Evaluation Of Triage Strategies For High Risk Human Papilloma Virus Testing As Primary Screening For Cervical Cancer

Objective:To evaluate the performance of several triage strategies of HR-HPV DNA testing as cervical cancer primary screening.we can provide clinical referenced evidence to formulate reliable and feasible screening strategy, and to ruduce the incidence of cervical cancer.Methods:Using the data from cross-sectional population-based studies carried out in Xiang yuan county Shan Xi province, totally 1788 women included in the study. All women were screened Liquid-based cytology (LBC),high-risk HPV DNA testing, and visual inspection with acetic acid (VIA). In the study, All women positive for any test were referred for colposcopy. And if the colposcopy result is positive, she will be referred for biopsy for the final pathology result. Our study simulates the strategy HR-HPV testing as cervical cancer primary screening and LBC, VIA, HR-HPVviral load for positive HPV as triage. We compare the strategies above by index of sensitivity, specificity, referral rate etal for HSIL(High-grade Squamous Introepithelial Lesion)and invasive cervical cancer and analyze the application value of strategies via AUC(area under curve).Results:The referral rate, sensitivity, specificity, positive predic value (PPV) of HPV primary screening for detecting HSIL and invasive cervical cancer are18.1%,95.7%,85.0% and 20.4%,respectively. The referral rate of the strategies of triage with LBC, VIA,HR-HPV viral load decreases to 8.7%,4.5% and 9.8%, respectively. The specificity of the triage strategies increases to 94.3%,97.5% and 93.1%, respectively. The PPV of the triage strategies increases to 37.2%,46.9%and 32%.the sensitivity decreases to84.1%,55.1% and 81.2%..The difference between the AUC of HPV primary screening and triage of LBC,HR-HPV low viral load is not statistically significant (P>0.0125),but compared with triage of VIA, high viral load is statistically significant (P<0.001)Conclusions:Concerned about economy and adaptability, enhancing the cut-off of HPV DNA (cut-off≥10pg/ml) to improve the screening efficiency is feasible and effective in low-resource areas;HPV primary screening with the triage of LBC can be considered in the high-resource areasand effective in low-resource areas;HPV primary screening with the triage of VIA is feasible in rural areas in China, but the skill of doctors should be payed full attention to.