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Cervical cancer is caused by persistent infection with carcinogenic human papillomaviruses HPV. HPV vaccination can control infections and prevents cancer development. Cervical screening can detect potentially premalignant conditions, which can be treated to prevent cervical cancer. Cervical screening programs include-screening of the general population and the separation of screen-positive women to focus treatment on potentially premalignant conditions.
HPV testing for the carcinogenic types of HPV is gradually replacing cytology-Pap testing, because HPV testing is more sensitive for detection of precancer malignancies. It is also more reproducible and adaptable to increasingly HPV-vaccinated populations. The leading treatment strategy in higher-resource regions combines partial HPV typing to identify the highest-risk types and Pap tests used in this case as a second test among HPV-positive women.
Use of computer-interpreted Pap tests for triage would permit the automation of the whole screening process. Fully automatable cervical screening strategy determined whether an automated algorithm could separate and prioritize HPV-positive women for treatment as accurately as conventionally interpreted Pap tests.
The researchers developed a novel risk score algorithm based on computer-scanned liquid-based slide features to separate HPV-positive women to target potentially premalignant conditions using a slide scanner that performs a high-speed image capture to detect features of the Pap test slide such as the presence of different cell types, nuclear size, and nuclear contour.
Among HPV-positive women, the algorithm matched the triage performance of abnormal Pap test results. Combined with HPV testing, the automated approach referred 91.7% of HPV-positive cases to immediate treatment while deferring 38.4% of HPV-positive women to one-year retesting (compared with 89.1% and 37.4%, respectively, for typing and Pap test triage). In the 2016-2017 validation, the predicted risk scores strongly correlated with Pap test results. Computer algorithm matches or exceeds Pap test performance, showing that totally automated cervical screening without Pap tests is feasible and can improve cervical screening.
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