Clinical performance of primary HPV screening cut-off for colposcopy referrals in HPV vaccinated cohort: Literature Review and observational study

Marikka Beecroft* (Corresponding Author), Mahalakshmi Gurumurthy, Maggie Cruickshank

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To understand the effect of changing from cytology-based to primary HPV screening on the positive predictive value (PPV) of colposcopy referrals for cervical intraepithelial neoplasia (CIN) in a cohort offered HPV vaccination.
DESIGN: Retrospective pre/post observational cohort study.
SETTING: Scotland
POPULATION or SAMPLE: 2193 women referred to colposcopy between September 2019 - February 2020 from from cytology-based screening and September 2020 – February 2021 from primary high-risk HPV (hrHPV) screening.
METHODS: Calculating Positive Predictive Values (PPVs) for 2 cohorts of women; one cytology-based
screening and the subsequent hrHPV primary screening as a pre/post observational study.
MAIN OUTCOME MEASURES: Positive predictive values of LBC and hrHPV cut-offs for colposcopy referral for CIN at colposcopy.
RESULTS: There was no significant difference in the PPV between referral from hrHPV and cytology (17.5%, CI 95%=14.3-20.7; 20.6, CI 95%=16.7-24.5) for referrals with a cut-off of low grade dyskaryosis (LGD); both met the Public Health England (PHE) standard set of 8-25%. hrHPV PPV (66.7, CI 95%=56.8-76.6) was comparable to cytology (64.1, CI 95%=55.8-72.4) for referrals with a cut-off of high grade dyskaryosis (HGD) but neither met the PHE standard set of 77-92%.
CONCLUSIONS:
Our results showed that tThe LGD PPV for HPV vaccinated women undergoing either LBC or HR-HPV screening were not statistically different and met the PHE performance criteria. HG dyskaryosis (HGD) PPVs of both techniques were similar indicating that colposcopy is performing in vaccinated cohort screened by hrHPV testing but neither did not meet the PHE threshold of 76.6-91.6% outlined in the
cervical standards data report. Further review of cut-off for selection for investigation at colposcopy is needed to ensure appropriate selection on the basis of risk.
Original languageEnglish
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Publication statusAccepted/In press - 25 Jun 2022

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