GIÁ TRỊ CỦA XÉT NGHIỆM HPV ĐẦU TAY TRONG TẦM SOÁT UNG THƯ CỔ TỬ CUNG

Abstract

Introduction: The FDA approved the primary screening with cobas HPV test in April 2014 to replace the first-line PAP test, and Vietnam’s Ministry of Health released the approval decision N^o1639 on March 19, 2021 on cervical cancer screening, with HPV testing alone or in combination with PAP test. However, physicians are hesitant to conduct HPV tests as the first-line screening test while studies worldwide have reported that the rate of women with negative PAP but positive HPV on detecting lesions from CIN2 or higher is 15 to 25%. Objectives: To determine the rate of precancerous lesions and cervical cancer with negative PAP but positive HPV results in order to provide evidence which could change the mindset and habits of healthcare professionals regarding cervical cancer screening. Materials and methods: Study design: Retrospective cross-sectional study. Study population: Women who underwent gynecological examination and received cervical screening with Pap and HPV test, with abnormal cervical biopsy results at Hung Vuong Hospital. Sample size: Entire sample population within the year 2021. Method: Outpatient records including complete PAP, HPV testing, and pathology results interpreted at Hung Vuong Hospital. Results: The compatibility between PAP and HPV accounts for 39.3% (101/257). The incompatibility between PAP and HPV accounts for 60.7% (156/257), of which negative Pap positive HPV is 46.7%. Based on pathology results, the rate of undetected disease by PAP is 51.4%. The cases of lesions from CIN 2 or higher have a rate of undetected disease by PAP of 12%, including one case of ACC and one case of AGC. For HPV, HPV(-) accounts for 18.7%. In cases of lesions from CIN 2 or higher, the rate of HPV(-) is 3.1%, including one case of AGC. The rate of PAP (+) and HPV (-) among the total number of cases is 14% (36/257), of which 83.3% are CIN1 and 16.7% are CIN2+ in need of monitoring and treatment, without cervical cancer. The rate of cases with cervical cancer screening with PAP test failing to detect diseases is 2.75 times as much as that with HPV test. For CIN 2+ cases, the rate of undetected disease by PAP is 3.9 times as much as that by the HPV test. Conclusion: To enhance effective prevention against cervical cancer, health care professionals should perform the primary HPV test. When this test is positive, colposcopy should be done for biopsy if necessary. Then  a Pap test would be performed  to evaluate the current cervical pathology. That will be available for following up.