Novel concepts in cervical cancer screening: a comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya

Infectious Agents and Cancer

Kapten Muthoka¹  Edwin Were²  Elkanah Omenge Orang’o²  Magnus von Knebel Doeberitz³  Oliver Rode³  Heike Sartor³  Hermann Bussmann³  Miriam Reuschenbach³  Davy Vanden Broeck⁴  Dietmar Schmidt⁵  Michael Byczkowski⁶ 

[1] Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya;Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany;International Centre of Reproductive Health, Ghent University, Ghent, Belgium;National Reference Centre for HPV, Brussels, Belgium;Laboratory of Molecular Pathology, AML, Antwerp, Belgium;MVZ of Histology, Cytology and Molecular Diagnostics, Department of Cytopathology, Trier, Germany;SAP SE, Walldorf, Germany;

关键词: Cervical cancer screening;    VIA;    HPV;    p16/Ki-67;    LMICs;    Dual staining;    HPV genotype;    HIV;   

DOI  :  10.1186/s13027-020-00323-6

来源: Springer

【 摘 要 】

BackgroundScreening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology.MethodsWe prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a p16INK4a /Ki-67 (CINtecPLUS®) dual stained slide that was prepared using the ThinPrep® 2000 Processor and evaluated by a pathologist trained in the methodology.ResultsIn 701 of a total of 800 women aged 18–64 years, all three investigations were performed and data could be analyzed. The HPV, VIA and dual stain cytology positivity were 33%, 7%, and 2% respectively. The HPV positivity rate of VIA positive cases was 32%. The five most common HPV types were HPV16, 52, 68, 58 and 35. The OR among HIV infected women of an HPV infection, VIA positivity and positive dual stain cytology were 2.6 (95%CI 1.5–4.3), 1.9 (95%CI 0.89–4.4) and 3.4 (95%CI 1.07–10.9) respectively. The sensitivity of VIA to detect a p16INK4a/Ki-67 positive transforming infection was 13% (95%CI 2–38).ConclusionsPrimary HPV testing appears feasible and should be considered as a primary screening test also in LMICs. The poor sensitivity of VIA renders it unsuitable as a triage test for HPV positive women. The utility of p16INK4a/Ki-67 dual stain cytology as a triage test for HPV positive women in LMICs should be further studied.

【 授权许可】

CC BY