Value of multi-quadrants biopsy:Pooled analysis of 11 population-based cervical cancer screening studies

Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs.However,there is no widely adopted biopsy guideline up to date.Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions.Methods:Eleven population-based cervical cancer screening studies were conducted in China.Cytology,highrisk human papillomavirus(hrHPV)testing and visual inspection were performed for primary screening.Females positive on one or more tests were referred for colposcopy and biopsy.The proportion of detected cervical intraepithelial neoplasia(CIN)2+and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared.Results:Among 4,923 females included,1,606 had quadrant lesion-targeted biopsy,and 3,317 had 4-quadrant random biopsy.The cumulative CIN2+yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21,0.34,and 0.58 for at most two,three and four quadrants targeted biopsies.Among hrHPV positive females with high-grade squamous intraepithelial lesion(HSIL)+cytology,the cumulative CIN2+yield of a second targeted biopsy in another quadrant was significantly increased(P<0.05).Among hrHPV-negative females,the yield of 4-quadrant random biopsies was 0.005,and the yield by lesion-targeted biopsies was 0.017.For hrHPV positive females who had 4-quadrant random biopsy,the additional CIN2+yield for HSIL+,low-grade squamous intraepithelial lesion(LSIL)cytology,or abnormal visual inspection via acetic acid and Lugol’s iodine(VIA/VILI)were 0.46,0.11,0.14.Conclusions:A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology,and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI.Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low-and middle-income countries.

Human papillomavirus distribution and cervical cancer epidemiological characteristics in rural population of Xinjiang,China

Background:Cervical cancer remains a major public health issue for the Uyghur women and other women living mainly in rural areas of Xinjiang.This study aims to investigate the distribution of human papillomavirus(HPV)infection and cervical cancer in rural areas of Xinjiang,China.Methods:Cervical cancer screening was performed on rural women aged 35 to 64 years from Xinjiang,China in 2017 through gynecological examination,vaginal discharge smear microscopy,cytology,and HPV testing.If necessary,colposcopy and biopsy were performed on women with suspicious or abnormal screening results.Results:Of the 216,754 women screened,15,518 received HPV testing.The HPV-positive rate was 6.75%(1047/15,518).Compared with the age 35-44 years group,the odds ratios(ORs)of HPV positivity in the age 45-54 years and 55-64 years groups were 1.18(95%confidence interval[Cl]:1.02-1.37)and 1.84(95%Cl:1.53-2.21),respectively.Compared with women with primary or lower education level,the ORs for HPV infection rates of women with high school and college education or above were 1.37(95%Cl:1.09-1.72)and 1.62(95%Cl:1.23-2.12),respectively.Uyghur women were less likely to have HPV infection than Han women,with an OR(95%Cl)of 0.78(0.61-0.99).The most prevalent HPV types among Xinjiang women were HPV 16(24.00%),HPV 33(12.70%),and HPV 52(11.80%).The detection rate of cervical intraepithelial neoplasia(CIN)2+was 0.14%and the early diagnosis rate of cervical cancer was 85.91%.The detection rates of vaginitis and cervicitis were 19.28%and 21.32%,respectively.Conclusions:The HPV infection rate in Xinjiang is low,but the detection rate of cervical cancer and precancerous lesions is higher than the national average level.Cervical cancer is a prominent public health problem in Xinjiang,especially in southern Xinjiang.