European Board and College of Obstetrics and Gynaecology (EBCOG)
European Association of Gynaecology and Obstetrics (EAGO)
Union of European Medical Societies (UEMS)
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17th European Congress of Obstetrics and GynaecologyCzech Republic
Prague, May 22 – 25, 2002
HPV DETECTION ADJUNCT TO CYTOLOGICAL CERVICAL CANCER SCREENING: INFLUENCE OF TEST THRESHOLDS
Marc ARBYN1, Philippe DE SUTTER2, Claire BOURGAIN3
1. Scientific Institute of Public Health, Belgium.
European Cervical Cancer Screening Network: Evaluation of New Screening Methods.
2. Department of Gynaecology, Hospital of the Free University of Brussels, Brussels, Belgium.
3. Department of Pathology, Hospital of the Free University of Brussels, Brussels, Belgium.
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Title
HPV DETECTION ADJUNCT TO CYTOLOGICAL CERVICAL CANCER SCREENING: INFLUENCE OF TEST THRESHOLDS
Authors
Marc ARBYN,
MD, DTM&H, MSc,
Epidemiologist,
Co-ordinator European Cervical Cancer Screening Network: Evaluation New Screening Methods
Scientific Institute of Public Health,
J. Wytsmanstreet 14,
B-1050 Brussels,
Belgium.
Tel: +32/2/642.50.21; Fax: +32/2/642.54.10
E-mail:
Philippe DE SUTTER,
MD,
Gynaecologist,
University Hospital of the Free University of Brussels (AZ VUB),
Laarbeeklaan 101,
B-1090 Brussels,
Belgium.
Claire BOURGAIN
MD,
Pathologist,
University Hospital of the Free University of Brussels (AZ VUB),
Laarbeeklaan 101,
B-1090 Brussels,
Belgium.
HPV DETECTION ADJUNCT TO CYTOLOGICAL CERVICAL CANCER SCREENING: INFLUENCE OF TEST THRESHOLDS
M. Arbyn1, C. Bourgain2, Ph. De Sutter3
1 Scientific Institute of Public Health, Brussels, Belgium.
2 Department of Pathology, Hospital of the Free University of Brussels, Brussels, Belgium.
3 Department of Gynaecology, Hospital of the Free University of Brussels, Brussels, Belgium
Introduction
More effective management of women showing minor cervical lesions using HPV DNA testing in comparison with repeat cytology has been documented recently. Accepting this evidence, HPV triage can be considered as a more adequate experimental arm (as alternative to simple cytological screening) in primary HPV screening trials. Such an experiment was recently set up in Brussels.
Material and methods
Three thousand women were randomised in 2 arms A and B. From all women cellular material was collected and processed using the AUTOCYTE system. An additional HYBRID CAPTURE II (HC2) test (targeting high-risk HPV types) was performed on residual material from all women in group A, but limited to ASCUS/LSIL cases in group B. Detection of histologically confirmed CIN2+ constituted the main study outcome. Methods and general baseline results were reported previously. We now focus on variation of accuracy according to cytological cut-off and viral load, expressed in relative light unit ratios (RLU), within group A.
Results
The relative sensitivity of cytology, defined at the decision criterion HSIL/AGUS+, could be enhanced with a factor of 1.5 by subsequent HPV testing of ASCUS/LSIL. Still 27% more CIN2+ could be detected by testing all subjects for HPV. Highest sensitivity (73.6%) for cytology is reached at the threshold of ASCUS+. The false-positive rate (FPR=1-Specificity) at this point is (3.7%). A significantly higher sensitivity for HC2 is reached at RLU>=1 (94.7%); the FPR was similar (3.0%). The proportion of the surface under the ROC-curve, was 0.86 for cytology and 0.98 for virology. The median RLU differed significantly between absence and presence of histological CIN, but no correlation with severity of dysplasia was observed.
Conclusions
HC2 at RLU=1 is more accurate than cytology for CIN2+ but the RLU value does not allow to predict accurately the degree of dysplasia.
Acknowledgements
This project was supported by grants from the European Commission and the Scientific Fund Willy Gepts.
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