TY - JOUR
T1 - Evaluation of triage strategies for high-risk human papillomavirus-positive women in cervical cancer screening
T2 - A multicenter randomized controlled trial in different resource settings in China
AU - Dang, Le
AU - Kong, Linghua
AU - Zhao, Yuqian
AU - Dai, Yi
AU - Ma, Li
AU - Wei, Lihui
AU - Zhang, Shulan
AU - Liu, Jihong
AU - Xi, Mingrong
AU - Chen, Long
AU - Duan, Xianzhi
AU - Xiao, Qing
AU - Abulizi, Guzhalinuer
AU - Zhang, Guonan
AU - Hong, Ying
AU - Zhou, Qi
AU - Xie, Xing
AU - Li, Li
AU - Niyazi, Mayinuer
AU - Zhang, Zhifen
AU - Tuo, Jiyu
AU - Ding, Yiling
AU - Qiao, Youlin
AU - Lang, Jinghe
N1 - Publisher Copyright:
© Chinese Journal of Cancer Research. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Objective: We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus (hrHPV)-positive women in primary healthcare settings in China. Methods: This study was undertaken in 11 rural and 9 urban sites. Women aged 35−64 years old were enrolled. HrHPV-positive women were randomly allocated to liquid-based cytology (LBC), visual inspection with acetic acid and Lugol’s iodine (VIA/VILI) (rural only) triage, or directly referred to colposcopy (direct COLP). At 24-month, hrHPV testing, LBC and VIA/VILI were conducted for combined screening. Results: In rural sites, 1,949 hrHPV-positive women were analyzed. A total of 852, 218 and 480 women were randomly assigned to direct COLP, LBC and VIA/VILI. At baseline, colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%−80%. LBC (n=3 and n=7) or VIA/VILI (n=8 and n=26) could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia (CIN) 2 or worse and CIN3+ compared with direct COLP (n=14 and n=23). For the 24-month cumulative detection rate of CIN2+, VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP. When stratified by age, baseline LBC triage+ performed best (P<0.001), peaking among women aged 35−44 years (Ptrend =0.002). In urban sites, 1,728 women were hrHPV genotyping test positive. A total of 408, 571 and 568 women were randomly assigned to direct COLP for HPV16/18+, direct COLP for other hrHPV subtypes+, and LBC triage for other hrHPV subtypes+. LBC (n=12 and n=31) significantly decreased the number of colposcopies needed to detect one CIN2+ and CIN3+ compared with direct COLP (n=14 and n=44). HPV16/18+ increased the 24-month cumulative detection rate of CIN2+ (17.89%, P<0.001). Conclusions: LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+ women and LBC triage for other hrHPV subtype+ women in urban settings might be feasible strategies.
AB - Objective: We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus (hrHPV)-positive women in primary healthcare settings in China. Methods: This study was undertaken in 11 rural and 9 urban sites. Women aged 35−64 years old were enrolled. HrHPV-positive women were randomly allocated to liquid-based cytology (LBC), visual inspection with acetic acid and Lugol’s iodine (VIA/VILI) (rural only) triage, or directly referred to colposcopy (direct COLP). At 24-month, hrHPV testing, LBC and VIA/VILI were conducted for combined screening. Results: In rural sites, 1,949 hrHPV-positive women were analyzed. A total of 852, 218 and 480 women were randomly assigned to direct COLP, LBC and VIA/VILI. At baseline, colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%−80%. LBC (n=3 and n=7) or VIA/VILI (n=8 and n=26) could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia (CIN) 2 or worse and CIN3+ compared with direct COLP (n=14 and n=23). For the 24-month cumulative detection rate of CIN2+, VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP. When stratified by age, baseline LBC triage+ performed best (P<0.001), peaking among women aged 35−44 years (Ptrend =0.002). In urban sites, 1,728 women were hrHPV genotyping test positive. A total of 408, 571 and 568 women were randomly assigned to direct COLP for HPV16/18+, direct COLP for other hrHPV subtypes+, and LBC triage for other hrHPV subtypes+. LBC (n=12 and n=31) significantly decreased the number of colposcopies needed to detect one CIN2+ and CIN3+ compared with direct COLP (n=14 and n=44). HPV16/18+ increased the 24-month cumulative detection rate of CIN2+ (17.89%, P<0.001). Conclusions: LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+ women and LBC triage for other hrHPV subtype+ women in urban settings might be feasible strategies.
KW - Cervical cancer screening
KW - LBC
KW - VIA/VILI
KW - hrHPV-positive
KW - triage strategy
UR - https://www.scopus.com/pages/publications/105011387665
U2 - 10.21147/j.issn.1000-9604.2022.05.09
DO - 10.21147/j.issn.1000-9604.2022.05.09
M3 - Article
AN - SCOPUS:105011387665
SN - 1000-9604
VL - 34
SP - 496
EP - 509
JO - Chinese Journal of Cancer Research
JF - Chinese Journal of Cancer Research
IS - 5
ER -
