Addressing Confusion about the Risks and Benefits of Co-Testing versus Human Papillomavirus Testing for Cervical Cancer Screening

摘要

We were confused by the paper presented by Hui et al. [1] as it appears to present the somewhat narrow view of a co-testing (human papillomavirus [HPV] nucleic acid testing [NAT] combined with cervical cytology) paradigm for cervical screening as being superior to an HPV-based program. Firstly, the authors appear to conflate cervical and vaginal lesions to the extent that they provide an incorrect definition for CIN as "cervical and vaginal intraepithelial neoplasia." In relation to the HPV typing of gynaecological biopsies undertaken, an HPV NAT assay, INFINITI, was used which has not been clinically validated for sensitivity, specificity or reproducibility according to the industry-wide standard, the Meijer Criteria [2]. As a result, it is impossible to assess the HPV NAT results from a clinical standpoint. Even if the second round of HPV test results (undertaken with the INFINITI assay) from the 18,200 cases were ignored, only 3 out of the 17 women with positive cytology and negative HPV-DNA results were identified as having high-grade lesions of the cervix.