Medical College of Wisconsin
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Proof-of-principle study of a novel cervical screening and triage strategy: Computer-analyzed cytology to decide which HPV-positive women are likely to have ≥CIN2. Int J Cancer 2017 Feb 01;140(3):718-725 PMID: 27696414 PMCID: PMC5159264

Pubmed ID



A challenge in implementation of sensitive HPV-based screening is limiting unnecessary referrals to colposcopic biopsy. We combined two commonly recommended triage methods: partial HPV typing and "reflex" cytology, evaluating the possibility of automated cytology. This investigation was based on 1,178 exfoliated cervical specimens collected during the enrollment phase of The Study to Understand Cervical Cancer Early Endpoints and Determinants (SUCCEED, Oklahoma City, OK). We chose a colposcopy clinic population to maximize number of outcomes, for this proof-of-principle cross-sectional study. Residual aliquots of PreservCyt were HPV-typed using Linear Array (LA, Roche Molecular Systems, Pleasanton, CA). High-risk HPV typing data and cytologic results (conventional and automated) were used jointly to predict risk of histologically defined ≥CIN2. We developed a novel computer algorithm that uses the same optical scanning features that are generated by the FocalPoint Slide Profiler (BD, Burlington, NC). We used the Least Absolute Shrinkage and Selection Operator (LASSO) method to build the prediction model based on a training dataset (n = 600). In the validation set (n = 578), for triage of all HPV-positive women, a cytologic threshold of ≥ASC-US had a sensitivity of 0.94, and specificity of 0.30, in this colposcopy clinic setting. When we chose a threshold for the severity score (generated by the computer algorithm) that had an equal specificity of 0.30, the sensitivity was 0.91. Automated cytology also matched ≥ASC-US when partial HPV typing was added to the triage strategy, and when we re-defined cases as ≥CIN3. If this strategy works in a prospective screening setting, a totally automated screening and triage technology might be possible.

Author List

Schiffman M, Yu K, Zuna R, Terence Dunn S, Zhang H, Walker J, Gold M, Hyun N, Rydzak G, Katki HA, Wentzensen N


Noorie Hyun PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin


2-s2.0-84995395328   9 Citations

MESH terms used to index this publication - Major topics in bold

Aged, 80 and over
Cross-Sectional Studies
Early Detection of Cancer
Mass Screening
Middle Aged
Papillomavirus Infections
Sensitivity and Specificity
Uterine Cervical Neoplasms
Vaginal Smears
jenkins-FCD Prod-300 626508253d14e4184314fb9f66322a03a5906796