Unit of Virus, Lifestyle, and Genes, Danish Cancer Institute, Copenhagen, Denmark.
Department of Gynecology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 2024 Sep;103(9):1781-1788. doi: 10.1111/aogs.14915. Epub 2024 Jul 16.
In Denmark, where human papillomavirus (HPV) -based cervical cancer screening is being implemented, the aim of this pilot implementation study was to test a specific screening algorithm, assess follow-up examination attendance, and measure the proportion of precancer lesions found in relation to the number of women referred for colposcopy.
From May 2017 to December 2020, 36 417 women in the uptake area of the Department of Pathology, Vejle Hospital, Region of Southern Denmark, were included in the HPV group. Women positive for HPV16/18 irrespective of cytology and women positive for other high-risk HPV (hrHPV) types having concomitant abnormal cytology were referred directly to colposcopy. Women positive for other hrHPV types and normal cytology were referred to repeat screening after 12 months, and hrHPV negative to routine screening after three years. We obtained information on screening results and subsequent histological diagnosis from the Danish Pathology Databank through September 2022.
3.6% of the women were referred to colposcopy after primary screening, 5% to repeat screening after 12 months, and 91.4% back to routine screening. High follow-up rates were observed: 96% attended colposcopy after primary screening, with 91% attending colposcopy after repeat screening. CIN3+ was detected at colposcopy following the primary screening in 28.1% of HPV16/18-positive women and 18.2% of those positive for other hrHPV types with concomitant abnormal cytology. Of the women with other hrHPV and simultaneous ASCUS/LSIL, 8% had CIN3+. At the repeat screening, 43% had become hrHPV negative, 55% were persistently positive for other hrHPV, and 2% had turned positive for HPV16/18. At the colposcopy following repeat screening, 10.1% of the women positive for other hrHPV were diagnosed with CIN3+, in comparison with 11.1% of the HPV16/18-positive women.
In this pilot implementation study, an algorithm for HPV-based screening was evaluated in a Danish setting. The results demonstrated high attendance at follow-up examinations and provided insights into the number of colposcopy referrals and the detection of CIN2 and CIN3+ cases. The results suggest that women testing positive for other hrHPV in combination with ASCUS/LSIL at primary screening could potentially be referred to repeat screening instead of an immediate colposcopy.
在丹麦，正在实施基于人乳头瘤病毒（HPV）的宫颈癌筛查，本试点实施研究的目的是测试特定的筛查算法，评估随访检查的参与率，并测量与转诊行阴道镜检查的人数相关的癌前病变比例。
2017 年 5 月至 2020 年 12 月，丹麦南丹麦大区维勒医院病理学系的吸收区纳入了 36417 名妇女，她们被纳入 HPV 组。HPV16/18 阳性的妇女，无论细胞学结果如何，以及同时细胞学异常的其他高危 HPV（hrHPV）阳性的妇女，均直接转诊行阴道镜检查。其他 hrHPV 阳性且细胞学正常的妇女在 12 个月后进行重复筛查，hrHPV 阴性的妇女在 3 年后进行常规筛查。截至 2022 年 9 月，我们通过丹麦病理学数据库获取了筛查结果和随后的组织学诊断信息。
初次筛查后，3.6%的妇女被转诊行阴道镜检查，5%的妇女在 12 个月后被转诊行重复筛查，91.4%的妇女回到常规筛查。观察到高随访率：初次筛查后，96%的妇女行阴道镜检查，其中 91%的妇女行重复筛查后行阴道镜检查。初次筛查后 HPV16/18 阳性妇女中 28.1%和同时细胞学异常的其他 hrHPV 阳性妇女中 18.2%在阴道镜检查中发现 CIN3+。在重复筛查中，其他 hrHPV 且同时 ASCUS/LSIL 的妇女中，8%有 CIN3+。在重复筛查中，43%的妇女 HPV 转阴，55%的妇女持续 hrHPV 阳性，2%的妇女 HPV16/18 阳性。在重复筛查后的阴道镜检查中，其他 hrHPV 阳性妇女中 10.1%被诊断为 CIN3+，而 HPV16/18 阳性妇女中 11.1%被诊断为 CIN3+。
在本试点实施研究中，评估了一种基于 HPV 的筛查算法在丹麦的应用情况。结果显示，随访检查的参与率较高，并提供了关于阴道镜检查转诊人数和 CIN2 和 CIN3+病例检出率的信息。结果表明，初次筛查时同时为 ASCUS/LSIL 且其他 hrHPV 阳性的妇女可能可以转诊行重复筛查，而不是立即行阴道镜检查。
