Clinical application of DNA ploidy to cervical cancer screening: A review

Abstract

Screening for cervical cancer with DNA ploidy assessment by automated quantitative image cytometry has spread throughout China over the past decade and now an estimated 1 million tests per year are done there. Compared to conventional liquid based cytology, DNA ploidy has competitive accuracy with much higher throughput per technician. DNA ploidy has the enormous advantage that it is an objective technology that can be taught in typically 2 or 3 wk, unlike qualitative cytology, and so it can enable screening in places that lack sufficient qualified cytotechnologists and cytopathologists for conventional cytology. Most papers on experience with application of the technology to cervical cancer screening over the past decade were published in the Chinese language. This review aims to provide a consistent framework for analysis of screening data and to summarize some of the work published from 2005 to the end of 2013. Of particular interest are a few studies comparing DNA ploidy with testing for high risk human papilloma virus (hrHPV) which suggest that DNA ploidy is at least equivalent, easier and less expensive than hrHPV testing. There may also be patient management benefits to combining hrHPV testing with DNA ploidy. Some knowledge gaps are identified and some suggestions are made for future research directions.

Keywords: Cervical cancer screening; DNA ploidy; Automated quantitative image cytometry; High risk HPV testing

Core tip: Although application of automated quantitative image cytometry to screen for cervical cancer was first developed in Canada, the United States and Europe, it is most widely used clinically in China where it is applied to about one million tests annually. Over sixty papers reporting the clinical results have been published in Chinese since 2005. As the first review of this topic in any language, in addition to the usual goals of a review, it has the opportunity to increase the awareness of the Chinese clinical experience for those outside of China and to increase awareness of the technology background for English readers in China.