A comprehensive evaluation of the accuracy of cervical pre-cancer detection methods in a high-risk area in East Congo

Br J Cancer. 2010 Mar 16;102(6):957-65. doi: 10.1038/sj.bjc.6605594. Epub 2010 Mar 2.

Abstract

Background: Given the high burden of cervical cancer in low-income settings, there is a need for a convenient and affordable method for detecting and treating pre-cancerous lesions.

Methods: Samples for comparing the accuracy of cytology, virology and histology were collected. Identification of HPV E6/E7 mRNA was performed using PreTect HPV-Proofer. HPV DNA detection was performed by GP5+/6+ PCR, followed by reverse line blot (RLB) for typing.

Results: A total of 343 women, aged 25-60 years, attending gynaecological polyclinics in DR Congo were included for sample enrolment. The test positivity rate was conventional and liquid-based cytology (LBC) at cutoff ASCUS+ of 6.9 and 6.6%, respectively; PreTect HPV-Proofer of 7.3%; and consensus DNA PCR for 14 HR types of 18.5%. Sixteen cases of CIN2+ lesions were identified. Of these, conventional cytology identified 66.7% with a specificity of 96.2%, LBC identified 73.3% with a specificity of 96.9%, all at cutoff ASCUS+. HR-HPV DNA detected all CIN2+ cases with a specificity of 85.9%, whereas PreTect HPV-Proofer gave a sensitivity of 81.3% and a specificity of 96.6%.

Conclusion: Both HPV detection assays showed a higher sensitivity for CIN2+ than did cytological methods. Detecting E6/E7 mRNA from only a subset of HR HPVs, as is the case with PreTect HPV-Proofer, resulted in a similar specificity to cytology and a significantly higher specificity than consensus HR HPV DNA (P<0.0001).

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Algorithms
  • Alphapapillomavirus / genetics
  • Alphapapillomavirus / isolation & purification
  • Congo / epidemiology
  • DNA, Viral / analysis
  • DNA, Viral / genetics
  • Early Detection of Cancer / methods*
  • Female
  • Humans
  • Middle Aged
  • Precancerous Conditions / diagnosis*
  • Precancerous Conditions / epidemiology
  • Precancerous Conditions / virology
  • Predictive Value of Tests
  • Risk Factors
  • Sensitivity and Specificity
  • Uterine Cervical Dysplasia / diagnosis*
  • Uterine Cervical Dysplasia / epidemiology
  • Uterine Cervical Dysplasia / etiology
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / etiology

Substances

  • DNA, Viral