Impact of technology on cytology outcome in cervical cancer screening of young and older women

TY - JOUR

T1 - Impact of technology on cytology outcome in cervical cancer screening of young and older women

AU - Rask, J

AU - Lynge, E

AU - Franzmann, M

AU - Hansen, B

AU - Hjortebjerg, A

AU - Rygaard, C

AU - Schledermann, D

AU - Wåhlin, A

AU - Rebolj, M

N1 - © 2013 UICC.

PY - 2014/5/1

Y1 - 2014/5/1

N2 - Little is known about age-dependent variation in outcomes of cervical cytology with modern technologies. This population-based study evaluated age-dependent changes after routine implementation of ThinPrep and SurePath technology in two independent laboratories, and controlled for time trends in a third laboratory using manually read conventional cytology continually. Data were collected from the Danish National Health Care Registers. For each laboratory, we compared proportions of abnormal cytology defined as atypical squamous cells of undetermined significance or worse (ASCUS+) by age and technology phase. The study included 489,960 cytological samples with no recent abnormality from women aged 23-59 years, routinely screened between 1998 and 2007. Implementation of SurePath liquid-based cytology (LBC) was followed by an increase in abnormal cytology in women aged 23-29 years from 4.6 to 6.1%, relative proportion (RP): 1.31 [95% confidence interval (CI): 1.08-1.61], and a decrease in women aged 45-59 years from 2.9 to 2.0%, RP: 0.71 (95% CI: 0.60-0.83). Implementation of ThinPrep LBC was followed by a decrease in abnormal cytology both in women aged 23-29 years from 7.7 to 6.8%, RP: 0.89 (95% CI: 0.78-1.02) and in women aged 45-59 years from 3.4 to 1.0%, RP: 0.30 (95% CI: 0.24-0.37). With implementation of imaging-assisted reading, regardless of the brand of technology, the proportion of abnormality increased by around 30% in all age groups (range from 19 to 41%). In the laboratory with unchanged technology no trends in abnormality proportions were observed. The impact of LBC implementation on cytological abnormality proportions varied considerably across age groups. What's new? While liquid based cytology (LBC) and automation assisted reading of cytological samples have been widely implemented in cervical screening, little is known about how cytological abnormality proportions change by age as a consequence of new technology implementation. This population-based study evaluated age-dependent changes after routine implementation of LBC, being one of the first studies analyzing the cervical cytology outcomes of different brands. The impact of LBC implementation varied considerably with age, with LBC tending to widen the age-specific differences in the proportions of abnormal samples. Imaging assisted reading, however, appeared to increase the proportions of abnormal cytology across age groups.

AB - Little is known about age-dependent variation in outcomes of cervical cytology with modern technologies. This population-based study evaluated age-dependent changes after routine implementation of ThinPrep and SurePath technology in two independent laboratories, and controlled for time trends in a third laboratory using manually read conventional cytology continually. Data were collected from the Danish National Health Care Registers. For each laboratory, we compared proportions of abnormal cytology defined as atypical squamous cells of undetermined significance or worse (ASCUS+) by age and technology phase. The study included 489,960 cytological samples with no recent abnormality from women aged 23-59 years, routinely screened between 1998 and 2007. Implementation of SurePath liquid-based cytology (LBC) was followed by an increase in abnormal cytology in women aged 23-29 years from 4.6 to 6.1%, relative proportion (RP): 1.31 [95% confidence interval (CI): 1.08-1.61], and a decrease in women aged 45-59 years from 2.9 to 2.0%, RP: 0.71 (95% CI: 0.60-0.83). Implementation of ThinPrep LBC was followed by a decrease in abnormal cytology both in women aged 23-29 years from 7.7 to 6.8%, RP: 0.89 (95% CI: 0.78-1.02) and in women aged 45-59 years from 3.4 to 1.0%, RP: 0.30 (95% CI: 0.24-0.37). With implementation of imaging-assisted reading, regardless of the brand of technology, the proportion of abnormality increased by around 30% in all age groups (range from 19 to 41%). In the laboratory with unchanged technology no trends in abnormality proportions were observed. The impact of LBC implementation on cytological abnormality proportions varied considerably across age groups. What's new? While liquid based cytology (LBC) and automation assisted reading of cytological samples have been widely implemented in cervical screening, little is known about how cytological abnormality proportions change by age as a consequence of new technology implementation. This population-based study evaluated age-dependent changes after routine implementation of LBC, being one of the first studies analyzing the cervical cytology outcomes of different brands. The impact of LBC implementation varied considerably with age, with LBC tending to widen the age-specific differences in the proportions of abnormal samples. Imaging assisted reading, however, appeared to increase the proportions of abnormal cytology across age groups.

KW - Adult

KW - Cytodiagnosis

KW - Female

KW - Humans

KW - Middle Aged

KW - Uterine Cervical Neoplasms

KW - Young Adult

U2 - 10.1002/ijc.28532

DO - 10.1002/ijc.28532

M3 - Journal article

C2 - 24122730

SN - 0020-7136

VL - 134

SP - 2168

EP - 2179

JO - Radiation Oncology Investigations

JF - Radiation Oncology Investigations

IS - 9

ER -