Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy
Objective To explore the utility of extended Human Papillomavirus (HPV) genotyping to detect cervical intraepithelial neoplasia grade 2 or more (CIN2+) in a ‘screen-and-treat’ strategy for HPV-positive women in low-resource settings.Design Prospective study of diagnostic accuracy.Setting The study t...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-12-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e057234.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850191532953436160 |
|---|---|
| author | Pierre Vassilakos Evelyn Tincho Bruno Kenfack Patrick Petignat Ania Wisniak Celine Broquet François Marcel Ndam Nsangou Michel Noubom Emilien Jeannot |
| author_facet | Pierre Vassilakos Evelyn Tincho Bruno Kenfack Patrick Petignat Ania Wisniak Celine Broquet François Marcel Ndam Nsangou Michel Noubom Emilien Jeannot |
| author_sort | Pierre Vassilakos |
| collection | DOAJ |
| description | Objective To explore the utility of extended Human Papillomavirus (HPV) genotyping to detect cervical intraepithelial neoplasia grade 2 or more (CIN2+) in a ‘screen-and-treat’ strategy for HPV-positive women in low-resource settings.Design Prospective study of diagnostic accuracy.Setting The study took place in West Cameroon between September 2018 and March 2020.Participants 2014 women were recruited. Asymptomatic, non-pregnant women aged 30–49 years without history of CIN treatment, anogenital cancer or hysterectomy were eligible.Interventions Participants performed self-sampling for HPV testing with GeneXpert followed by visual inspection with acetic acid and Lugol’s iodine (VIA) triage before treatment if required.Main outcome measures Liquid-based cytology, biopsies and endocervical brushing were performed in HPV-positive women as quality control. We assessed the detection rate of CIN2+ by HPV genotyping (two pools of genotypes obtained from the Xpert system, pool_1 (HPV 16, 18, 45) and pool_2 (HPV 16, 18, 45, 31, 33, 35, 52, 58)), VIA and cytology.Results 382 (18.2%) women were HPV-positive among which 11.5% (n=44) were CIN2+. Of those 44 participants, 41 were triaged positive by extended genotyping, versus 35 by VIA and 33 by cytology. Overall, triage positivity was of 68.4% for extended genotyping, 59.3% for VIA and 14.8% for cytology, with false positive rates of 83.4%, 84.1% and 37.7%, respectively. Extended genotyping had a higher sensitivity for CIN2+ detection (93.2%, CI: 81.3 to 98.6) than VIA (79.5%, CI: 64.7 to 90.2, p=0.034) and cytology (75.0%, CI: 59.7 to 86.8, p=0.005). No significant difference was observed in the overtreatment rate in triaged women by extended genotyping or VIA (9.9%, CI: 8.6 to 11.3, and 8.8%, CI: 7.7 to 10.1), with a ratio of 6.0 and 6.3 women treated per CIN2+ diagnosed.Conclusion Triage of HPV-positive women with extended HPV genotyping improves CIN2+ detection compared with VIA with a minor loss of specificity and could be used to optimize the management of HPV-positive women.Trial registration number NCT03757299. |
| format | Article |
| id | doaj-art-754ce4c50e3546ebbe02b9e7b00ddc86 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-754ce4c50e3546ebbe02b9e7b00ddc862025-08-20T02:14:54ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2021-057234Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracyPierre Vassilakos0Evelyn Tincho1Bruno Kenfack2Patrick Petignat3Ania Wisniak4Celine Broquet5François Marcel Ndam Nsangou6Michel Noubom7Emilien Jeannot8Geneva Foundation for Medical Education and Research, Geneva, SwitzerlandDepartment of Gynecology, Obstetrics and Maternal Health, University of Dschang, Dschang District Hospital, Dschang, CameroonDepartment of Gynecology, Obstetrics and Maternal Health, University of Dschang, Dschang District Hospital, Dschang, CameroonGeneva University Hospitals Department of Gynaecology and Obstetrics, Geneva, SwitzerlandGeneva University Hospitals Department of Gynaecology and Obstetrics, Geneva, SwitzerlandObstetrics and Gynecology, Geneva University Hospitals, Geneva, SwitzerlandDepartment of Gynecology, Obstetrics and Maternal Health, University of Dschang, Dschang District Hospital, Dschang, CameroonDepartment of Gynecology, Obstetrics and Maternal Health, University of Dschang, Dschang District Hospital, Dschang, CameroonInstitute of Global Health, Faculty of Medicine, University of Geneva, Geneva, SwitzerlandObjective To explore the utility of extended Human Papillomavirus (HPV) genotyping to detect cervical intraepithelial neoplasia grade 2 or more (CIN2+) in a ‘screen-and-treat’ strategy for HPV-positive women in low-resource settings.Design Prospective study of diagnostic accuracy.Setting The study took place in West Cameroon between September 2018 and March 2020.Participants 2014 women were recruited. Asymptomatic, non-pregnant women aged 30–49 years without history of CIN treatment, anogenital cancer or hysterectomy were eligible.Interventions Participants performed self-sampling for HPV testing with GeneXpert followed by visual inspection with acetic acid and Lugol’s iodine (VIA) triage before treatment if required.Main outcome measures Liquid-based cytology, biopsies and endocervical brushing were performed in HPV-positive women as quality control. We assessed the detection rate of CIN2+ by HPV genotyping (two pools of genotypes obtained from the Xpert system, pool_1 (HPV 16, 18, 45) and pool_2 (HPV 16, 18, 45, 31, 33, 35, 52, 58)), VIA and cytology.Results 382 (18.2%) women were HPV-positive among which 11.5% (n=44) were CIN2+. Of those 44 participants, 41 were triaged positive by extended genotyping, versus 35 by VIA and 33 by cytology. Overall, triage positivity was of 68.4% for extended genotyping, 59.3% for VIA and 14.8% for cytology, with false positive rates of 83.4%, 84.1% and 37.7%, respectively. Extended genotyping had a higher sensitivity for CIN2+ detection (93.2%, CI: 81.3 to 98.6) than VIA (79.5%, CI: 64.7 to 90.2, p=0.034) and cytology (75.0%, CI: 59.7 to 86.8, p=0.005). No significant difference was observed in the overtreatment rate in triaged women by extended genotyping or VIA (9.9%, CI: 8.6 to 11.3, and 8.8%, CI: 7.7 to 10.1), with a ratio of 6.0 and 6.3 women treated per CIN2+ diagnosed.Conclusion Triage of HPV-positive women with extended HPV genotyping improves CIN2+ detection compared with VIA with a minor loss of specificity and could be used to optimize the management of HPV-positive women.Trial registration number NCT03757299.https://bmjopen.bmj.com/content/12/12/e057234.full |
| spellingShingle | Pierre Vassilakos Evelyn Tincho Bruno Kenfack Patrick Petignat Ania Wisniak Celine Broquet François Marcel Ndam Nsangou Michel Noubom Emilien Jeannot Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy BMJ Open |
| title | Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy |
| title_full | Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy |
| title_fullStr | Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy |
| title_full_unstemmed | Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy |
| title_short | Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy |
| title_sort | utility of extended hpv genotyping for the triage of self sampled hpv positive women in a screen and treat strategy for cervical cancer prevention in cameroon a prospective study of diagnostic accuracy |
| url | https://bmjopen.bmj.com/content/12/12/e057234.full |
| work_keys_str_mv | AT pierrevassilakos utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy AT evelyntincho utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy AT brunokenfack utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy AT patrickpetignat utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy AT aniawisniak utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy AT celinebroquet utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy AT francoismarcelndamnsangou utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy AT michelnoubom utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy AT emilienjeannot utilityofextendedhpvgenotypingforthetriageofselfsampledhpvpositivewomeninascreenandtreatstrategyforcervicalcancerpreventionincameroonaprospectivestudyofdiagnosticaccuracy |