医学
宫颈上皮内瘤变
细胞学
宫颈癌
急诊分诊台
入射(几何)
肿瘤科
阴道镜检查
巴氏染色
基因分型
生物标志物
妇科
产科
内科学
癌症
病理
基因型
基因
化学
急诊医学
物理
光学
生物化学
作者
C. Allen Chang,Shih-Chu Ho,Yee‐Fun Su,Yi‐Chen Juan,Chueh‐Yi Huang,An‐Shine Chao,Zen-Shing Hsu,Chih-Hung Chang,Chyng‐Wen Fwu,Ting‐Chang Chang
标识
DOI:10.1016/j.ygyno.2021.02.011
摘要
Objective Human papillomavirus (HPV) testing as the primary cervical cancer screening followed by reflex cytology if high-risk HPV is present (hrHPV+) is recently adopted in some countries. However, reflex cytology's sensitivity is variable, and a suitable triage approach for hrHPV+ remains controversial. Here, we compared the performance of three triage tools in hrHPV+ women. Methods Three triage tools—cytology, HPV16/18 genotyping, and DNA methylation biomarker PAX1m—were analyzed for their clinical performance in hrHPV+ women. In addition, women without cervical cancer at enrollment were followed for histologically confirmed high-grade cervical intraepithelial neoplasia or worse (CIN3+) annually using Papanicolaou smear. Results Of 4762 women aged ≥20 years enrolled, 502 (10.5%) were hrHPV+. PAX1m and cytology demonstrated similar accuracy (>90%), sensitivity (>78%), and specificity (>92%) as triage tools in 429 hrHPV+ women aged 30–64 years. PAX1m had better accuracy and specificity (91.6% and 92.5%, respectively) than HPV16/18 (76.9% and 76.8%, respectively). The incidence of CIN3+ among hrHPV+ women was 10.7 cases/1000 person-years. The incidence was significantly greater in PAX1m-positive women than in PAX1m-negative women. Conclusions PAX1m has comparable clinical performance to cytology and better accuracy and specificity than HPV16/18 as the triage tool for detecting CIN3+ in hrHPV+ women. The PAX1m assay is thus a promising molecular-based triage tool for early detection of CIN and predicting disease progression in hrHPV+ women. It can be especially useful in countries where adequate cytology-based infrastructure is lacking, such as some Southeast Asian countries, for cervical cancer screening and prevention.
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