1. Results of Sentinel Sites Study
Dr Karin Denton

2. HPV testing as a triage for women with low grade cytological abnormalities: results from the sentinel sites studies.
Kelly R, Patnick J, Kitchener HC, Moss SM
Br J Cancer Sep 27;105(7):983-8.

3. North Bristol NHS Trust/Avon Cervical screening programme
Results
Study took place between 1 Jan 2008 and 1 April 2009
Data collected until September 2009
Analysis conducted independently at Cancer Screening Evaluation Unit, Institute of Cancer Research
Over 90% of women attended colposcopy
North Bristol NHS Trust/Avon Cervical screening programme

4. HPV positive rates by age group and initial cytology result
Borderline
Mild
Total
Age Grp
No of women
HPV + n (%)
25-34
3121
2144
(68.7)
2203
1964
(89.2)
5324
4108
(77.2)
35-49
2783
1165
(41.9)
1129
869
(77.0)
3912
2034
(52.0)
50-64
603
187
(31.0)
212
141
(66.5)
815
328
(40.2)
6507
3496
(53.7)
3544
2974
(83.9)
10051
6470
(64.4)
North Bristol NHS Trust/Avon Cervical screening programme

5. North Bristol NHS Trust/Avon Cervical screening programme
SSS Results from different centres HPV positive rate by site and initial cytology 1
Site
Borderline
Mild
Total n
HPV +ve
(%) A B C D E F
1263
643
2557
789
663
592
866 (68.6)
224 (34.8)
(43.4)
(57.7)
406 (61.2)
434 (73.3)
404
523
1507
420
557
133
370 (91.6)
(73.4)
(81.8)
372 (88.6)
500 (89.8)
116 (87.2)
1667
1116
4064
1209
1220
7255
(74.1)
608 (52.1)
(57.7)
827 (68.4)
906 (74.3)
550 (75.9)
North Bristol NHS Trust/Avon Cervical screening programme

6. North Bristol NHS Trust/Avon Cervical screening programme
SSS Results from different centres HPV positive rate by site and initial cytology 2
Site
Borderline
Mild
Total n
HPV +ve
(%)
Centre C
(Thinprep® LBC)
1188
543 (47.7)
798
669 (83.8)
1986
(61.0)
(BD SurepathTM LBC)
426
216 (50.7)
241
204 (84.6)
667
420 (63.0)
3903
(58.2)
2179
(87.7)
6082
(68.7)
1661
874 (52.6)
897
704 (78.5)
2558
(61.7)
North Bristol NHS Trust/Avon Cervical screening programme

7. Sentinel Site Study Results at colposcopy
CIN 1
CIN2
CIN3+
n (%) BL
25-34
35-49
50-64
(20.4)
(16.3)
(15.8)
(10.0)
(8.3)
(2.3)
142* (7.4)
(6.1)
(2.9)
Total
(18.8)
(9.0)
(6.7)
Mild
(26.7)
(29.6)
(23.8)
(12.4)
(10.9)
(6.2)
(6.3)
(3.8)
(2.3)
(27.5)
(11.7)
(5.4)
(22.8)
(10.2)
(6.1)
*Includes 3 invasive cancers
North Bristol NHS Trust/Avon Cervical screening programme

8. Sentinel Site Study PPV of colposcopy by site 1
Borderline
Mild
No attending colposcopy
PPV
CIN2+
CIN3+ A B C D E F
803
178
978
430
355
417
21.5
11.2
11.6
16.5
9.3
20.9
7.8
6.2
5.0
7.4
2.5
11.5
350
317
1104
354
440
112
25.4
9.1
15.9
21.8
10.9
30.0
7.1
3.5
4.8
7.6
15.2
North Bristol NHS Trust/Avon Cervical screening programme

9. North Bristol NHS Trust/Avon Cervical screening programme
Sentinel Sites Study Rate of disease at 1, 2 3 and >3 years after negative colposcopy in 956 women with long term follow-up
Time since negative colposcopy
Abnormal cytology
CIN1
CIN2
CIN3
No. % %.
1 year
2 years
3 years
>3 years 10 19 25 30
1.0
2.0
2.6
3.1 18 33 38 49
1.9
3.5
4.0
5.1 6 16 23
0.6
1.7
2.4 28
2.9
North Bristol NHS Trust/Avon Cervical screening programme

10. North Bristol NHS Trust/Avon Cervical screening programme
Test of Cure
Preliminary data only in un-triaged women
3203 women had test of cure
Failed test of cure by 18.3%
6.2% by abnormal cytology
12.1% by HPV +ve with normal cytology
Increased ‘failure’ rates with lower CIN grade
Persistent CIN2+ in 7%
3% in HPV +ve
13% in cytology +ve
North Bristol NHS Trust/Avon Cervical screening programme

11. Bristol experience

12. Bristol Outcome Lletz histology for mild and borderline HPV positive smears with CIN 2/3 on PB(%)
Nil
HPV/
inflam
CIN1
CIN2
CIN3
Micro
B’line
HPV 3 13 10 35 38 1
Mild 8 12 29 41 2

13. National outcomes 90% attendance Half had PB (47% negative histology)
2.4% had LLETZ ( 28% neg histology)
1/3 of identified CIN1 were not treated
Apparent overall cytological progression was 3.4% at 12 months

14. Role for HPV testing Test of cure

15. Management outcome in women referred to Colposcopy following HPV Test of Cure (TOC)
Mohini Vachhani, Mary Brett*,
Anne Vaughton, Vikki Finch, John Murdoch
Colposopy Clinic and *Cellular Pathology Dept,
Southmead Hospital
Presented 22/06/2011
(Also, poster at BSCCP meeting /2011)

16. Results No of samples with HPV TOC test = 2369
HPV negative = 2017 (85%)  routine recall
HPV positive = 352 (15% - National rate 18%)  colposcopy
Referred to Southmead = 141
Referred to St Michael’s = 211

17. Outcome TZ seen; NAD –> Cytology follow up in Community (n = 66)
TZ seen; abnormality seen (n = 22):
2 LLETZ (CIN 1, CIN2)
16 biopsy (3 CIN1, 13 neg)
4 rpt cytology (all negative)

18. Outcome
Colposcopy was unsatisfactory in 30% of cases (i.e.TZ not seen): n = 38
6 had further LLETZ (all negative)
13 had Bx (1 CIN 1, 12 neg)

19. Outcome Total no with repeat LLETZ = 8 cases
7 had involved margins in index LLETZ
2/8 with satisfactory colp and abnormality seen (Histo: CIN1, CIN2)
6/8 with unsatisfactory colp (Histo: all negative)

20. Conclusion
Women with positive TOC are at minimal risk of residual CIN (6/126 =4.8%)
5/126 (4%) = CIN1
1/126 (0.8%) = CIN2
Nationally PPV for CIN2 or worse = 2.9% and for CIN3 or worse = 0.4%

21. Other studies
H Kitchener et al. BJOG 2008, 15(8):
Of cyto neg/HPV pos referrals to colp, 9/75 had CIN (at 6, 12 or 24 months follow up post-LLETZ; 4 CIN1, 4 CIN2, 1 CIN3)
= 12% treatment failure rate.
(Compared with Southmead data: 6/126 had residual CIN = 4.8%)

22. Changes to KC61?
Don’t panic, no change to data collection or categories

23. Longer term impact on KC61 data
BC rate will fall (due to loss of 2nd and 3rd bc)
Mild rate will also fall depending on previous policy
Will be visible effect from year 1
High grade rate will also fall slightly because women will be referred on a prior low grade result

24. PPV should remain unaffected

25. Caution
You must decide on a diagnosis and stick to it regardless of HPV result
Do not use BC?HG in order to get an HPV test
Follow the management protocol

26. ABC3
? Launch date
Will abolish BC?HG

28. KEY TO CODES & ABBREVIATIONS
 Action codes
A routine recall
Rm early repeat in 'm' months
S suspend from recall
PROVISIONAL Result codes
Ø * ?glandular neoplasia (non cervical)
G * ?glandular neoplasia (non cervical) (HPV tested)
1 inadequate
2 negative (not HPV tested)
N negative (HPV tested)
3 low grade dyskaryosis (not HPV tested)
M low grade dyskaryosis (HPV tested)
4 high grade dyskaryosis (severe)
5 high grade dyskaryosis ?invasive squamous carcinoma
6 ?glandular neoplasia of endocervical type
7 high grade dyskaryosis (moderate)
8 borderline change in squamous cells (not HPV tested)
B borderline change in squamous cells (HPV tested)
9 borderline change in endocervical cells
E borderline change in endocervical cells (HPV tested)

29. * non-cervical neoplasia treated as negative for CSP management
Infection codes
Ø (zero) HPV negative
9 (nine) HPV positive
U HPV result inadequate/unreliable
Miscellaneous
NTDD Next Test Due Date
BLUE indicates codes used on NHAIS in format
Cytology result – HPV infection code – Action code
RED indicates manual action required to reset NTDD

30. Questions?