TY - JOUR
T1 - Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot
AU - Rebolj, Matejka
AU - Mathews, Christopher S.
AU - Denton, Karin
AU - Appleyard, Tracey‐Louise
AU - Cruickshank, Margaret
AU - Cuschieri, Kate
AU - Ellis, Kay
AU - Evans, Chris
AU - Frew, Viki
AU - Giles, Thomas
AU - Gray, Alastair
AU - Holbrook, Miles
AU - Hunt, Katherine
AU - Kitchener, Henry
AU - Levine, Tanya
AU - McBride, Emily
AU - Mesher, David
AU - Palmer, Timothy
AU - Parker, Janet
AU - Rimmer, Elizabeth
AU - Rudge Pickard, Hazel
AU - Sargent, Alexandra
AU - Smith, David
AU - Smith, John
AU - Soldan, Kate
AU - Stubbs, Ruth
AU - Tidy, John
AU - Tyler, Xenia
AU - Waller, Jo
N1 - Funding Information:
The data in this article belongs to the former Public Health England and the authors cannot provide access to the relevant data sets to third parties. Requests for data and pre-application advice should instead be made to Office for Data Release ([email protected]). Christopher S. Mathews held an honorary appointment at Public Health England to process the data for the pilot. Karin Denton reports personal fees from Public Health England during the conduct of the study and travel support from Hologic outside the submitted work; chairs the Public Health England Laboratory Clinical Professional Group, the HPV Development Group, and several groups related to the evaluation of self-sampling; was a consultant to the Scally Review of cervical screening in Ireland and the Royal College of Obstetricians and Gynaecologists review of cervical cancer audit in Ireland (both completed in 2019); and has prepared expert medicolegal reports for claimants and defendants, including cases of cervical cancer. Matejka Rebolj reports grants from Public Health England during the conduct of the study and lecture fees from Hologic outside the submitted work, is a member of the Public Health England Laboratory Technology Group and HPV Self-Sampling Operational Steering Group and Project Board, and has attended meetings with various human papillomavirus assay manufacturers. Public Health England supported the epidemiological evaluation of the HPV pilot (ODR1718_428). Matejka Rebolj and Christopher Mathews were supported by Cancer Research UK (C8162/A27047). Public Health England had a role in designing the pilot and in the collection of the data and commented on the manuscript. Cancer Research UK had no role in designing the study, in the collection of the data, or in the writing of the manuscript.
Funding Information:
Public Health England supported the epidemiological evaluation of the HPV pilot (ODR1718_428). Matejka Rebolj and Christopher Mathews were supported by Cancer Research UK (C8162/A27047). Public Health England had a role in designing the pilot and in the collection of the data and commented on the manuscript. Cancer Research UK had no role in designing the study, in the collection of the data, or in the writing of the manuscript.
Publisher Copyright:
© 2022 The Authors. Cancer Cytopathology published by Wiley Periodicals LLC on behalf of American Cancer Society.
PY - 2022/7
Y1 - 2022/7
N2 - 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 [ORadj], 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 ORadj 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 (ORadj, 2.05; 95% CI, 1.43-2.93). Conclusions: Quality-controlled cervical screening programs can avoid inappropriate overgrading of HPV-positive cytology.
AB - 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 [ORadj], 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 ORadj 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 (ORadj, 2.05; 95% CI, 1.43-2.93). Conclusions: Quality-controlled cervical screening programs can avoid inappropriate overgrading of HPV-positive cytology.
KW - Cancer Research
KW - Oncology
UR - http://www.scopus.com/inward/record.url?scp=85127598420&partnerID=8YFLogxK
U2 - 10.1002/cncy.22572
DO - 10.1002/cncy.22572
M3 - Article
SN - 1934-662X
VL - 130
SP - 531
EP - 541
JO - Cancer Cytopathology
JF - Cancer Cytopathology
IS - 7
ER -
