Journal
EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY
Volume 210, Issue -, Pages 275-280Publisher
ELSEVIER
DOI: 10.1016/j.ejogrb.2017.01.009
Keywords
Screening; Diagnostic cytology; Dual-stain cytology; CINtec (R) PLUS cytology test; Triage; ASCUS (abnormal squamous cells of undetermined significance); LSIL (low-grade squamous intraepithelial lesion); p16/Ki-67 dual-stain cytology; p16; Ki-67
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Cervical cancer screening saves lives. Secondary prevention in cervical cancer screening relies on the results of primary cytology and/or HPV testing. However, primary screening with cytology has a low sensitivity, and HPV screening has a low specificity. This means that either cancers are missed, or women are over-treated. To improve performance outcomes, the concept of dual-stain cytology (CINtec (R) PLUS Cytology test) has been introduced. In this approach, additional staining with p16/Ki-67 is performed in cases where cytology results are abnormal (LSIL or ASCUS) and/or HPV-positive. Another way to describe this approach might be diagnostic cytology. In order to assess the value of this diagnostic cytology, a systematic literature review was conducted of dual-stain cytology performance across multiple studies until May 2016. In a Belgian screening population (women age 25-65 years), dual-stain cytology was significantly more sensitive (66%) and slightly less specific (-1.0%) than cytology. In the population referred to colposcopy or with abnormal cytology (ASCUS, LSIL), dual-staining showed a significantly higher increase in specificity, and a slightly lower sensitivity than HPV testing. Specificity gains resulted in fewer false positives and an increase in the number of correct referrals to colposcopy. Dual-staining with p16/Ki-67 cytology is an attractive biomarker approach for triage in cervical cancer screening. (C) 2017 Elsevier B.V. All rights reserved.
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