Triage of high-risk HPV positive women in cervical cancer screening.
BACKGROUND
High-risk human papillomavirus (hrHPV) testing is expected to replace cytology as primary screening method for cervical cancer screening in an increasing number of countries. The high sensitivity of hrHPV testing is combined with a limited specificity which makes triaging of hrHPV positive women necessary. As an ideal triage method does not yet exist, an optimal triage strategy for hrHPV positive women based on current knowledge should be obtained. The aim of this article is to present an overview of available options for triage of hrHPV positive women, with their strengths and limitations and possible future opportunities.


METHODS
Current knowledge on morphological biomarkers, molecular biomarkers and combined triage strategies will be discussed to give an overview of the state-of-the-art on triaging hrHPV positive women. The literature search was limited to studies on triage strategies for hrHPV positive women. Expert commentary: Experience with morphology-based biomarkers makes these a valuable triage method. However, they lack the ability of differentiating productive from transforming infections. Molecular biomarkers are objective, highly reproducible, can be used in high throughput testing, and show promising results. With more extensive knowledge on these molecular markers, cervical cancer screening may transform to a full molecular screening in the future.
a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands.
Renée Mf
RM
Ebisch
b Department of Pathology , Radboud university medical center , Nijmegen , The Netherlands.
Albert G
AG
Siebers
a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands.
Remko P
RP
Bosgraaf
a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands.
Leon Fag
LF
Massuger
a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands.
Ruud Lm
RL
Bekkers
c Department of Medical Microbiology , Radboud university medical center , Nijmegen , The Netherlands.
Willem Jg
WJ
Melchers
D015415:Biomarkers / Q000032:analysis; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D057166:High-Throughput Screening Assays / Q000379:methods; D006801:Humans; D008403:Mass Screening / Q000379:methods; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology
D015415:Biomarkers
Cervical cancer; cervical intraepithelial neoplasia; human papillomavirus; molecular biomarkers; morphological biomarkers; screening; self-sampling; triage