16/18 genotyping in triage of persistent human papillomavirus infections with negative cytology in the English cervical screening pilot
Menée en Angleterre auprès de 127 238 femmes participant à un programme de dépistage du cancer du col de l'utérus et auprès de trois laboratoires d'analyses, cette étude évalue l'effet de protocoles de sélection, comportant la recherche des papillomavirus humains de type 16 et 18 dès la première session de dépistage et un rappel 12 ou 24 mois plus tard en cas de test positif et d'analyse cytologique négative, sur le taux de colposcopies réalisées et le taux de lésions cervicales CIN2+ détectées
Background : In the English pilot of primary cervical screening with high-risk human papillomavirus (HR-HPV), we exploited natural viral clearance over 24 months to minimise unnecessary referral of HR-HPV+ women with negative cytology. Three laboratories were permitted to use 16/18 genotyping to select women for referral at 12-month recall. We estimated the clinical impact of this early genotyping referral.
Methods : The observed numbers of women referred to colposcopy and with detected high-grade cervical intraepithelial neoplasia (CIN2+), and of women who did not attend early recall in the three laboratories were compared with those estimated to represent a situation without an early genotyping referral. The 95% confidence intervals (CI) for the differences between the protocols were calculated by using a parametric bootstrap.
Results : Amongst 127,238 screened women, 16,097 (13%) had HR-HPV infections. The genotyping protocol required 5.9% (95% CI: 4.4–7.7) additional colposcopies and led to a detection of 1.2% additional CIN2+ (95% CI: 0.6–2.0), while 2.3% (95% CI: 2.1–2.5) fewer HR-HPV+/cytology− women did not attend the early recall compared with the non-genotyping protocol.
Conclusions : In a screening programme with high quality of triage cytology and high adherence to early recall,16/18 genotyping of persistent HPV infections does not substantially increase CIN2+ detection.
British Journal of Cancer , article en libre accès, 2019