Efficacy of point‐of‐care thermal ablation among high‐risk human papillomavirus positive women in China
Thermal ablation is a point‐of‐care ablative treatment technique for cervical intraepithelial neoplasia (CIN). However, limited information is available about its efficacy in low‐ and middle‐income countries. We evaluated the efficacy of thermal ablation in treatment of CIN detected through high‐ris...
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| Published in: | International journal of cancer Vol. 148; no. 6; pp. 1419 - 1427 |
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| Main Authors: | , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Hoboken, USA
John Wiley & Sons, Inc
15-03-2021
Wiley Subscription Services, Inc |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Thermal ablation is a point‐of‐care ablative treatment technique for cervical intraepithelial neoplasia (CIN). However, limited information is available about its efficacy in low‐ and middle‐income countries. We evaluated the efficacy of thermal ablation in treatment of CIN detected through high‐risk human papillomavirus (HPV) screening in China. Women positive on high‐risk HPV and having colposcopically suspected lesions eligible for ablation underwent colposcopy, biopsy and thermal ablation in one visit. Women ineligible were recalled for large loop excision of transformation zone (LLETZ) when histopathology results were high‐grade CIN. Posttreatment follow‐up at 6 months or more was with HPV test and cytology followed by colposcopy and biopsy for HPV and/or cytology‐positive women. Cure was defined as either negative cytology and HPV test or absence of histopathology proved CIN in any positive women. Of total 218 HPV‐positive women treated with thermal ablation (n = 170) or LLETZ (n = 48), 196 reported for follow‐up evaluation. For women with histologically confirmed CIN at baseline (thermal ablation‐104; LLETZ‐38), cure rates were 84.6% for thermal ablation and 86.8% for LLETZ. Cure rates after thermal ablation were 90.3% for CIN grade one (CIN1) and 76.2% for CIN grade two or worse (CIN2+). HPV clearance rate was 80.4% in women undergoing thermal ablation, which was lower for HPV16/18 compared to other oncogenic types (67.6% vs 85.7%). HPV test had a negative predictive value (NPV) of 98.7% to detect CIN2+ at follow‐up and the positive predictive value (PPV) was 40.4%. Thermal ablation is effective to treat CIN as well as to clear the high‐risk HPV infection. HPV test has high PPV and NPV in following up patients posttreatment.
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When premalignant cervical lesions are detected following HPV screening, thermal ablation (TA) may be an ideal point‐of‐care treatment option for lower‐income regions. But is it effective enough to warrant widespread use in these areas? In this prospective Chinese study, the authors found that the answer is yes, with the added benefit that TA may also clear high‐risk HPV infection. These results support the use of thermal ablation following colposcopy during a single clinic visit, in order to improve access to treatment of premalignant cervical lesions in regions with fewer resources. |
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| Bibliography: | Funding information China Medical Board, Grant/Award Number: 16‐255; Chinese Academy of Medical Sciences Initiative for Innovative Medicine, Grant/Award Number: 2016‐I2M‐1‐019; Sanming Project of Medicine in Shenzhen, Grant/Award Number: SZSM201612042; Shenzhen Healthcare Research Project, Grant/Award Numbers: SZXJ2017011, SZGW2018005 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0020-7136 1097-0215 |
| DOI: | 10.1002/ijc.33290 |