Institute of Public Health, University of Copenhagen, Denmark.
Nat Rev Clin Oncol. 2009 Dec;6(12):699-706. doi: 10.1038/nrclinonc.2009.167. Epub 2009 Nov 10.
Six European, randomized, controlled trials that will compare human papillomavirus (HPV) testing with cytological testing for cervical screening are under way. We reviewed the results published so far to compare the benefits and costs for participating women. At baseline screening, use of HPV testing increased the detection of cervical intraepithelial neoplasia (CIN) grade 2+. Detection of CIN3+ was significantly increased in two trials (relative risks [RRs] 1.70 and 2.26), but not in three other trials (RRs 1.03, 1.09 and 1.31). In three trials, seven extra women had a false-positive test for each extra detected CIN2+ case; although, in another trial, this number was 49 in women > or =35 years of age. The outcome of HPV testing versus cytological testing depends not only on the relative accuracy of the primary test but also on how radical the different triage procedures are. In two trials with published outcomes from the subsequent screening round, an approximately 50% reduction in CIN3+ detection was evident in the subsequent screening. However, in these two trials the screening modalities changed between the baseline and subsequent screening rounds, so these data do not show the effect of a switch from primary screening with cytological testing to primary screening with HPV testing.
正在进行六项欧洲、随机、对照试验，旨在比较人乳头瘤病毒（HPV）检测与细胞学检测在宫颈筛查中的应用。我们对迄今为止发表的结果进行了回顾，以比较参与女性的获益和成本。在基线筛查中，HPV 检测的使用增加了宫颈上皮内瘤变（CIN）2+的检出率。两项试验（相对风险 [RR] 1.70 和 2.26）中 CIN3+的检出率显著增加，但其他三项试验（RR 1.03、1.09 和 1.31）则未增加。在三项试验中，每检出一个额外的 CIN2+病例，就会有 7 名女性的 HPV 检测出现假阳性；尽管在另一项试验中，这一数字在≥35 岁的女性中为 49。HPV 检测与细胞学检测的结果不仅取决于初始检测的相对准确性，还取决于不同分流程序的激进程度。在两项具有后续筛查结果发表的试验中，在后续筛查中，CIN3+的检出率明显降低了约 50%。然而，在这两项试验中，基线和后续筛查轮次之间的筛查方式发生了变化，因此这些数据并未显示从细胞学检测的初级筛查切换到 HPV 检测的初级筛查的效果。
