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 [documento electrónico] / Marcela Riveros Ángel,  . - 2021.
Obra : International Journal of Cancer

Idioma : Inglés (eng)

Resumen :	In the context of opportunistic cervical cancer screening settings of low-and-middle-income 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.
Mención de responsabilidad :	Armando Baena, Maria C. Agudelo, Carolina Lopez, Arianis Tatiana Ramírez, Kelly Melisa Castañeda, Astrid M. Bedoya, Marcela Riveros, Guadalupe Posada, Mauricio Borrero, Carlos A. Buitrago, David Suescun, Luis J. Gomez, Juan C. Ochoa, Mark Stoler, Julia Gage, Philip E. Castle, Peter Sasieni, Maribel Almonte, Rolando Herrero, Gloria I. Sanchez, for the ASCUS-COL Trial Group
Referencia :	Int J Cancer. 2020 Oct 2.
DOI (Digital Object Identifier) :	10.1002/ijc.33318
PMID :	33006400
En línea :	https://onlinelibrary.wiley.com/doi/10.1002/ijc.33318
Enlace permanente :	https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5749