Optical coherence tomography with higher specificity than Papanicolaou
cytology in patients with high-risk human papillomavirus: a prospective
cohort study
Abstract
Objective To assess triage of HPV-positive women by optical coherence
tomography (OCT), with or without HPV16/18 genotyping, compare with
cytology. Design A prospective cohort study. Setting The Second Xiangya
Hospital in China. Population 813 participants with high-risk
HPV(hrHPV)-positive and cervical cytology results received OCT before
colposcopy between 1 March 2021 and 1 October 2021. Methods OCT
examinations were performed on an outpatient basis. Cytological and
histological results during follow-up were obtained from the Department
of Pathology at the Second Xiangya Hospital. Main outcome measures OCT
and cytology results were compared with the pathological results to
calculate sensitivity, specificity, and immediate CIN3+ risk. The
advantages and disadvantages of OCT and cytology triage of
hr-HPV-positive women were compared. Results HPV16/18 genotyping with
OCT triage has a specificity of CIN3+ lesions [61.1%; 95% CI,
57.6%-64.6%], CIN2+ [66.0%; 95% CI, 62.4%-69.6%]. HPV16/18
genotyping with cytology triage has a specificity of CIN3+[44.0%;
95% CI, 40.4%-47.6%], CIN2+ [47.0%; 95% CI, 43.2%-50.8%].
The OCT triage has a higher specificity and positive predictive
value(PPV) compared to the cytology with a significant difference. The
OCT triage has a similar immediate CIN3+ risk compared to the cytology.
Conclusion The combination of OCT and HPV triage (both genotyping and
non-genotyping) is feasible in terms of immediate CIN2+/CIN3+ risk, and
the OCT triage strategy reduces the number of colposcopies and improves
the specificity and positive predictive value of the test compared to
the cytological triage strategy.