Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Cost and Effectiveness Comparison of Immediate Colposcopy Versus Human Papillomavirus DNA Testing in Management of Atypical Squamous Cells of Undetermined Significance in Turkish Women

  • Kececioglu, Mehmet (Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital) ;
  • Seckin, Berna (Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital) ;
  • Baser, Eralp (Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital) ;
  • Togrul, Cihan (Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital) ;
  • Kececioglu, Tugban Seckin (Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital) ;
  • Cicek, Mahmut Nedim (Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital) ;
  • Gungor, Tayfun (Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital)
  • Published : 2013.01.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: A small but significant proportion of cases with atypical squamous cells of undetermined significance (ASCUS) may harbour CIN 2-3, or even invasive carcinoma. Although immediate colposcopy, HPV-DNA testing or expectant management are three recommended options in ASCUS triage, a consensus does not currently exist on which one of these approaches is the most efficient. In this study, we aimed to compare the performance and cost of immediate colposcopy and colposcopy based on the human papillomavirus (HPV) testing for detecting histologically confirmed high-grade cervical intraepithelial neoplasia (CIN) in women with ASCUS. Materials and Methods: Records of 594 women with an index Papanicolaou smear showing ASCUS were retrospectively analyzed. Women in the immediate colposcopy arm were referred directly to colposcopy (immediate colposcopy group, n=255) and those in the HPV triage arm were proceeded to colposcopy if the high-risk HPV (hrHPV) test was positive (HPV triage group, n=339). High grade CIN (CIN2+) detection rate and treatment costs were compared between the groups. Results: The detected rate of CIN2+ was higher in the HPV triage group compared to immediate colposcopy group (8% vs. 1.6%, p=0.011). In the HPV triage group, the total cost, cost per patient, and the cost for detecting one case of high grade CIN were higher than the immediate colposcopy group (p<0.001). Conclusions: In women with ASCUS cytology, HPV DNA testing followed by colposcopy is more costly than immediate colposcopy, but this approach is associated with a higher rate of CIN2+ detection. This findings suggest that HPV DNA testing combined with cervical cytology could reduce the referral rate to colposcopy.

Keywords

References

  1. Arbyn M, Buntinx F, Van Ranst M, et al (2004). Virologic versus cytologic triage of women with equivocal pap smears: a meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia. J Natl Cancer Inst, 96, 280-93. https://doi.org/10.1093/jnci/djh037
  2. Bosch F X, Manos MM, Munoz N, et al (1995). Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (Ibscc) study group. J Natl Cancer Inst, 87, 796-802. https://doi.org/10.1093/jnci/87.11.796
  3. Brink AA, Snijders PJ, Meijer CJ, et al (2006). Hpv Testing In Cervical Screening. Best Pract Res Clin Obstet Gynaecol, 20, 253-66. https://doi.org/10.1016/j.bpobgyn.2005.10.009
  4. Cuzick J, Arbyn M, Sankaranarayanan R, et al (2008). Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries. Vaccine, 10, 29-41.
  5. Cuzick J, Szarewski A, Cubie H, et al (2003). Management of women who test positive for high-risk types of human papillomavirus: The Hart Study. Lancet, 362, 1871-6. https://doi.org/10.1016/S0140-6736(03)14955-0
  6. Gustafsson L, Ponten J, Zack M, et al (1997). International incidence rates of invasive cervical cancer after introduction of cytological screening. Cancer Causes Control, 8, 755-63. https://doi.org/10.1023/A:1018435522475
  7. Kim JJ, Wright TC, Goldie SJ (2002). Cost-effectiveness of alternative triage strategies for atypical squamous cells of undetermined significance. Jama, 287, 2382-90. https://doi.org/10.1001/jama.287.18.2382
  8. Kim JJ, Wright TC, Goldie SJ (2005). Cost-effectiveness of human papillomavirus dna testing in The United Kingdom, The Netherlands, France, and Italy. J Natl Cancer Inst, 97, 888-95. https://doi.org/10.1093/jnci/dji162
  9. Kinney WK, Manos MM, Hurley LB, et al (1998). Where's the high-grade cervical neoplasia? the importance of minimally abnormal papanicolaou diagnoses. Obstet Gynecol, 91, 973-6. https://doi.org/10.1016/S0029-7844(98)00080-5
  10. Kulasingam SL, Kim JJ, Lawrence WF, et al (2006). Cost-Effectiveness analysis based on the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion triage study. J Natl Cancer Inst, 98, 92-100. https://doi.org/10.1093/jnci/djj009
  11. Manos MM, Kinney WK, Hurley LB, et al (1999). Identifying women with cervical neoplasia: using human papillomavirus dna testing for equivocal papanicolaou results. JAMA, 281, 1605-10.
  12. Nanda K, Mccrory DC, Myers ER, et al (2000). Accuracy of the papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med, 132, 810-9. https://doi.org/10.7326/0003-4819-132-10-200005160-00009
  13. Naucler P, Ryd W, Tornberg S, et al (2009). Efficacy of hpv dna testing with cytology triage and/or repeat hpv dna testing in primary cervical cancer screening. J Natl Cancer Inst, 101, 88-99. https://doi.org/10.1093/jnci/djn444
  14. Nobbenhuis MA, Walboomers JM, Helmerhorst TJ, et al (1999). Relation of human papillomavirus status to cervical lesions and consequences for cervical-cancer screening: a prospective study. Lancet, 354, 20-5. https://doi.org/10.1016/S0140-6736(98)12490-X
  15. Ronco G, Giorgi-Rossi P, Carozzi F, et al (2006). Human papillomavirus testing nd liquid-based cytology in primary screening of women younger than 35 years: results at recruitment for a randomised controlled trial. Lancet Oncol, 7, 547-55. https://doi.org/10.1016/S1470-2045(06)70731-8
  16. Schiffman M and Solomon D (2003). Findings to date from the ascus-lsil triage study (Alts). Arch Pathol Lab Med, 127, 946-9.
  17. Solomon D, Schiffman M, Tarone R (2001). Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst, 93, 293-9. https://doi.org/10.1093/jnci/93.4.293
  18. Solomon D, Schiffman M, Tarone R (2002). Ascus lsil triage study (Alts) conclusions reaffirmed: response to a november 2001 commentary. Obstet Gynecol, 99, 671-4. https://doi.org/10.1016/S0029-7844(02)01922-1

Cited by

  1. Clinical Significance of Atypical Squamous Cells of Undetermined Significance in Detecting Preinvasive Cervical Lesions in Post-Menopausal Turkish Women vol.15, pp.16, 2014, https://doi.org/10.7314/APJCP.2014.15.16.6639
  2. Acceptability of Self-Sampling HPV Testing Among Thai Women for Cervical Cancer Screening vol.15, pp.17, 2014, https://doi.org/10.7314/APJCP.2014.15.17.7437
  3. Clinical management of the first ASCUS report in Chile. Prospective single-cohort study vol.133, pp.6, 2015, https://doi.org/10.1590/1516-3180.2014.9142511
  4. Colposcopy Requirement of Papanicolaou Smear after Atypical Squamous Cells of Undetermined Significance (ASC-US) by Follow-up Protocol in an Urban Gynaecology Clinic, a Retrospective Study in Thailand vol.16, pp.12, 2015, https://doi.org/10.7314/APJCP.2015.16.12.4977
  5. Multifaceted Usage of HPV Related Tests and Products in the Management of Cervical Cancer - a Review vol.16, pp.6, 2015, https://doi.org/10.7314/APJCP.2015.16.6.2145
  6. Clinical Significance of Atypical Squamous Cells of Undetermined Significance among Patients Undergoing Cervical Conization vol.16, pp.18, 2016, https://doi.org/10.7314/APJCP.2015.16.18.8145