138 Chapter 6 Screening round completed Referral to gynaecologist Repeat test at 12m Referral to gynaecologist DNA methylation either or not combined with HPV genotyping Primary test Sampling method Triage algorithm A B Self-collected sample or clinician-collected cervical sample HPV DNA test Screening round completed Referral to gynaecologist Screening round completed Cytology on clinician-collected cervical sample Repeat cytology at 12m non-HPV16/18 NILM NILM ≥HSIL ASC-US/LSIL ≥ASC-US/LSIL Referral to gynaecologist HPV16/18 HPV DNA test Screening round completed Cytology on clinician-collected cervical sample NILM ≥HSIL ASC-US/LSIL Self-collected sample or clinician-collected cervical sample Figure 6.2 Overview of current cervical cancer screening in the Netherlands and proposed methylation-based strategy. (A) Current HPV-based cervical cancer screening in the Netherlands; (B) Proposed strategy for the use of methylation analysis as a secondary triage test for hrHPV-positive women with ASC-US/LSIL cytology. Abbreviations: ASC-US, atypical squamous cells of undetermined significance; DNA, deoxyribonucleic acid; HPV, human papillomavirus; HSIL, high-grade squamous intraepithelial lesion; LSIL, low-grade intraepithelial lesion; 12m, twelve months; me, methylation; NILM, negative for intraepithelial lesion or malignancy; –, negative; and +, positive
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