing high-grade cervical lesions

Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women

Oncogenes and tumor angiogenesis: the HPV-16 E6 oncoprotein activates the vascular endothelial growth factor (VEGF) gene promoter in a p53 independent manner

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