Abstract
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | International Journal of Cancer |
| Vol/bind | 116 |
| Udgave nummer | 1 |
| Sider (fra-til) | 122-9 |
| Antal sider | 7 |
| ISSN | 0020-7136 |
| DOI | |
| Status | Udgivet - 2005 |
| Udgivet eksternt | Ja |
Bibliografisk note
(c) 2005 Wiley-Liss, Inc.Adgang til dokumentet
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I: International Journal of Cancer, Bind 116, Nr. 1, 2005, s. 122-9.
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review
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TY - JOUR
T1 - Triage using HPV-testing in persistent borderline and mildly dyskaryotic smears: proposal for new guidelines
AU - Bais, Aagje G
AU - Rebolj, Matejka
AU - Snijders, Peter J F
AU - de Schipper, Frits A
AU - van der Meulen, Dries A J
AU - Verheijen, René H M
AU - Voorhorst, Feja
AU - van Ballegooijen, Marjolein
AU - Meijer, Chris J L M
AU - Helmerhorst, Theo J M
N1 - Keywords: Adult; Cervical Intraepithelial Neoplasia; DNA, Viral; Female; Follow-Up Studies; Humans; Mass Screening; Middle Aged; Papillomaviridae; Papillomavirus Infections; Prospective Studies; Tumor Virus Infections; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vaginal Smears
PY - 2005
Y1 - 2005
N2 - In the Netherlands 2% of cervical smears in the cervical cancer screening program are read as borderline or mildly dyskaryotic cytology (BMD smear). Only in about 10% of these women a high-grade CIN lesion (CIN II-III) is present; therefore referral is for the majority unnecessary. In our study triage with high-risk HPV (hrHPV) testing was used to identify women at risk for development of high-grade CIN lesions after a repeat BMD smear. A "wait-and-see" period was incorporated allowing clearance of HPV and regression of the lesion. Women with a low-grade lesion, irrespective of their HPV status, were monitored at 12 months; women with a high-grade lesion were monitored at 6 and 12 months. Fifty-one of the 105 women (49%) were hrHPV negative at baseline; none of them showed progression of the lesion within the first year of follow-up (NPV 100%). High-grade CIN was present in 1 patient who was HPV negative at baseline (2%); she demonstrated regression after 12 months. Nineteen of the hrHPV positive women (35%) demonstrated a high-grade CIN lesion at baseline and 3 cleared hrHPV after 6 months, with a subsequent regression of CIN. Ten women remained hrHPV positive with persistence of high-grade CIN and were eventually treated. At baseline, 35 hrHPV positive women demonstrated a low-grade lesion, 19 remained hrHPV positive after 12 months and 5 developed high-grade CIN. Sixteen out of the 35 cleared the hrHPV infection without progression of the lesion. In conclusion, triage, using hrHPV testing for women with persistent BMD cytology, can select women who are not at risk for development of high-grade CIN. We recommend return to the screening program without referral for colposcopic examination if hrHPV is absent. For hrHPV positive women, a repeat hrHPV test after another 6 months is suggested. Referral is only required if persistence of hrHPV is established.
AB - In the Netherlands 2% of cervical smears in the cervical cancer screening program are read as borderline or mildly dyskaryotic cytology (BMD smear). Only in about 10% of these women a high-grade CIN lesion (CIN II-III) is present; therefore referral is for the majority unnecessary. In our study triage with high-risk HPV (hrHPV) testing was used to identify women at risk for development of high-grade CIN lesions after a repeat BMD smear. A "wait-and-see" period was incorporated allowing clearance of HPV and regression of the lesion. Women with a low-grade lesion, irrespective of their HPV status, were monitored at 12 months; women with a high-grade lesion were monitored at 6 and 12 months. Fifty-one of the 105 women (49%) were hrHPV negative at baseline; none of them showed progression of the lesion within the first year of follow-up (NPV 100%). High-grade CIN was present in 1 patient who was HPV negative at baseline (2%); she demonstrated regression after 12 months. Nineteen of the hrHPV positive women (35%) demonstrated a high-grade CIN lesion at baseline and 3 cleared hrHPV after 6 months, with a subsequent regression of CIN. Ten women remained hrHPV positive with persistence of high-grade CIN and were eventually treated. At baseline, 35 hrHPV positive women demonstrated a low-grade lesion, 19 remained hrHPV positive after 12 months and 5 developed high-grade CIN. Sixteen out of the 35 cleared the hrHPV infection without progression of the lesion. In conclusion, triage, using hrHPV testing for women with persistent BMD cytology, can select women who are not at risk for development of high-grade CIN. We recommend return to the screening program without referral for colposcopic examination if hrHPV is absent. For hrHPV positive women, a repeat hrHPV test after another 6 months is suggested. Referral is only required if persistence of hrHPV is established.
U2 - 10.1002/ijc.20958
DO - 10.1002/ijc.20958
M3 - Journal article
C2 - 15751045
SN - 0020-7136
VL - 116
SP - 122
EP - 129
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 1
ER -