Comparison of primary cytology, primary HPV testing and co-testing as cervical cancer screening for Chinese women: a population-based screening cohort

Abstract

ObjectivesWe compared clinical performance of three strategies of primary human papillomavirus (HPV) testing, primary cytology and co-testing for cervical cancer screening.DesignA population-based prospective cohort study of clinical performance of screening strategy.SettingPatients recruited from community in Changzhi County, Shanxi Province, China.Patient3209 women aged 30–64 years without gynaecological issues.Primary and secondary outcome measuresThe performance of different screening strategies for detecting cervical intraepithelial neoplasia grade 2 or more severe (CIN2+).ResultsA total of 53 CIN2+ and 31 CIN3+ cases are detected. For CIN2+, sensitivity of primary HPV (95.9%) and co-testing (98.0%) are not statistically different, but significantly higher than primary cytology (48.0%). Specificity (86.8%), colposcopy referral rate (7.8%) and number of colposcopies required to detect one case (9.8) for primary HPV are better than co-testing (79.8%, 11.9%, 14.3%, respectively). For CIN3+, primary HPV, co-testing have 100% of sensitivity and specificity, which is significantly higher than primary cytology (56.7% and 90.2%). Number of colposcopies required to detect one case for primary HPV (15.9) is better than co-testing (23.8).ConclusionsCompared with co-testing, HPV primary screening had comparable sensitivity and higher specificity for CIN2+ detection, and both of them showed better performance than cytology primary screening in cervical cancer screening.

Real-world effectiveness of cytology and HPV-based screening strategy in cervical cancer screening: A cross-sectional population-based study in Chengdu, China

“…First, our findings suggest that the age-standardized abnormality rates of primary screening results were significantly higher for HPV-based screening compared with cytology. This supports the conclusion that the HPV-based method is more sensitive than cytology as a primary screening method, could detect more people with suspicious cervical lesions and reduce the rate of underdiagnosis [26,27]. Second, the proportion of abnormal colposcopy results following HPV-based primary screening was also much higher than that of cytology, indicating that HPV testing combined with genotyping and cytology triage for primary screening has higher accuracy, which may relatively improve the benefit of colposcopy in cases where there is a higher colposcopy referral rate for HPV-based testing [28,29].…”

Understanding the Dynamics of Human Papillomavirus and Diagnostic Discrepancies in Cervical Pathology: A Single Center Experience

“…Studies showed that both HPV testing and cytology increased the sensitivity and specificity of CC screening while lowering false-positive cases [55], with the potential to lower the rates of diagnostic inconsistencies [17]. This, in turn, ensures that most CCs will be detected during subsequent diagnosis [56,57]. The integration of cytology and HPV genotyping detection offers a more efficient approach to assessing the morbidity risks associated with cervical CIN II and III lesions [30].…”

Cervical cancer: Challenges and prevention strategies: A narrative review

“…72 There are now three alternatives that are advised for CC screening for those between the ages of 21 and 65: primary HPV testing every 5 years, cytology alone every 3 years, and co-testing with the combination of cytology and HPV testing every 5 years. 73,74 Primary HPV testing and co-testing are more successful than cytology alone in identifying high-grade cervical intraepithelial neoplasia in individuals aged 25-65 who are at moderate risk.…”