An approach to optimizing cervical cancer screening based on the results of an extended HPV-test

Optimizing cervical cancer screening algorithms is the key to achieving increased coverage of women with secondary prevention activities.

The purpose of this study was to develop an approach to optimize cervical cancer screening based on a primary extended HPV-test.

Materials and methods. To develop a predictive model for assessing the risk of having severe cervical dysplasia women were examined using a cytological method (619), an extended HPV-test with genotyping (14 types) and quantitative determination of viral load (n=619) and a histological method (n=185) as indicated. To validate the developed prognostic model, data from examination of 3482 women using a cytological method and a molecular-biological method – an extended HPV test were calculated.

Results. The increase in the concentration of human papillomavirus with an increase in the degree of transformation of the cervical epithelium was shown for 14 types in total and 16, 33 and 58 types separately. The threshold for a high probability of severe cervical dysplasia is 4lg HPV DNA (14 HPV types in total and 16, 33, 58 types individually) per 105 human cells. The developed multifactorial prognostic model for the presence of high-grade squamous intraepithelial lesion is statistically significant and, according to the results of validation, showed Se=95,2 %, Sp=88,7 %, PPV=16,0 %, NPV=99,9 %, and diagnostic efficiency=88,9 %.

Conclusion. The proposed algorithm for primary sorting of patients, based on a single examination method – an extended HPV test, will make it possible to increase the specificity of the first stage of screening, reduce the level of overdiagnosis and the number of redundant examinations of women in the future.

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