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Hong Xie,1,2,* Jian Huang,2,3,* Mei Ye,4 Jie Xu,3 Rong Zou,3 Zhaoqi Zhang,5 Jun Luo,2,6 Shanyun Wang,7 Guohong Liu,3 Gang Wang,3 Jianxiang Geng,2,8 Wanqiu Huang3 1Department of Gynecology, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, People’s Republic of China; 2The Cross-Strait Precision Medicine Association-HPV Infection Disease Professional Committee, Nanjing, People’s Republic of China; 3Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Centre for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 4Nanjing Jiangning District Maternal and Child Health and Family Planning Service Center, Nanjing, People’s Republic of China; 5Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 6Reproductive Testing Quality Control Department of Central Laboratory, Jiangsu Health Vocational College, Nanjing, People’s Republic of China; 7Zhongshan Hospital of Traditional Chinese Medicine, the Second Clinical School of Guangzhou University of Chinese Medicine, Zhongshan, People’s Republic of China; 8Department of Pathology, Nanjing Hospital of Traditional Chinese Medicine, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wanqiu Huang, Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Centre for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, 200240, People’s Republic of China, Email wqhuang@sjtu.edu.cnPurpose: To evaluate the diagnostic performance of the current three-step cervical cancer screening strategy in Chinese women and explore the optimized value of integrating human papillomavirus (HPV) testing, ThinPrep cytology test (TCT), and colposcopic visual inspection with acetic acid/Lugol’s iodine (VIA/VILI) for improving cervical disease detection.Patients and Methods: A retrospective study was conducted on 11,405 outpatients of Shenzhen People’s Hospital (2018– 2023). Inclusion criteria were a history of sexual activity plus at least one of the following: high-risk HPV (HR-HPV) positivity, abnormal TCT results, or highly suspicious symptoms. Exclusions included prior hysterectomy, cervical cancer (CC) treatment history, pregnancy, or incomplete medical records. The diagnostic performance of HR-HPV testing, TCT, and colposcopic VIA/VILI results was evaluated using pathologically confirmed high-grade squamous intraepithelial lesion (HSIL) and CC as the reference standard. The calculated metrics comprised sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC).Results: Among the cohort, the positive rates were 71.56% for HR-HPV, 32.57% for abnormal cytology, and 9.34% for colposcopic VIA/VILI. For detecting HSIL/CC, the NPVs of HPV testing, TCT, and colposcopic VIA/VILI were 0.976, 0.955, and 0.965, respectively. Combined use of the three modalities achieved an NPV of 0.999 for HSIL/CC. Integrating colposcopic VIA/VILI into primary screening also reduced both false-positive and false-negative results compared with single-modality strategies.Conclusion: In this large real-world retrospective cohort, combining HPV testing, TCT, and colposcopic VIA/VILI improves the diagnostic accuracy of high-grade cervical disease (HSIL and CC), with practical feasibility for clinical application. However, this integrated approach needs prospective multi-center validation before widespread promotion in cervical cancer screening among community populations.Keywords: uterine cervical neoplasms, human papillomavirus, cytology, colposcopy, mass screening, China |