Opportunistic screening protocols for cervical carcinoma among different female populations in Chongqing

Abstract

Objective To evaluate the 5 protocols of opportunistic screening for cervical carcinoma among different female populations, in order to explore optional protocol for the women with different clinical characteristics. Methods A total of 24 530 women who admitted in 13 maternal and child health hospitals from January 2013 to December 2015 and completed our follow-up were recruited in this study. According to their clinical characteristics, they were divided into 5 groups: group A (young females, 21~24 years old), group B (lactating women), group C (with identified infertility, 25~39 years old), group D (perimenopausal and elderly women), group E (women of childbearing age, 25~39 years old). Five protocols were used for opportunistic screening, that is, visual inspection after acetic acid (VIA), thinprep cytologic test (TCT), human papillomavirus (HPV)-DNA test, colposcopy, and combination of TCT and HPV-DNA test. All the suspected cases (at least 1 positive result) underwent biopsy, and/or cervical conization when necessary. All the cases were followed up once a year, for 2 years. Histological diagnosis of cervical intraepithelial neoplasia (CIN) grade Ⅱ and above lesions was regarded as the follow-up endpoints. The sensitivity, specificity, positive predictive value, negative predictive value, Youden's index and area under curve (AUC) of CIN Ⅱ+ were calculated for different screening schemes (VIA, TCT, HPV, colposcopy and TCT+HPV) in order to evaluate the diagnostic accuracy of these protocols. Results ① In group A, there was no significant difference in AUC among the 5 protocols (P>0.005). ② In group B, the AUCs of HPV and TCT+HPV were significantly greater than those of the other protocols (P < 0.005). ③In group C, the AUC of the combined screening was greater than those of the other ones, with statistical differences (P < 0.005). ④In group D, the AUCs of TCT, HPV, and the combined screening were significantly greater than those of the other ones (P < 0.005). ⑤ In group E, the AUC of HPV was significantly greater than those of the other ones (P < 0.005). Conclusion Different opportunistic screening protocols for cervical carcinoma are suitable for the women with different clinical characteristics. Optional screening protocols can improve the detection rate.

Keywords

• uterine cervical neoplasms
• precancerous conditions
• opportunistic screening