Benefit of double-reading cytology smears as a triage strategy among high-risk human papillomavirus-positive women in Mexico
Por:
Ramirez-Palacios, Paula, Chen, Aiyu, Flores, Yvonne N., Crespi, Catherine M., Lazcano-Ponce, Eduardo, Alvarez-Escobedo, Daniel, Torres-Ibarra, Leticia, Rivera-Paredez, Berenice, Leon-Maldonado, Leith, Hernandez-Lopez, Rubi, Mendiola-Pastrana, Indira R., Mendez-Hernandez, Pablo, Cuzick, Jack, Carmona, Enrique, Figueroa, Hector, Montiel-Cordero, Fernando, Meneses-Leon, Joacim, Rao, Jianyu, Salmeron, Jorge, Wheeler, Cosette, Gravitt, Path, Schmeler, Kathleen M., Castle, Philipe, Granados, Victor, Bishai, David, Ramirez, Paula, Mendiola-Pastrana, Indira, Hernandez-Avila, Mauricio, Franco, Eduardo, Lorincz, Attila, Moscicki, Anna Barbara, Pastrana, Guadalupe
Publicada:
1 oct 2020
Resumen:
Background The goal of this study was to determine whether the detection
of histologically confirmed cases of cervical high-grade squamous
intraepithelial lesions or worse (HSIL+) can be increased by having each
liquid-based cytology (LBC) slide read by 2 cytotechnologists as part of
routine screening.
Methods Over 36,212 women aged 30 to 64 years participated in the
Forwarding Research for Improved Detection and Access for Cervical
Cancer Screening and Triage (FRIDA) Study in Mexico between 2013 and
2016. For each participant, 2 cervical samples were collected at the
same clinic visit, one to test for high-risk human papillomavirus
(hrHPV) and the other for LBC, which was used to triage those with a
hrHPV positive result. LBC slides were evaluated by 7 cytotechnologists,
with each slide read independently by 2 blinded cytotechnologists. All
women with atypical cells of undetermined significance or a worse result
were referred to colposcopy for further evaluation and diagnosis. Three
pathologists evaluated the biopsy specimens to confirm the final HSIL+
diagnosis. The HSIL+ detection rates for the single versus double
reading were estimated and compared.
Results A total of 3,914 women with a positive hrHPV result were triaged
with LBC. The first and second cytology readings resulted in 43 HSIL+
cases detected; the double-reading strategy detected 9 additional HSIL+
cases, resulting in a total of 52 HSIL+ cases. The HSIL+ detection rate
increased from 10.99/1000 with a single reading to 13.29/1000 with the
double-reading strategy (P = .004).
Conclusion A 20.9% increase in HSIL+ cases detected was achieved with a
double reading of the LBC slides in this sample of hrHPV-positive women.
Filiaciones:
Inst Mexicano Seguro Social, Unidad Invest Epidemiol & Serv Salud, Delegac Morelos, Cuernavaca, Morelos, Mexico
Univ Calif Los Angeles, Fielding Sch Publ Hlth, Dept Biostat, Los Angeles, CA USA
Univ Calif Los Angeles, Fielding Sch Publ Hlth, Dept Hlth Policy & Management, Los Angeles, CA USA
Univ Calif Los Angeles, Fielding Sch Publ Hlth, Kaiser Permanente Ctr Hlth Equ, Los Angeles, CA USA
Univ Calif Los Angeles, UCLA Canc Prevent & Control Res Ctr, Fielding Sch Publ Hlth, Los Angeles, CA USA
Univ Calif Los Angeles, Jonsson Comprehens Canc Ctr, Los Angeles, CA USA
Inst Nacl Salud Publ, Ctr Invest Salud Poblac, Cuernavaca, Morelos, Mexico
Inst Mexicano Seguro Social, Unidad Med Familiar, Hosp Gen Reg 1, Cuernavaca, Morelos, Mexico
Univ Nacl Autonoma Mexico, Fac Med, Ctr Invest Polit Poblac & Salud, Mexico City, DF, Mexico
Inst Nacl Salud Publ, Catedra CONACYT, Cuernavaca, Morelos, Mexico
Secretaria Salud Tlaxcala, Dept Calidad & Educ Salud, Santa Ana Chiautempan, Mexico
Univ Autonoma Tlaxcala, Fac Ciencias Salud, Zacatelco, Mexico
Queen Mary Univ London, Ctr Canc Prevent, Wolfson Inst Prevent Med, London, England
Lab CITOMED, Cuernavaca, Morelos, Mexico
Lab Estatal Salud Publ, Lab Citol, Tlaxcala, Mexico
Hosp Mujer Tlaxcala, Tlaxcala, Mexico
Univ Calif Los Angeles, Dept Pathol & Lab Med, Los Angeles, CA USA
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