Clinical performance of triage strategies for HPV-positive women in cervical cancer screening in rural Yunnan China

作者：Xiuwei Zhai, Tong Kong, Xue Yang, Jing Yu, Dao Yan, Hongying Yang, Hongping Zhang, Rufei Duan · 发表于：BMC Cancer · 年份：2025 · DOI：10.1186/s12885-025-15375-3 · 被引用次数：3 · 研究领域：Cervical Cancer and HPV Research、Global Cancer Incidence and Screening、Women's cancer prevention and management

OBJECTIVE: To evaluate the clinical performance of triage strategies for HPV-positive women in rural Yunnan, China, with the aim of optimizing HPV test-based cervical cancer screening. METHODS: We recruited 417 HPV-positive women, who additionally underwent mRNA testing, AI-assisted cytology, PAX1 and SOX1 DNA methylation testing. We compared the sensitivity, specificity, area under the curve (AUC), and number needed to colposcopy for one cervical lesion detection of several triage approaches, for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+). RESULTS: Among single triage strategies, cytology demonstrated a sensitivity of 54.2% (95% CI: 33.2%-73.8%), a specificity of 75.1% (95% CI: 70.4%-79.2%), an AUC of 0.65 (95% CI: 0.53-0.77), and an number needed to colposcopy for one lesion detection of 8.5. Compared with cytology, PAX1 methylation exhibited superior sensitivity (87.5%, 95% CI: 66.5%-96.7%) and specificity (90.6%, 95% CI: 87.1%-93.2%), with an improved AUC of 0.89, and a reduced colposcopy referral of 2.8. Adding SOX1 to PAX1 maintained sensitivity (87.5%) but slightly reduced specificity (88.3%), resulting in an AUC of 0.88. mRNA testing showed higher sensitivity (75.0%) but lower specificity (44.5%) and a declined AUC (0.60). Among combined triage strategies, HPV-16/18 genotyping with reflex cytology for non-16/18 types yielded a sensitivity of 62.5%, a specificity of 54.5%, and an AUC of 0.59. HPV-16/18 genotyping with reflex PAX1/SOX1 methyla...