Human papillomavirus testing by hybrid capture appears to be useful in triaging women with a cytologic diagnosis of atypical squamous cells of undetermined significance

Can papilloma virus testing be used to improve cervical cancer screening?

This report investigates different options for using human papillomavirus (HPV) testing in cervical cancer prevention. These options are evaluated by a stochastic model of the progression of pre-malignancy and its relationship to HPV infection. Three screening policies are compared: 2 based on cytological screening, with or without HPV testing, and 1 in which HPV testing is the primary screening method. A policy of HPV testing for women with mildly abnormal smears would have little effect on the overall incidence of invasive cancer when compared with a policy of repeat cytology, provided follow-up is efficient. Moreover, the potential value of HPV testing as a primary screening method is strongly dependent on the proportion of neoplasias that are HPV-negative. Important factors in assessing the future role of HPV testing would be cost-effectiveness and benefits from improved compliance.

Virologic screening

Detection of high risk human papillomaviruses (HPV) has a high potential value for secondary prevention of cervical cancer. HPV testing can augment the sensitivity of conventional cytologic screening and can be used for triaging patients with a history of mild cytological abnormalities or low grade cervical intraepithelial neoplasia (CIN). Before screening for high risk HPVs can be generally recommended, refined commercially available HPV tests have to be established and their value has to shown in large epidemiologic studies.

Detection and typing of human papillomavirus in biopsy and cytological specimens by polymerase chain reaction and restriction enzyme analysis: a method suitable for semiautomation

Screening for high-risk human papillomavirus (HPV) types allows the detection of women at a high risk of cervical squamous carcinomas, thereby defining a subset of patients targeted for more intensive screening and follow-up. Thirty-four cervical biopsy specimens and isolated cells from cervical smears of normal women or women diagnosed with high-grade intraepithelial lesion (HGSIL) were screened for the presence of HPV by in situ hybridization (ISH) and/or by polymerase chain reaction (PCR). The exact HPV type was determined using a novel restriction typing method. The detection of HPV was facilitated greatly by the use of a PCR-enzyme-linked immunosorbent assay (ELISA)-based method. HPV was detected by PCR in 32% of the biopsy specimens, whereas only 23% had a positive staining by ISH. In one case, a double infection was detected by ISH as well as by PCR. In two cases, the presence of HPV was detected by both methods but the exact type was different. Analyzing cells isolated from cervical smears by the PCR-ELISA technique or by PCR followed by agarose gel electrophoresis, HPV was detected only in patients with HGSIL and not in the control group. The PCR system is more sensitive than conventional ISH, and the PCR-ELISA system presented in this study is efficient in screening large series of cytological samples. Furthermore, this system allows exact HPV typing on the microtiter plate. These innovations may allow the application of HPV detection and typing as a routine screening method to identify patients with a high risk of developing cervical neoplasia.

Evaluation of the Hybrid Capture human papillomavirus deoxyribonucleic acid detection test

OBJECTIVE

Our purpose was to evaluate the sensitivity and accuracy of a new, nonradioactive human papillomavirus deoxyribonucleic acid detection method.

STUDY DESIGN

Cervical samples from 520 women were assayed for human papillomavirus deoxyribonucleic acid with both the Hybrid Capture test and polymerase chain reaction.

RESULTS

Human papillomavirus deoxyribonucleic acid was detected with Hybrid Capture in 106 (42%) of 254 samples from women with no evidence of cervical intraepithelial neoplasia and 211 (79%) of 266 with cervical intraepithelial lesions or cervical cancer. There was a good correlation between Hybrid Capture and polymerase chain reaction. Hybrid Capture correctly identified 92% of samples found to contain a human papillomavirus type with a high or intermediate oncogenic risk with polymerase chain reaction. Although Hybrid Capture can quantify the amount of human papillomavirus deoxyribonucleic acid present in a sample, no correlation was observed between the relative amount of human papillomavirus deoxyribonucleic acid detected with Hybrid Capture and the grade of cervical lesion.

CONCLUSION

The Hybrid Capture test is a sensitive and accurate method for identifying human papillomavirus types of high and intermediate oncogenic risk in clinical specimens.

Cervical Cancer: Screening and Prevention of Invasive Disease

Cancer of the cervix is one of the leading causes of cancer-related deaths in women in the United States and accounts for more cancer deaths than any other cancer in third-world countries. Various screening procedures have been developed, but many issues need to be resolved for cervical cancer screening to be effective. Large segments of the population who do not undergo regular screening account for most of the patients with invasive cancers in the United States and worldwide. Allocation of resources and widespread educational programs for these target populations are needed to promote adequate cytologic screening programs and to reduce the death rate from squamous carcinoma of the cervix.

Viral testing for genital human papillomavirus infections: recent progress and clinical potentials

Recent technologic advances indicate the potential role and applications of human papillomavirus (HPV) DNA testing in the routine screening for cervical neoplasia, diagnostic triage of females with inconclusive cervical cytologic smears, and quality control of cytologic and pathologic practices.

Human papillomavirus testing in primary cervical screening

Several studies have examined the role of tests for human papillomavirus (HPV) in screening for cervical cancer but as yet the relevance is unclear. We looked at HPV testing for types 16, 18, 31, and 33 on material taken at the time of a cervical smear in 2009 eligible women having routine screening. Women with any degree of dyskaryosis or high levels of one of these HPV types were referred for colposcopy. 44% of the cervical intraepithelial neoplasia (CIN) lesions of grade 2/3 detected had negative cytology and were found only by HPV testing. A further 22% of the CIN 2/3 lesions were positive for HPV but showed only borderline or mild cytological changes. The positive predictive value of HPV testing was 42%, which was similar to that for moderate dyskaryosis. HPV types 16 and 31 were more sensitive and specific for CIN 2/3 than were types 18 or 33. However, 25% of the CIN 2/3 lesions were not detected by these four HPV tests. We suggest that HPV testing could usefully augment but not replace conventional cytology. These results should stimulate a much larger randomised trial to assess the impact of these improved CIN 2/3 detection rates on the subsequent incidence of invasive cancer.

Epidemiology of cervical intraepithelial neoplasia: the role of human papillomavirus

The evidence implicating specific HPV types in the aetiology of cervical cancer is now strong enough to establish a causative role. HPV infection of the cervix affects the developing immature metaplastic cells of the transformation zone. Cervical neoplasia can be viewed as the interaction of high risk papillomavirus and immature metaplastic epithelium. Once maturity is reached, there is minimal risk of subsequent development of cervical squamous neoplasia. Exposure to HPV is an extremely common event, especially in young sexually active women. Yet, despite frequent HPV exposure at that phase of life in which the cervical transformation zone is at its most vulnerable, established expressed disease is relatively uncommon. Most studies in which the natural history of CIN is not altered by cervical biopsy reveal a progression rate from low to high grade CIN of less than one third. Where viral type is taken into account, however, the progression rate from normal but high risk HPV-infected cervical epithelium to CIN 2 or 3 is higher. Despite this, most cervical abnormalities will not transform into invasive cancer, even if left untreated. The variance between the high rate of HPV infection, the intermediate rate of CIN and the relatively low rate of cervical cancer establishes a stepwise gradient of disease of increasing severity with decreasing prevalence. In an immunocompetent host, HPV infection alone does not appear to be sufficient to induce the step from high grade CIN to invasion. Epidemiological studies indicating that HPV infection with oncogenic viral types is far more common than cervical neoplasia suggest the necessity of cofactors in cervical carcinogenesis. The long time-lag between initial infection and eventual malignant conversion suggests that random events may be necessary for such conversion, and the spontaneous regression of many primary lesions suggests that most patients are not exposed to these random events. Potential cofactors include cigarette smoking, hormonal effects of oral contraceptives and pregnancy, dietary deficiencies, immunosuppression and chronic inflammation. In those women who develop cervical cancer, malignant progression is rarely rapid, more commonly taking many years or decades. Malignant progression has been documented in patients who presented initially with only low grade HPV-induced atypia. On the other hand, progression may be a misnomer, as 'apparent' progression may really represent adjacent 'de novo' development of higher grade CIN. Although most cervical cancers contain high risk HPV types, up to 15% of such cancers test negative for HPV, raising the possibility that a few, usually more aggressive, cervical cancers may arise from from a non-viral source.(ABSTRACT TRUNCATED AT 400 WORDS)