| Title: |
Impact of knowledge of human papillomavirus positivity on cervical cytology performance in Latin America |
| Authors: |
Ramírez, Arianis Tatiana; Mesher, David; Baena, Armando; Salgado, Yuli; Kasamatsu, Elena; Cristaldo, Carmen; Álvarez, Rodrigo; Rojas, Freddy David; Ramírez, Katherine; Guyot, Julieta; Henríquez, Odessa; González Palma, Hans; Flores, Bettsy; Peñaranda, Jhaquelin; Vero, María José; Robinson, Isabel; Rol, Mary Luz; Rodríguez, Guillermo; Terán, Carolina; Ferrera, Annabelle; Picconi, María Alejandra; Calderon, Alejandro; Mendoza, Laura; Wiesner, Carolina; Almonte, Maribel; Herrero, Rolando; Colucci, María Celeste; Reynaga, Daysi Colque; Fernández, Daniel Llanos; Ortube, Omar; Martínez, Sandra; González, Emmanuel; Guillén, Diego; Cabrera, Yessy; Mongelós, Pamela; Rodríguez, María Isabel; Soilán, Ana; Ortega, Marina; Duarte, Elizabeth; García, Laura; Caserta, Benedicta; Darragh, Teresa; Downham, Laura |
| Contributors: |
IARC; International Agency for Research on Cancer; United Nations Population Fund; UNICEF; WHO; World Bank Special Program of Research; Development and Research Training in Human Reproduction; World Health Organization; Pan American Health Organization; National Cancer Institute; NCI; Center for Global Health; National Agency for the Promotion of Research, Technological Development and Innovation-PICT; Ministry of Science, Technology and Innovation; Ministry of Health; National Cancer Institute of Colombia; Costa Rica Social Security Fund; National Council for Science and Technology |
| Source: |
JNCI: Journal of the National Cancer Institute ; volume 117, issue 4, page 644-652 ; ISSN 0027-8874 1460-2105 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2024 |
| Description: |
Background Cervical cytology is recommended by the World Health Organization as a triage option in human papillomavirus (HPV)-based cervical cancer screening programs. We assessed the performance of cytology to detect CIN3+ without and with knowledge of HPV positivity. Methods Women were screened with cytology and HPV across ESTAMPA study centers in Latin America. Screen-positives were referred to colposcopy with biopsy and treatment as needed. Cytology was initially interpreted without knowing HPV results. A subset of cytologies from HPV-positive women were reinterpreted at the same laboratories, with knowledge of HPV status, blinded to previous cytology and histological diagnosis. Performance indicators for cytology to detect CIN3+ without and with knowledge of HPV positivity were estimated. Findings A total of 4087 women were included, of which 490 had histologically confirmed CIN3+ (455 CIN3 and 35 cancers). Cytology sensitivity without knowledge of HPV positivity for CIN3+ was 47.2% (95% CI = 42.5 to 51.9), whereas with knowledge of HPV positivity, the sensitivity was higher (58.9%, 95% CI = 54.2 to 63.5; P < .0001). The specificity without knowledge of HPV was 89.4% (95% CI = 88.2 to 90.5), whereas with knowledge of HPV positivity was 78.9% (95% CI = 77.4 to 80.4; P < .0001). Performance estimates varied by study center for cytology without knowing the HPV positivity (range = 32.8%-61.5% for sensitivity; range = 80.7%-98.6% for specificity). Similarly, performance varied with knowledge of HPV positivity (36.1%-93.4% for sensitivity; 39.6%-98.6% for specificity). Conclusion The increase in sensitivity of cytology with HPV knowledge was limited and highly variable, reinforcing the need for alternative triage methods to support cervical cancer elimination goals. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/jnci/djae283 |
| DOI: |
10.1093/jnci/djae283/60629423/djae283.pdf |
| Availability: |
https://doi.org/10.1093/jnci/djae283; https://academic.oup.com/jnci/advance-article-pdf/doi/10.1093/jnci/djae283/60629423/djae283.pdf; https://academic.oup.com/jnci/article-pdf/117/4/644/60629423/djae283.pdf |
| Rights: |
https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Accession Number: |
edsbas.EDEA2D9C |
| Database: |
BASE |