{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T06:43:46Z","timestamp":1786171426061,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100009228","name":"Region \u00d6rebro l\u00e4n","doi-asserted-by":"publisher","award":["OLL\u20101014240"],"award-info":[{"award-number":["OLL\u20101014240"]}],"id":[{"id":"10.13039\/501100009228","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009228","name":"Region \u00d6rebro l\u00e4n","doi-asserted-by":"publisher","award":["OLL\u20101004308"],"award-info":[{"award-number":["OLL\u20101004308"]}],"id":[{"id":"10.13039\/501100009228","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Primary cervical screening with testing for human papillomavirus (HPV) brings increased detection of women with low\u2010grade squamous intraepithelial lesion recommended for follow\u2010up with colposcopy. This study evaluates whether co\u2010testing (HPV + cytology) or testing for HPV alone can safely replace colposcopy as follow\u2010up for histologically confirmed low\u2010grade squamous intraepithelial lesions. It estimates these strategies' diagnostic performance in detecting histological high\u2010grade squamous intraepithelial or more severe lesions at follow\u2010up and analyzes their relative cost\u2010effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>This is a retrospective cohort study on follow\u2010up data of women aged 23\u201370 with histological low\u2010grade squamous intraepithelial lesion, diagnosed during 2017\u20132018, with an analysis of data from the Swedish National Cervical Screening Registry. Out of the 14\u2009643 women with low\u2010grade squamous intraepithelial lesions, 4213 women with complete data on HPV, cytology, and histology results were analyzed. The primary outcome was to estimate the diagnostic performance of the strategies of co\u2010testing (HPV + cytology) and human papillomavirus\u2010alone in detecting histological high\u2010grade squamous intraepithelial or more severe lesions in the follow\u2010up of histological low\u2010grade squamous intraepithelial lesions. The secondary outcome was to perform a cost\u2010effectiveness analysis of these strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Using co\u2010testing as the primary follow\u2010up and reserving colposcopy for women who tested positive for HPV or cytology results yielded a sensitivity of 96% for high\u2010grade squamous intraepithelial or more severe lesions. HPV\u2010alone testing had 88% sensitivity. Adding colposcopy to co\u2010testing would require 1735 (70%) additional examinations to detect 14 (3.9%) more women with high\u2010grade squamous intraepithelial or more severe lesions. No cancer cases were missed by co\u2010testing or HPV\u2010alone. The cost of detecting one extra high\u2010grade squamous intraepithelial or more severe lesion by adding colposcopy to co\u2010testing was 81\u2009959 EUR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Histological low\u2010grade squamous intraepithelial lesion follow\u2010up can be safely managed with co\u2010testing, considerably reducing the number of colposcopies and associated costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70255","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T06:56:31Z","timestamp":1779519391000},"page":"1871-1878","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balancing diagnostic accuracy and cost in the follow\u2010up of histological low\u2010grade squamous intraepithelial lesions"],"prefix":"10.1111","volume":"105","author":[{"given":"Riina","family":"Aarnio","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden, Department of Obstetrics and Gynaecology Danderyd University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasudha","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Ryen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University Health Care Research Center \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1458-1542","authenticated-orcid":false,"given":"Lovisa","family":"Bergengren","sequence":"additional","affiliation":[{"name":"Department of Women's Health, Faculty of Medicine and Health \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62218-7"},{"key":"e_1_2_13_3_1","unstructured":"National Cervical Cancer Prevention Guidelines\u2014RCC [Internet]. 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