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The Efficiency of Type-Specific High-Risk Human Papillomavirus Models in the Triage of Women with Atypical Squamous Cells of Undetermined Significance

Authors Wang Y, Gao S, Wang Y, Chen F, Deng H, Lu Y

Received 23 March 2020

Accepted for publication 26 May 2020

Published 1 July 2020 Volume 2020:12 Pages 5265—5275

DOI https://doi.org/10.2147/CMAR.S254330

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo


Yangzhen Wang,1 Shanshan Gao,1 Yuxia Wang,1 Fuchun Chen,2 Hailong Deng,3 Yongfang Lu1

1Department of Central Laboratory, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, People’s Republic of China; 2Department of Gynecology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, People’s Republic of China; 3Department of Pathology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, People’s Republic of China

Correspondence: Yongfang Lu
Department of Central Laboratory, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, People’s Republic of China
Tel +86-597-2205918
Email lyongfanglu@163.com

Purpose: To evaluate the performance of different high-risk human papillomavirus (HR-HPV) genotype models in triaging women with cytological diagnosis of atypical squamous cells of undetermined significance (ASCUS).
Patients and Methods: A total of 36,679 Chinese women who underwent cytology and HR-HPV genotyping assessments during cervical cancer screening were enrolled in this study. Women with cytology-proven ASCUS were referred for further screening by colposcopy and biopsy. The study endpoint was histological detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) at any of the follow-up visits. The sensitivity, specificity, positive predictive values (PPVs), negative predictive values (NPVs), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of different HR-HPV genotype combination models were estimated.
Results: In all, 1675 (4.9%) women were identified as having ASCUS, 1454 women underwent colposcopy and biopsy, and 6.0% (87/1454) women were identified as having CIN2+ lesions. Among those with ASCUS who were identified as having CIN2+, the HR-HPV infection rate was 97.7%, and the prevalence rates of HPV-16, − 18, − 31, − 33, − 35, − 39, − 45, − 51, − 52, − 56, − 58, − 59, − 66 and − 68 were 48.3%, 8.0%, 6.9%, 4.6%, 1.1%, 2.3%, 3.4%, 3.4%, 26.4%, 1.1%, 17.2%, 2.3%, 0.0% and 0.0%, respectively. Compared to other HR-HPV-type combination models, the HPV16/18/31/33/52/58 model achieved a higher sensitivity [93.1 (87.8– 98.4)], specificity [73.0 (70.7– 75.4)], PPV [18.0 (14.5– 21.5)], NPV [99.4 (98.9– 99.9)], PLR [3.7 (3.1– 3.8)] and NLR [0.06 (0.03– 0.18)] for the triage of ASCUS patients, but the colposcopy referral rate (30.9%) was significantly lower than that of the recommended HR-HPV model (44.0%).
Conclusion: This study confirms that the specific HR-HPV genotype HPV16/18/31/33/52/58 is an alternative strategy for ASCUS triage and can effectively reduce the high burden of colposcopy referrals in China.

Keywords: human papillomavirus, high-risk, genotyping, atypical squamous cells of undetermined significance, cervical intraepithelial neoplasia

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