Utilization of human papillomavirus testing for cervical cancer prevention in a university hospital

Abstract

This study aimed to evaluate the performance and cost of using polymerase chain reaction (PCR) and hybrid capture in the detection of cervical intraepithelial neoplasia (CIN) in patients with cytological abnormalities (ASCUS/low-grade squamous intraepithelial lesion - LSIL), and the feasibility of implementing these methods in Brazil's Unified National Health System (SUS). Colposcopy gave a negative predictive value of 92.86% and efficiency of 87.8% for diagnosing CIN. The sensitivity of PCR and hybrid capture for detecting CIN was 83.33% and 66.67%, respectively, and the negative predictive value for diagnosing CIN2/CIN3 was 100% and 94.74%, respectively. The annual cost for 80 patients was lower when all patients with ASCUS/LSIL were referred for colposcopy than when HPV testing was performed and those with positive results were referred for colposcopy. Therefore, at present, it is financially unfeasible for the National Health System to implement HPV testing to screen patients with cytological abnormalities (ASCUS/LSIL). However, considering that large-scale use might make such methods cheaper, PCR should be the chosen method, since it is less expensive, more sensitive, and has a high negative predictive value.

Prevention of cervical cancer in women with ASCUS in the Brazilian Unified National Health System: cost-effectiveness of the molecular biology method for HPV detection

“…In 2007, our research group published a study 14 on the use of molecular biology methods in the Brazilian Unified National Health System (SUS, acronym in Portuguese) for treating patients with ASCUS and LSIL cytology for cervicalvaginal, cervical, and uterine cancer prevention. Our results indicated that one must consider the cost per use of wide-scale prevention programs, and PCR screening should be the choice method because it is cheaper and more sensitive than other screening methods.…”

Frequency and genotyping of human papillomavirus in women submitted to citology

“…In a study by Nomelini et al (30) , HCII showed 47.5% of positivity for high-risk HPV in the sample, whereas PCR diagnosed 87.5% of positive cases showing poor correlation between them (κ<0.4). It is believed that the failure to detect the positive samples through HCII is due to low viral load in samples, occasionally making them false-positives and false-negatives.…”

“…Several studies have demonstrated high correlation between the HCII and PCR techniques, reaching 76.5-90% (30) . To Saini et al (31) , PCR was more sensitive (81.8%) compared with HCII (36.4%) in detecting HPV, though HCII's specificity was much higher (96.6%) than PCR's (58.6%).…”

Comparação das técnicas de captura de híbridos e PCR para a detecção de HPV em amostras clínicas

“…Muitos autores têm demonstrado alta concordância entre as técnicas de CH e PCR, atingindo de 76,5% a 90 % (3,20,22,33) . Em comparação com o método de PCR, a CH demonstra sensibilidade de 91,7% (5,33) .…”

“…Em um estudo realizado por Nomelini et al (20) , a CH apresentou 47,5% de amostras positivas para HPV de alto risco, enquanto a PCR diagnosticou 87,5% de casos positivos, mostrando fraca concordância (40%) entre ambas (κ > 0,4). Os autores acreditam que a falha na detecção das amostras positivas pela CH seja devida à baixa carga viral nas amostras, tornando-as ocasionalmente falso-positivas e falso-negativas (2) .…”