{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T01:16:15Z","timestamp":1771550175632,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:00:00Z","timestamp":1587686400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81761128006"],"award-info":[{"award-number":["81761128006"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2020,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Improvement in managing HPV\u2010positive women is urgently needed. Based on a population\u2010based study which included 2112 women aged 49 to 69 from Shanxi, China, we aimed to evaluate the clinical performance of multiple triage strategies based on liquid\u2010based cytology (LBC), p16<jats:sup>INK4a<\/jats:sup>, viral load and partial genotyping, as a single or combined strategy for detecting cervical intraepithelial neoplasia grade 2\/3 or higher (CIN2+\/CIN3+) in women who tested positive by Hybrid Capture 2 (HC2). Among 452 HC2\u2010positive women, the test positivity of LBC (ASC\u2010US+), p16<jats:sup>INK4a<\/jats:sup>, HPV16\/18 and HPV16\/18\/31\/33\/45 were 39.6%, 38.5%, 18.0% and 40.0%, respectively. Compared to LBC (ASC\u2010US+) triage, a single triage strategies using p16<jats:sup>INK4a<\/jats:sup> or extended genotyping (SureX HPV16\/18\/31\/33\/45) achieved comparable sensitivity (relative sensitivity: 1.08, 95% confidence interval [CI]: 0.93\u20101.26 and 0.96, 95% CI: 0.76\u20101.22) and specificity (relative specificity: 1.05, 95% CI: 0.96\u20101.14 and 1.02, 95% CI: 0.92\u20101.14) for CIN3+. Viral load triage using a \u226550 RLU\/CO cut\u2010point also yielded similar results with LBC (ASC\u2010US+). Among combined triage strategies, HPV16\/18 genotyping with reflex p16<jats:sup>INK4a<\/jats:sup> showed higher sensitivity and slightly lower specificity than LBC (ASC\u2010US+) for CIN3+ detection, however, the differences were not statistically significant. Of note, after a negative result by p16<jats:sup>INK4a<\/jats:sup> or LBC among HPV16\/18 negative women, the posttest probability of CIN3+ was lower than 1%. Our study suggested that p16<jats:sup>INK4a<\/jats:sup>, extended genotyping and increased viral load cut\u2010point could be promising alternatives to cytology triage. Combined triage algorithms of HPV16\/18 with reflex p16<jats:sup>INK4a<\/jats:sup> or cytology, if negative, are associated with the substantial low posttest risk sufficient to release women to next screening round.<\/jats:p>","DOI":"10.1002\/ijc.33001","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T04:31:08Z","timestamp":1586147468000},"page":"2053-2064","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Triage options to manage high\u2010risk human papillomavirus<scp>\u2010<\/scp>positive women: A population\u2010based cross\u2010sectional study from rural China"],"prefix":"10.1002","volume":"147","author":[{"given":"Remila","family":"Rezhake","sequence":"first","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Chen","sequence":"additional","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shang\u2010Ying","family":"Hu","sequence":"additional","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xue\u2010Lian","family":"Zhao","sequence":"additional","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xun","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Cao","sequence":"additional","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"},{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital and Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Shenzhen China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"You\u2010Lin","family":"Qiao","sequence":"additional","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9294-0005","authenticated-orcid":false,"given":"Fang\u2010Hui","family":"Zhao","sequence":"additional","affiliation":[{"name":"National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Arbyn","sequence":"additional","affiliation":[{"name":"Unit of Cancer Epidemiology Belgian Cancer Centre  Sciensano, Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,4,24]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Cervical Cancer: An NCD We Can Overcome","author":"World Health Organization","year":"2018"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(16)30099-7"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.06.095"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4823"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70570-9"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.38.8389"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4924"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pvr.2019.04.011"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2017.08.015"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2015.11.015"},{"key":"e_1_2_9_12_1","unstructured":"ArbynM LionL YuillS GultekinM CanfellK. 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