Journal
EXPERT REVIEW OF MOLECULAR DIAGNOSTICS
Volume 16, Issue 9, Pages 961-974Publisher
TAYLOR & FRANCIS AS
DOI: 10.1080/14737159.2016.1217157
Keywords
Human papillomavirus; cervical cancer; cervical intraepithelial neoplasia (CIN); screening; triage; cytology; genotyping; DNA methylation; p16; Ki-67 dual-stained cytology; biomarker
Categories
Funding
- European Commission [666800]
- FP7 ERC-ADV grant Mass-care [322986]
- H2020 Societal Challenges Programme [666800] Funding Source: H2020 Societal Challenges Programme
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Introduction: Primary HPV-testing has been shown to provide a superior detection of women at risk of cervical (pre)cancer compared to cytology-based screening. However, as most high-risk HPV infections are harmless, additional triage testing of HPV-positive women is necessary to identify those with cervical (pre)cancer. In this paper, we compare the performance, advantages and limitations of clinically relevant available triage strategies for HPV-positive women.Areas covered: Many different colposcopy triage strategies, comprising both microscopy-based and molecular (virus/host-related) markers, have been suggested: Pap cytology, p16/Ki-67 dual-stained cytology, HPV16/18 genotyping, viral DNA methylation and host cell DNA methylation. Literature search was limited to triage strategies that have achieved at least phase 2 of the five-phase framework for biomarker development and studies including large cohorts (100 hrHPV-positive women). Triage markers were stratified by sample type (cervical scrape, self-collected sample) and by study population (screening, non-attendee, referral).Expert commentary: At present, repeat Pap cytology and Pap cytology combined with HPV16/18 genotyping are the only triage strategies that have been robustly shown to be ready for implementation. Other strategies such as p16/Ki-67 dual-stained cytology and host cell DNA methylation analysis, with or without additional HPV16/18 genotyping, are attractive options for the near future.
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