Background: Up until recently, cervical cytology was the mainstay for cervical cancer screening. However, the established association between human papillomavirus (HPV) infection and cervical cancer has led to changes in preventive strategies with cytology being replaced by the use of high risk HPV (hrHPV) testing and primary prevention being achieved by HPV vaccination. In this context, the role of cervical cytology is shifting to secondary triage of HPV positive women. As vaccination is leading to decreased HPV infections and significant cervical abnormalities (CIN2+), data on the impact of HPV vaccination of cervical cytology metrics, including positive predictive value (PPV) and negative predictive value (NPV) is starting to emerge. Summary: This is a review of updates in cervical cancer screening, including the use of primary HPV testing and the impact of HPV vaccination on cytology as part of cervical cancer screening. Key Messages: Cervical cancer screening and prevention is undergoing significant changes as there is widespread implementation of HPV vaccination and hrHPV testing is becoming the entry point for secondary prevention. Optimal screening approaches and intervals in this setting are currently been analyzed including the use of cytology and other ancillary techniques for triage of positive cases, as well as the effect of vaccination on the PPV and NPV of cytology in the detection of CIN2+.


中文翻译：

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HPV 疫苗接种时代细胞学在宫颈癌筛查中的未来作用

背景：直到最近，宫颈细胞学仍是宫颈癌筛查的主要手段。然而，人乳头瘤病毒 (HPV) 感染与宫颈癌之间已建立的关联导致预防策略发生变化，细胞学被高危 HPV (hrHPV) 检测所取代，一级预防通过 HPV 疫苗接种实现。在这种情况下，宫颈细胞学的作用正在转向 HPV 阳性女性的二次分诊。由于疫苗接种导致 HPV 感染减少和显着宫颈异常 (CIN2+)，有关 HPV 疫苗接种对宫颈细胞学指标（包括阳性预测值 (PPV) 和阴性预测值 (NPV)）影响的数据开始出现。摘要：这是对宫颈癌筛查更新的回顾，包括使用初级 HPV 检测和 HPV 疫苗接种对细胞学的影响作为宫颈癌筛查的一部分。关键信息：随着 HPV 疫苗接种的广泛实施和 hrHPV 检测正在成为二级预防的切入点，宫颈癌筛查和预防正在发生重大变化。目前正在分析这种情况下的最佳筛查方法和间隔，包括使用细胞学和其他辅助技术对阳性病例进行分类，以及疫苗接种对细胞学检测 CIN2+ 的 PPV 和 NPV 的影响。随着HPV疫苗接种的广泛实施和hrHPV检测正成为二级预防的切入点，宫颈癌筛查和预防正在发生重大变化。目前正在分析这种情况下的最佳筛查方法和间隔，包括使用细胞学和其他辅助技术对阳性病例进行分类，以及疫苗接种对细胞学检测 CIN2+ 的 PPV 和 NPV 的影响。随着HPV疫苗接种的广泛实施和hrHPV检测正成为二级预防的切入点，宫颈癌筛查和预防正在发生重大变化。目前正在分析这种情况下的最佳筛查方法和间隔，包括使用细胞学和其他辅助技术对阳性病例进行分类，以及疫苗接种对细胞学检测 CIN2+ 的 PPV 和 NPV 的影响。