HPV 疫苗接种人群中，以 HPV 检测为基础的初筛在转诊行阴道镜检查中的临床效能：观察性研究。
Clinical performance of primary HPV screening cut-off for colposcopy referrals in HPV-vaccinated cohort: Observational study.
机构信息
Aberdeen Centre for Women's Health Research (ACWHR), University of Aberdeen, Aberdeen, UK.
出版信息
BJOG. 2023 Jan;130(2):210-213. doi: 10.1111/1471-0528.17284. Epub 2022 Sep 7.
OBJECTIVE
To understand the effect of changing from cytology-based to primary HPV screening on the positive predictive value (PPV) of colposcopy referrals for cervical intraepithelial neoplasia (CIN) in a cohort offered HPV vaccination.
DESIGN
Retrospective pre/post observational cohort study.
SETTING
Scotland.
POPULATION OR SAMPLE
2193 women referred to colposcopy between September 2019 and February 2020 from cytology-based screening and between September 2020 and February 2021 from primary high-risk HPV (hrHPV) screening.
METHODS
Calculating positive predictive values (PPVs) for two cohorts of women; one having liquid-based cytology screening and the other, the subsequent hrHPV cervical screening as a pre/post observational study.
MAIN OUTCOME MEASURES
Positive predictive values of LBC and hrHPV cut-offs for colposcopy referral for CIN at colposcopy.
RESULTS
Three papers fitted our criteria; these reported results only for cytology-based screening. The PPV was lower for women in HPV-vaccinated cohorts indicating a lower prevalence of disease. Vaccination under the age of 17 had the lowest PPV reported. Scottish colposcopy data concerning hrHPV and cytology showed a non-significant difference between PPV (17.5%, 95% CI 14.3-20.7, and 20.6, 95% CI 16.7-24.5, respectively) for referrals with a cut-off of low grade dyskaryosis (LGD); both met the standard set of 8-25%. The hrHPV PPV (66.7, 95% CI 56.8-76.6) was comparable to cytology (64.1, 95% CI 55.8-72.4) for referrals with a cut-off of high grade dyskaryosis (HGD) but neither met the standard set of 77-92%.
CONCLUSIONS
Current literature only provides PPVs for LBC and, overall, the vaccinated cohort had lower PPVs. Only LG dyskaryosis met PHE criteria. The PPV for HPV-vaccinated women undergoing either LBC or HR-HPV screening were not statistically different. However, similar to papers in the current literature, HG dyskaryosis (HGD) PPVs of both techniques did not meet the PHE threshold of 76.6-91.6% outlined in the cervical standards data report.
目的
了解细胞学筛查转变为初级 HPV 筛查对接受 HPV 疫苗接种人群中宫颈上皮内瘤变（CIN）的阴道镜转诊阳性预测值（PPV）的影响。
设计
回顾性前后观察队列研究。
地点
苏格兰。
人群或样本
2019 年 9 月至 2020 年 2 月间，2193 名因细胞学筛查而转诊至阴道镜检查的女性；2020 年 9 月至 2021 年 2 月间，2193 名因初级高危型 HPV（hrHPV）筛查而转诊至阴道镜检查。
方法
计算两组女性的阳性预测值（PPV）：一组接受液基细胞学筛查，另一组接受随后的 hrHPV 宫颈筛查，这是一项前后观察性研究。
主要观察指标
阴道镜检查中 LBC 和 hrHPV 截点对 CIN 阴道镜转诊的阳性预测值。
结果
有 3 篇论文符合我们的标准；这些论文仅报告了基于细胞学筛查的结果。HPV 疫苗接种队列中的女性 PPV 较低，表明疾病的患病率较低。17 岁以下人群接种 HPV 疫苗的报告 PPV 最低。苏格兰的 hrHPV 和细胞学阴道镜检查数据显示，低级别细胞学异常（LGD）转诊的截定点（分别为 17.5%、95%CI 14.3-20.7 和 20.6、95%CI 16.7-24.5）之间的 PPV 无显著差异；两者均符合 8-25%的标准设定。高危级细胞学异常（HGD）转诊截定点的 hrHPV PPV（66.7、95%CI 56.8-76.6）与细胞学检查（64.1、95%CI 55.8-72.4）相似，但均不符合 77-92%的标准设定。
结论
目前的文献仅提供了 LBC 的 PPV，总体而言，接种疫苗的队列 PPV 较低。只有 LGD 符合 PHE 标准。接受液基细胞学检查或 HR-HPV 筛查的 HPV 疫苗接种女性的 PPV 无统计学差异。然而，与当前文献中的论文一样，两种技术的 HGD（HGD）PPV 均未达到宫颈标准数据报告中 76.6-91.6%的 PHE 阈值。
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