Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot

Abstract

BACKGROUND: Overcalling of abnormalities has been a concern for using cytology triage after positive high-risk human papillomavirus (HPV) tests in cervical screening. METHODS: The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the English HPV pilot. The pilot compared routine implementation of primary cervical screening based on cytology (N = 931,539), where HPV test results were not available before cytology reporting, with that based on HPV testing (N = 403,269), where cytology was only required after positive HPV tests. RESULTS:Revealed HPV positivity was associated with a higher direct referral to colposcopy after any abnormality (adjusted odds ratio [OR adj ], 1.16; 95% confidence interval [CI], 1.14-1.18). Laboratories with higher direct referral referred fewer persistently HPV-positive women after early recall. The detection of high-grade cervical intraepithelial neoplasia (CIN2+) after direct referral increased with an OR adj of 1.17 (95% CI, 1.13-1.20) for informed versus uninformed cytology. Generally, the positive predictive value (PPV) of colposcopy for CIN2+ remained comparable under both conditions of interpreting cytology. In women 50 to 64 years old with high-grade dyskaryosis, however, the PPV increased from 71% to 83% after revealing HPV positivity (OR adj , 2.05; 95% CI, 1.43-2.93). CONCLUSIONS: Quality-controlled cervical screening programs can avoid inappropriate overgrading of HPV-positive cytology.

Prevalence of human papillomavirus genotypes and related cervical morphological results in southern Hunan Province of China, 2018–2020: Baseline measures at a tertiary institution prior to mass human papillomavirus vaccination

“…Cytology screening in patients with a high-risk HPV genotype is the conventional method ( Rebolj et al, 2022 ). The distribution of different cervical cytology results in each HPV genotype group, especially the high-risk genotypes, is helpful in evaluation of the risk of morphological changes.…”

Supporting the implementation of new healthcare technologies by investigating generalisability of pilot studies using area-level statistics

“…The pilot used the same eligibility criteria [6]. The outcomes have been reported in detail previously [6,7,[20][21][22][23][24]. The six pilot laboratories were distributed across England (Fig.…”

“…Individual-level data generated during the pilot's first (prevalence) screening round were retrieved from laboratory information systems [6,7,[20][21][22][23][24]. We compared the age-specific values for screening process indicators directly observed in the pilot (with exact binomial 95% CI) and those obtained after standardisation by IMD quintile.…”

Recent advances in the cervical screening programme

“…Knowledge of the hrHPV result appears to influence the cytological reporting, with samples that were hrHPV positive more likely to have borderline and low-grade changes compared with hrHPV-negative samples. 10 In women over 50 years of age, the addition of hrHPV triage improved the differentiation between dyskaryosis and hormone-related age artefacts. Overall, knowing the hrHPV status of the test enhanced the detection of pre-cancerous changes compared with liquidbased cytology screening alone, while enabling those with normal cytology to be conservatively managed.…”

“…Most HPV screening programmes that have transitioned from cytology screening use cytology triage to improve the specificity and control colposcopy referrals. Knowledge of the hrHPV result appears to influence the cytological reporting, with samples that were hrHPV positive more likely to have borderline and low‐grade changes compared with hrHPV‐negative samples 10 . In women over 50 years of age, the addition of hrHPV triage improved the differentiation between dyskaryosis and hormone‐related age artefacts.…”