RT info:eu-repo/semantics/article
T1 Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus : results from the ESTAMPA multicentric screening study
A1 Valls, Joan
A1 Baena, Armando
A1 Venegas, Gino
A1 Celis, Marcela
A1 González, Mauricio
A1 Sosa, Carlos
A1 Santin, Jorge Luis
A1 Ortega, Marina
A1 Soilán, Ana
A1 Turcios, Elmer
A1 Figueroa, Jacqueline
A1 Rodríguez de la Peña, Margarita
A1 Figueredo, Alicia
A1 Beracochea, Andrea Verónica
A1 Pérez, Natalia
A1 Martínez Better, Josefina
A1 Lora, Oscar
A1 Jiménez, Julio Yamil
A1 Giménez, Diana
A1 Fleider, Laura
A1 Salgado, Yuly
A1 Martínez, Sandra
A1 Bellido Fuentes, Yenny
A1 Flores, Bettsy
A1 Tatti, Silvio
A1 Villagra, Verónica
A1 Cruz Valdez, Aurelio
A1 Terán, Carolina
A1 Sánchez, Gloria Inés
A1 Rodríguez, Guillermo
A1 Picconi, María Alejandra
A1 Ferrera, Annabelle
A1 Mendoza Torres, Laura Patricia
A1 Calderón, Alejandro
A1 Murillo, Raúl
A1 Wiesner, Carolina
A1 Broutet, Nathalie
A1 Luciani, Silvana
A1 Pérez, Carlos
A1 Darragh, Teresa M.
A1 Jerónimo, José
A1 Herrero, Rolando
A1 Almonte, Maribel
A2 Universidad Nacional de Asunción. Instituto de Investigaciones en Ciencias de la Salud
AB Background. Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women.Methods. This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30–64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit.Findings. Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7–49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9–93·2) for CIN3+, whereas specificity was 50·1% (48·5–51·8) for less than CIN2 and 47·1% (45·5–48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3–95·3] in those aged 30–49 years vs 77·6% [68·6–85·0] in those aged 50–65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8–47·6] vs 61·8% [58·7–64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001).Interpretation. Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women.
PB The Lancet
YR 2023
FD 2023-03
LK http://hdl.handle.net/20.500.14066/4414
UL http://hdl.handle.net/20.500.14066/4414
LA eng
NO Correspondence to: Dr Joan Valls, Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon 69366, France. vallsj@iarc.who.int
NO Consejo Nacional de Ciencia y Tecnología
DS MINDS@UW
RD 17-jul-2024