METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
方法:从2017年5月至2020年12月,病理科摄取区的36417名妇女,Vejle医院,丹麦南部地区,包括在HPV组中。无论细胞学如何,对HPV16/18呈阳性的妇女和对其他高危HPV(hrHPV)类型呈阳性并伴有异常细胞学的妇女直接转诊至阴道镜检查。其他hrHPV类型和细胞学正常的女性在12个月后被转介重复筛查。三年后常规筛查hrHPV阴性。截至2022年9月,我们从丹麦病理学数据库获得了有关筛查结果和随后的组织学诊断的信息。
结果:3.6%的女性在初次筛查后接受阴道镜检查,5%至12个月后重复筛查,91.4%回到常规筛查。观察到高随访率:初次筛查后有96%参加阴道镜检查,重复筛查后,91%参加阴道镜检查。在初次筛查后的阴道镜检查中,有28.1%的HPV16/18阳性女性和18.2%的其他hrHPV类型伴随异常细胞学阳性女性检测到CIN3+。在同时患有其他hrHPV和ASCUS/LSIL的女性中,8%hadCIN3+。在重复筛选时,43%的人已经变成hrHPV阴性,55%的人对其他hrHPV持续阳性,2%的HPV16/18阳性。在重复筛查后的阴道镜检查中,10.1%的其他hrHPV阳性的女性被诊断为CIN3+,与11.1%的HPV16/18阳性女性相比。
结论:在这项试点实施研究中,在丹麦环境中评估了基于HPV的筛查算法.结果表明,随访检查的出勤率很高,并提供了对阴道镜转诊次数以及CIN2和CIN3病例检测的见解。结果表明,在初次筛查中与ASCUS/LSIL联合检测其他hrHPV阳性的女性可能会被称为重复筛查,而不是立即进行阴道镜检查。