Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Dutch National Institute for Public Health and the Environment, Centre for Population Screening, Bilthoven, the Netherlands.
J Med Screen. 2019 Dec;26(4):221-224. doi: 10.1177/0969141319864991. Epub 2019 Jul 25.
Several studies have shown that there is an upward shift in the classification of cervical cytology when high-risk human papillomavirus (hrHPV) status is known to be positive. The Netherlands implemented primary hrHPV screening with reflex cytology as the primary screening test in 2017. Prior to implementation of the new programme, we investigated whether knowledge of hrHPV status influences cytology rating.
Using a set of 200 cytology slides that had been previously tested, two pairs of cytotechnicians rated 100 slides per pair twice: first without knowledge of hrHPV status and then, after a wash-out period of two months, with knowledge of hrHPV status.
We found that hrHPV positive slides were more likely to be rated up over the referral threshold (i.e. from negative for intraepithelial lesion or malignancy to atypical squamous cells of undetermined significance+) than hrHPV negative slides at the second review when hrHPV status was known (relative risk = 3.2; 95% confidence interval: 1.3–7.9).
If the same upward shift in ratings were to be observed in the national programme, it may have implications for referrals of women with low-grade lesions.
多项研究表明，当已知高危型人乳头瘤病毒（hrHPV）呈阳性时，宫颈细胞学分类会向上转移。荷兰于 2017 年实施了以高风险型 HPV 检测为初筛、以细胞学检查为补充的宫颈癌筛查策略。在实施新方案之前，我们调查了 hrHPV 状态的知晓情况是否会影响细胞学分级。
本研究使用了一组 200 张已检测的细胞学涂片，由两对细胞学技术员每对各重复评估 100 张涂片：第一次评估时不了解 hrHPV 状态，两个月洗脱期后，了解 hrHPV 状态后再次评估。
当知晓 hrHPV 状态时，hrHPV 阳性的涂片在第二次评估时比 hrHPV 阴性的涂片更有可能被评为高于转诊阈值（即从上皮内病变或恶性肿瘤阴性转为不典型鳞状细胞意义不明确+）（相对风险=3.2；95%置信区间：1.3-7.9）。
如果在全国性方案中观察到相同的分级上调，这可能会对低级别病变女性的转诊产生影响。
