Department of Community Medicine & Department of Clinical Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.
Department of Pathology, University Hospital of North Norway, 9019 Tromsø, Norway.
Int J Environ Res Public Health. 2023 Feb 25;20(5):4119. doi: 10.3390/ijerph20054119.
A specific, cost-effective triage test for minor cytological abnormalities is essential for cervical cancer screening among younger women to reduce overmanagement and unnecessary healthcare utilization. We compared the triage performance of one 13-type human papillomavirus (HPV) DNA test and one 5-type HPV mRNA test.
We included 4115 women aged 25-33 years with a screening result of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) recorded in the Norwegian Cancer Registry during 2005-2010. According to Norwegian guidelines, these women went to triage (HPV testing and repeat cytology: 2556 were tested with the Hybrid Capture 2 HPV DNA test, which detects the HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68; and 1559 were tested with the PreTect HPV-Proofer HPV mRNA test, which detects HPV types 16, 18, 31, 33, and 45). Women were followed through December 2013.
HPV positivity rates at triage were 52.8% and 23.3% among DNA- and mRNA-tested women ( < 0.001), respectively. Referral rates for colposcopy and biopsy and repeat testing (HPV + cytology) after triage were significantly higher among DNA-tested (24.9% and 27.9%) compared to mRNA-tested women (18.3% and 5.1%), as were cervical intraepithelial neoplasia grade 3 or worse (CIN3+) detection rates (13.1% vs. 8.3%; < 0.001). Ten cancer cases were diagnosed during follow-up; eight were in DNA-tested women.
We observed significantly higher referral rates and CIN3+ detection rates in young women with ASC-US/LSIL when the HPV DNA test was used at triage. The mRNA test was as functional in cancer prevention, with considerably less healthcare utilization.
对于年轻女性的宫颈癌筛查，需要一种特异性、经济有效的细胞学异常分流检测方法，以减少过度管理和不必要的医疗保健利用。我们比较了一种 13 型人乳头瘤病毒（HPV）DNA 检测和一种 5 型 HPV mRNA 检测的分流性能。
我们纳入了 4115 名年龄在 25-33 岁之间的女性，这些女性在 2005-2010 年期间的挪威癌症登记处记录的筛查结果为不典型鳞状细胞意义不明（ASC-US）或低度鳞状上皮内病变（LSIL）。根据挪威指南，这些女性进行了分流（HPV 检测和重复细胞学检查：2556 名女性接受了 Hybrid Capture 2 HPV DNA 检测，该检测可检测 HPV 类型 16、18、31、33、35、39、45、51、52、56、58、59 和 68；1559 名女性接受了 PreTect HPV-Proofer HPV mRNA 检测，该检测可检测 HPV 类型 16、18、31、33 和 45）。这些女性的随访时间截至 2013 年 12 月。
在接受 DNA 和 mRNA 检测的女性中，分流时 HPV 阳性率分别为 52.8%和 23.3%（<0.001）。与 mRNA 检测组相比，DNA 检测组行阴道镜检查和活检以及分流后重复检测（HPV+细胞学）的转诊率明显更高（24.9%和 27.9%比 18.3%和 5.1%），宫颈上皮内瘤变 3 级或更高级别（CIN3+）的检出率也更高（13.1%比 8.3%；<0.001）。随访期间诊断了 10 例癌症病例，其中 8 例在 DNA 检测组。
在年轻的 ASC-US/LSIL 女性中，使用 HPV DNA 检测进行分流时，我们观察到转诊率和 CIN3+检出率显著更高。mRNA 检测在癌症预防方面同样有效，但医疗保健利用率明显较低。
