Comparison of immediate colposcopy, repeat conventional cytology and high-risk human papillomavirus testing for the clinical management of atypical squamous cells of undetermined significance cytology in routine health services of Medellin, Colombia: The ASCUS-COL trial

ABSTRACT : In the context of opportunistic cervical cancer screening settings of low-and-middleincome countries, little is known about the benefits of high-risk human papillomavirus (hrHPV) testing on high-grade cervical abnormality detection among women with atypical squamous cells of undetermined...

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Autores:
Baena Zapata, Armando
Agudelo Fernández, María Cecilia
López Uran, Carolina
Ramírez Pineda, Arianis Tatiana
Castañeda Vanegas, Kelly Melisa
Bedoya, Astrid Milena
Riveros, Marcela
Posada, Guadalupe
Borrero Franco, Mauricio
Buitrago Duque, Carlos Arturo
Suescun, David
Gómez Upegui, Luis Jaime
Ochoa, Juan
Stoler, Mark
Gage, Julia
Castle, Philip
Sasieni, Peter
Almonte, Maribel
Herrero, Rolando
Sánchez Vásquez, Gloria Inés
Tipo de recurso:
Article of investigation
Fecha de publicación:
2020
Institución:
Universidad de Antioquia
Repositorio:
Repositorio UdeA
Idioma:
eng
OAI Identifier:
oai:bibliotecadigital.udea.edu.co:10495/29491
Acceso en línea:
http://hdl.handle.net/10495/29491
Palabra clave:
Papillomaviridae
Neoplasias del Cuello Uterino - diagnóstico
Uterine Cervical Neoplasms - diagnosis
Colombia
Citología ASCUS
ASC-US cytology
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
Description
Summary:ABSTRACT : In the context of opportunistic cervical cancer screening settings of low-and-middleincome countries, little is known about the benefits of high-risk human papillomavirus (hrHPV) testing on high-grade cervical abnormality detection among women with atypical squamous cells of undetermined significance (ASC-US) cytology in routine clinical practice. We compared the effectiveness of immediate colposcopy (IC), conventional cytology at 6 and 12 months (colposcopy if ≥ASC-US) (RC) and hrHPV testing (colposcopy if hrHPV-positive) (HPV) to detect cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) among women aged 20 to 69 years with ASC-US in routine care. Participants (n = 2661) were evenly randomized into three arms (n = 882 IC, n = 890 RC, n = 889 HPV) to receive services by routine healthcare providers and invited to an exit visit 24 months after recruitment. Histopathology was blindly reviewed by a quality-control external panel (QC). The primary endpoint was the first QC-diagnosed CIN2+ or CIN3+ detected during three periods: enrolment (≤6 months for IC and HPV, ≤12 months for RC), follow-up (between enrolment and exit visit) and exit visit. The trial is completed. Colposcopy was done on 88%, 42% and 52% of participants in IC, RC and HPV. Overall, 212 CIN2+ and 52 CIN3+ cases were diagnosed. No differences were observed for CIN2+ detection (P = .821). However, compared to IC, only HPV significantly reduced CIN3+ cases that providers were unable to detect during the 2-year routine follow-up (relative proportion 0.35, 95% CI 0.09-0.87). In this context, hrHPV testing was the most effective and efficient management strategy for women with ASC-US cytology.