부산대학교 도서관

Keywords: cervical cancer; double reading; high-risk HPV; liquid-based cytology; screening; Mexico Background The goal of this study was to determine whether the detection of histologically confirmed cases of cervical high-grade squamous intraepithelial lesions or worse (HSIL+) can be increased by having each liquid-based cytology (LBC) slide read by 2 cytotechnologists as part of routine screening. Methods Over 36,212 women aged 30 to 64 years participated in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA) Study in Mexico between 2013 and 2016. For each participant, 2 cervical samples were collected at the same clinic visit, one to test for high-risk human papillomavirus (hrHPV) and the other for LBC, which was used to triage those with a hrHPV positive result. LBC slides were evaluated by 7 cytotechnologists, with each slide read independently by 2 blinded cytotechnologists. All women with atypical cells of undetermined significance or a worse result were referred to colposcopy for further evaluation and diagnosis. Three pathologists evaluated the biopsy specimens to confirm the final HSIL+ diagnosis. The HSIL+ detection rates for the single versus double reading were estimated and compared. Results A total of 3,914 women with a positive hrHPV result were triaged with LBC. The first and second cytology readings resulted in 43 HSIL+ cases detected; the double-reading strategy detected 9 additional HSIL+ cases, resulting in a total of 52 HSIL+ cases. The HSIL+ detection rate increased from 10.99/1000 with a single reading to 13.29/1000 with the double-reading strategy (P = .004). Conclusion A 20.9% increase in HSIL+ cases detected was achieved with a double reading of the LBC slides in this sample of hrHPV-positive women. Article Note: The first 2 authors contributed equally to this article. We thank Alvaro Benitez-Rodriguez and Alvaro Acosta-Rosillo for help and support with this project. We also thank Darron Ferris, Kathleen M. Schmeler, and Carlos Aranda for training the health care staff to ensure that the colposcopy procedures were performed properly. We thank the local health staff and authorities in Tlaxcala for their enthusiastic work (Angeles Romero, Elena Leal, Azucena Zempoaltecatl, Juana Nava, Yunuen Arcos, Thelma Rizo, Yuridia Cadena Silva, and Ana Landa) as well as the cytotechnologists who made this project possible (Ariel Perez Vazquez, German Rojas Sauz, Mariana Aguilar Jimenez, Efren Texis Zanjuampa, Sonia Bautista Matias, Enrique Bonilla, and Roberto Cortes). Finally, we thank the women who participated in the study. The FRIDA Study investigators are Cosette Wheeler, Patti Gravitt, Enrique Carmona, Hector Figueroa, Kathleen M Schmeler, Philipe Castle, Victor Granados, David Bishai, Paula Ramirez, Leith Leon-Maldonado, Daniel Alvarez-Escobedo, Rubi Hernandez-Lopez, Indira Mendiola-Pastrana, Mauricio Hernandez-Avila, Leticia Torres-Ibarra, Eduardo Lazcano-Ponce, Eduardo Franco, Jack Cuzick, Attila Lorincz, Anna Barbara Moscicki, Yvonne N. Flores, Joacim Meneses-Leon, Pablo Mendez-Hernandez, Berenice Rivera-Paredez, Guadalupe Pastrana, and Jorge Salmeron. The FRIDA Study sponsors did not play a role in designing the study; collecting, analyzing or interpreting the data; writing the report; or submitting the paper for publication. Byline: Paula Ramirez-Palacios, Aiyu Chen, Yvonne N. Flores, Catherine M. Crespi, Eduardo Lazcano-Ponce, Daniel Alvarez-Escobedo, Leticia Torres-Ibarra, Berenice Rivera-Paredez, Leith Leon-Maldonado, Rubi Hernandez-Lopez, Indira R. Mendiola-Pastrana, Pablo Mendez-Hernandez, Jack Cuzick, Enrique Carmona, Hector Figueroa, Fernando Montiel-Cordero, Joacim Meneses-Leon, Jianyu Rao, Jorge Salmeron,