Abstract：
High-risk human papilloma virus (hrHPV) DNA testing is more sensitive than cytology screening, achieving greater protection against cervical cancer. Controversy exists regarding the preferred screening method for women 25-30 years of age. At this age, infection with HPV is common and usually transient. Consequently, hrHPV screening in this age group is fraught with high false-positive screening results, leading to more colposcopies and unnecessary treatments with the potential for harm. In the present study, we aimed to compare the results of two screening methods in relation to high-grade cervical intraepithelial lesion detection rate in the young age group of 25-30 years.
Retrospective information on cervical cytology, hrHPV testing, colposcopy referrals and histologic results, from one screening round, were retrieved from the Maccabi HealthCare Health Maintenance Organization centralized database during the study period from March 1, 2017 to April 1, 2019 for 25- to 30-year-old women. Screening with hrHPV testing for types 16, 18 and 12 other hrHPV types was compared with the conventional PAP liquid-based cytology (LBC) test. Odds ratio (OR) of detection with 95% confidence interval (CI) was calculated for cervical intraepithelial neoplasia (CIN) grade 3 or higher (CIN 3+).
During the study period, 42 244 women 25-30 years old underwent cervical cancer screening; of them, 20 997 were screened with LBC between March 1, 2017 and March 1, 2018 and compared with 21 247 who were screened with hrHPV between April 1, 2018 and April 1, 2019. Testing for hrHPV resulted in a higher colposcopy referral rate compared with primary LBC screening: 9.8% vs 7.8%, respectively; (OR 1.28; 95% CI 1.2-1.37; p < 0.001). Screening with hrHPV led to significantly higher detection of CIN 3+ lesions (OR 1.4; 95% CI 1.2-1.6; p < 0.001) compared with LBC. HPV infections with non-16/18 hrHPV (other hrHPV) were the most prevalent (84.8%).
In women 25-30 years old, primary hrHPV screening was associated with a higher detection rate of CIN 3+ compared with cytology screening and should be considered for primary screening in this age group.
Retrospective information on cervical cytology, hrHPV testing, colposcopy referrals and histologic results, from one screening round, were retrieved from the Maccabi HealthCare Health Maintenance Organization centralized database during the study period from March 1, 2017 to April 1, 2019 for 25- to 30-year-old women. Screening with hrHPV testing for types 16, 18 and 12 other hrHPV types was compared with the conventional PAP liquid-based cytology (LBC) test. Odds ratio (OR) of detection with 95% confidence interval (CI) was calculated for cervical intraepithelial neoplasia (CIN) grade 3 or higher (CIN 3+).
During the study period, 42 244 women 25-30 years old underwent cervical cancer screening; of them, 20 997 were screened with LBC between March 1, 2017 and March 1, 2018 and compared with 21 247 who were screened with hrHPV between April 1, 2018 and April 1, 2019. Testing for hrHPV resulted in a higher colposcopy referral rate compared with primary LBC screening: 9.8% vs 7.8%, respectively; (OR 1.28; 95% CI 1.2-1.37; p < 0.001). Screening with hrHPV led to significantly higher detection of CIN 3+ lesions (OR 1.4; 95% CI 1.2-1.6; p < 0.001) compared with LBC. HPV infections with non-16/18 hrHPV (other hrHPV) were the most prevalent (84.8%).
In women 25-30 years old, primary hrHPV screening was associated with a higher detection rate of CIN 3+ compared with cytology screening and should be considered for primary screening in this age group.
摘要：
背景：高危型人乳头瘤病毒（hrHPV）DNA检测比细胞学筛查更敏感，实现对宫颈癌的更大保护。关于25-30岁女性的首选筛查方法存在争议。在这个年龄,HPV感染是常见的，通常是短暂的。因此,这个年龄组的hrHPV筛查充满了高的假阳性筛查结果，导致更多的阴道镜和不必要的治疗，有可能造成伤害。在本研究中,我们的目的是在25~30岁的年轻年龄组中,比较两种筛查方法对高级别宫颈上皮内病变检出率的影响.
方法：宫颈细胞学回顾性资料，HRHPV检测，阴道镜转诊和组织学结果，从一轮筛选中，在2017年3月1日至2019年4月1日的研究期间，从MaccabiHealthCare健康维护组织集中数据库中检索了25至30岁的女性。用hrHPV检测筛选16、18和12种其他hrHPV类型与常规PAP液基细胞学(LBC)检测进行比较。计算宫颈上皮内瘤变（CIN）3级或更高（CIN3）的95％置信区间（CI）的检测几率（OR）。
结果：在研究期间，42244名25-30岁的妇女接受了宫颈癌筛查；其中，在2017年3月1日至2018年3月1日期间，对20997例进行了LBC筛查，并与在2018年4月1日至2019年4月1日期间进行了hrHPV筛查的21247例进行了比较。与原发性LBC筛查相比，hrHPV检测导致更高的阴道镜转诊率：9.8％vs7.8％，分别为（OR1.28；95%CI1.2-1.37；p<0.001）。与LBC相比，用hrHPV筛查导致CIN3+病变的检出率明显更高（OR1.4；95％CI1.2-1.6；p<0.001）。非16/18hrHPV（其他hrHPV）感染最普遍（84.8%）。
结论：在25-30岁的女性中，与细胞学筛查相比,初次hrHPV筛查的CIN3+检出率较高,在该年龄组的初次筛查中,应考虑进行初筛.
方法：宫颈细胞学回顾性资料，HRHPV检测，阴道镜转诊和组织学结果，从一轮筛选中，在2017年3月1日至2019年4月1日的研究期间，从MaccabiHealthCare健康维护组织集中数据库中检索了25至30岁的女性。用hrHPV检测筛选16、18和12种其他hrHPV类型与常规PAP液基细胞学(LBC)检测进行比较。计算宫颈上皮内瘤变（CIN）3级或更高（CIN3）的95％置信区间（CI）的检测几率（OR）。
结果：在研究期间，42244名25-30岁的妇女接受了宫颈癌筛查；其中，在2017年3月1日至2018年3月1日期间，对20997例进行了LBC筛查，并与在2018年4月1日至2019年4月1日期间进行了hrHPV筛查的21247例进行了比较。与原发性LBC筛查相比，hrHPV检测导致更高的阴道镜转诊率：9.8％vs7.8％，分别为（OR1.28；95%CI1.2-1.37；p<0.001）。与LBC相比，用hrHPV筛查导致CIN3+病变的检出率明显更高（OR1.4；95％CI1.2-1.6；p<0.001）。非16/18hrHPV（其他hrHPV）感染最普遍（84.8%）。
结论：在25-30岁的女性中，与细胞学筛查相比,初次hrHPV筛查的CIN3+检出率较高,在该年龄组的初次筛查中,应考虑进行初筛.
