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


CONCLUSIONS
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).
Hovland
S
S
NorChip AS, Industriveien 8, Klokkarstua 3490, Norway. Siri.hovland@norchip.com
Arbyn
M
M
Lie
A K
AK
Ryd
W
W
Borge
B
B
Berle
E J
EJ
Skomedal
H
H
Kadima
T M
TM
Kyembwa
L
L
Billay
E M
EM
Mukwege
D
D
Chirimwami
R B
RB
Mvula
T M
TM
Snijders
P J
PJ
Meijer
C J L M
CJ
Karlsen
F
F
D000328:Adult; D000465:Algorithms; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification; D003223:Congo / Q000453:epidemiology; D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology
D004279:DNA, Viral