1
|
Sakai M, Ohara T, Suzuki H, Kadomoto T, Inayama Y, Shitanaka S, Sumitomo M, Matsumura N, Yamanoi K. Clinical impact of age‑specific distribution of combination patterns of cytology and high‑risk HPV status on cervical intraepithelial neoplasia grade 2 or more. Oncol Lett 2023; 26:384. [PMID: 37559589 PMCID: PMC10407864 DOI: 10.3892/ol.2023.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 06/29/2023] [Indexed: 08/11/2023] Open
Abstract
To the best of our knowledge, the present study is the first to elucidate the significance of cytology and high-risk human papillomavirus (hrHPV) status in different age groups for the detection of cervical intraepithelial neoplasia (CIN)2, CIN3 and squamous cell carcinoma (SCC). There were 12 combinations based on cytology and hrHPV status [cytology: Atypical squamous cells (ASC) of undetermined significance, low-grade squamous intraepithelial lesion, ASC not excluding high-grade squamous intraepithelial lesion (HSIL) and HSIL; hrHPV status: HPV16/18-positive (16/18+), hrHPV positive for subtypes other than 16/18 (others+) and hrHPV-negative (hrHPV-)]. All patients were categorized into four groups based on age (18-29, 30-39, 40-49 and ≥50 years). For patients with CIN2, CIN3 and SCC (CIN2+) (n=107), the distribution of cytology and hrHPV was investigated in each age group. In addition, for all patients (n=446), the occurrence of CIN2+ in each of the 12 combinations was investigated in each age group. In the 18-29-year age group, the most common combination was HSIL and 16/18+, followed by HSIL and others+, which accounted for 73% of CIN2+ cases. The occurrence of HSIL and 16/18+ decreased with increasing age, and no cases occurred in the 50-year age group. In the 18-29-year age group, all patients with HSIL and 16/18+ were diagnosed with CIN2+. CIN2+ was predominantly detected in patients with HSIL in the 18-29-year age group, as well as hrHPV- and others+. This definite distinction was not observed in any other age group. For CIN2+, the distribution patterns of cytology and hrHPV status combinations varied significantly among different age groups. Accordingly, the clinical impact of the combination of cytological findings and hrHPV status can vary among age groups.
Collapse
Affiliation(s)
- Mie Sakai
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 663-8501, Japan
- Department of Obstetrics and Gynecology, Shiga General Hospital, Moriyama, Shiga 524-8524, Japan
| | - Tsutomu Ohara
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 663-8501, Japan
- Department of Obstetrics and Gynecology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Haruka Suzuki
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 663-8501, Japan
- Department of Obstetrics and Gynecology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tatsuki Kadomoto
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 663-8501, Japan
| | - Yoshihide Inayama
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 663-8501, Japan
- Department of Obstetrics and Gynecology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Shimpei Shitanaka
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 663-8501, Japan
- Department of Obstetrics and Gynecology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Masahiro Sumitomo
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 663-8501, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Graduate School of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Koji Yamanoi
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo 663-8501, Japan
- Department of Obstetrics and Gynecology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| |
Collapse
|
2
|
Liu H, Wei J, Zhong M, Xu M, Feng S, Peng X, Liu H, Li J, Song W, Zhong Y, Huang X, Zeng K. Evaluation of HPV infection helps to direct ALA-PDT of condyloma acuminata. Photodiagnosis Photodyn Ther 2023; 43:103696. [PMID: 37429462 DOI: 10.1016/j.pdpdt.2023.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Aminolaevulinic acid-mediated photodynamic therapy (ALA-PDT) is increasingly applied for the treatment of condyloma acuminata (CA). However, the determinants for the sessions and end points of ALA-PDT treatment remains unclear. Here, we recorded HPV screening, evaluated the frequency and efficacy of ALA-PDT in different types of CA, in order to individualize ALA-PDT treatment to CA. METHODS A total of 227 CA patients with HPV infection and visible warts were recruited. Prior to PDT, visible lesions were removed by radio frequency or microwave. HPV DNA detection were performed before each PDT treatment and at follow-up. Treatment was ended after two consecutive negative HPV DNA detection. RESULTS Of the 227 patients, 119 patients received ALA-PDT and 116 patients completed all treatments. We found that CA patients with multiple-site infection, intra-luminal infection or multiple-type of HPV infection required more sessions of ALA-PDT. The recurrence rate was 8.62% (10/116). Viral load was significantly lower after six PDT treatments compared to viral load after three PDT treatments. Gender, HPV subtypes and warts location had no significant effect on the recurrence rate. CONCLUSION Comprehensive evaluation of HPV infection state helps to individualize ALA-PDT treatment scheme for CA patients and predict the therapeutic efficacy.
Collapse
Affiliation(s)
- Hui Liu
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China; Department of Dermatology and Venereology, Shenzhen Center for Chronic Disease Control, Shenzhen 518000, PR China
| | - Junxiao Wei
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - Meizhen Zhong
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - Meinian Xu
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - Sining Feng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - Xiaoming Peng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - Hui Liu
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - Junpeng Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - Weicheng Song
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - YiXiu Zhong
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China
| | - Xiaowen Huang
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China.
| | - Kang Zeng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, PR China.
| |
Collapse
|
3
|
Ji L, Chen M, Yao L. Strategies to eliminate cervical cancer in China. Front Oncol 2023; 13:1105468. [PMID: 37333817 PMCID: PMC10273099 DOI: 10.3389/fonc.2023.1105468] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Cervical cancer is a widely distributed disease that is preventable and controllable through early intervention. The World Health Organization has identified three key measures, coverage populations and coverage targets to eliminate cervical cancer. The WHO and several countries have conducted model predictions to determine the optimal strategy and timing of cervical cancer elimination. However, specific implementation strategies need to be developed in the context of local conditions. China has a relatively high disease burden of cervical cancer but a low human papillomavirus vaccination rate and cervical cancer screening population coverage. The purpose of this paper is to review interventions and prediction studies for the elimination of cervical cancer and to analyze the problems, challenges and strategies for the elimination of cervical cancer in China.
Collapse
Affiliation(s)
- Lu Ji
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Manli Chen
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Lan Yao
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
4
|
Zhang X, Chen W, Zhu X, Bi H, Zhao Q, Fu Y, Zhang L, Zhang C, Huang N. Multiple Center Research on Relationship Between Screening Quality and Detection of Cervical Cancer - Six Provinces, China, June-December 2021. China CDC Wkly 2023; 5:301-305. [PMID: 37193312 PMCID: PMC10182903 DOI: 10.46234/ccdcw2023.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 05/18/2023] Open
Abstract
What is already known about this topic? The effective implementation of cervical cancer examination programs requires improved cervical cancer screening coverage and quality. What is added by this report? The detection rate of ≥high-grade squamous intraepithelial lesions (HSIL) in 6 hospitals was 19.6%. Not having undergone screening in the last 5 years and abnormal screening results had a negative association with detection of ≥HSIL, and abnormal screening results would increase the risk of detection by 75% compared with normal screening results. Additionally, low-grade, high-grade, and cancer of colposcopic impression were associated with a higher risk for detecting ≥HSIL. What are the implications for public health practice? It is essential to disseminate health knowledge about cervical cancer control to women in order to increase their awareness and screening rates. Additionally, it is necessary to further strengthen the training of professional staff to improve the quality of cervical cancer prevention, including screening, colposcopic examination, and follow-up for target female populations.
Collapse
Affiliation(s)
- Xiaosong Zhang
- Obstetrics and Gynecology Department of Peking University First Hospital, Beijing, China
| | - Weihong Chen
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinxin Zhu
- Obstetrics and Gynecology Department of Peking University First Hospital, Beijing, China
| | - Hui Bi
- Obstetrics and Gynecology Department of Peking University First Hospital, Beijing, China
- Hui Bi,
| | - Qingping Zhao
- The Obstetrics and Gynecology Department of the Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu City, Sichuan Province, China
| | - Yunfeng Fu
- Medical Center for Cervical Diseases, Women's Hospital School of Medicine Zhejiang University, Hangzhou City, Zhejiang Province, China
| | - Lina Zhang
- Obstetrics and Gynecology Department of Changzhou Maternal and Child Health Care Hospital, Changzhou City, Jiangsu Province, China
| | - Chunmei Zhang
- Obstetrics and Gynecology Department of Yanbian Maternal and Child Health Care Hospital. Yanji City, Jilin Province, China
| | - Ning Huang
- Obstetrics and Gynecology Department of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning City, Guangxi Zhuang Autonomous Region, China
| |
Collapse
|
5
|
Bao H, Zhao Y, Zhang X, Bi H, Cong S, Fang L, Wang HJ, Wang L. HPV-negative high-grade cervical precancerous lesions or invasive cancer in China: A post hoc analysis of a multicentric clinical study. Int J Gynaecol Obstet 2023; 161:159-167. [PMID: 36444986 DOI: 10.1002/ijgo.14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate HPV-negative cervical high-grade precancerous lesions or cancer in China. METHODS Histologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were searched in a multicentric clinical study. All patients underwent cobas HPV testing, liquid-based cytology, DNA ploidy analysis, and colposcopy-guided biopsy. According to clinical practice, patients underwent p16ink4a staining and cone biopsy. Comparisons were made between HPV-negative and -positive patients for clinical characteristics. RESULTS The study found 61 cases of cobas HPV-negative CIN2+ among 797 cases of histologically confirmed CIN2+, including 38 CIN2, 20 CIN3, and 3 invasive cancers. The prevalence of HPV-negative CIN2+ and CIN3+ was 7.7% (95% confidence interval [CI] 5.8-9.5) and 5.7% (95% CI 3.5-8.0), respectively. Among 24 cases with p16 staining, 20 showed p16 positivity. The proportions of normal or minor abnormalities in terms of colposcopy, cytology, and DNA ploidy were higher in HPV-negative cases than in HPV-positive cases. When adding cytology to the screening of symptomatic or previously HPV-positive women, the prevalence of HPV-negative CIN2+ or CIN3 would decrease by approximately 50%. CONCLUSION Less than one-tenth of CIN2+ are missed by HPV-only screening, and they have smaller lesions than HPV-positive cases. Colposcopy should be considered for symptomatic or previously HPV-positive women with HPV-negative results.
Collapse
Affiliation(s)
- Heling Bao
- Maternal and Child Health Department, School of Public Health, Peking University, Beijing, China.,National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yun Zhao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Xiaosong Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Hui Bi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Shu Cong
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liwen Fang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hai-Jun Wang
- Maternal and Child Health Department, School of Public Health, Peking University, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
6
|
Chen Z, Lin H, Zheng J, Cai L, Chen Z, Li J, Yu L. Epidemiological study of HPV infection in 40,693 women in Putian: a population study based on screening for high-risk HPV infection. BMC Infect Dis 2022; 22:893. [DOI: 10.1186/s12879-022-07893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
The infection rate of human papillomavirus (HPV) is high in the coastal regions of China. However, the infection rate among high-risk genotypes of women in Putian City is unknown. Therefore, this study aimed to analyse the epidemiology of high-risk HPV infection among women in Putian and provide a reference for the diagnosis, treatment and vaccination of cervical cancer in this region.
Methods
The data used were obtained from the Chinese government’s public health program (“Cervical and Breast Cancer Screening Project”). A total of 40,693 female cervical cell exfoliation samples screened for high-risk HPV at the Affiliated Hospital of Putian University from July 2020 to December 2021 were enrolled. DNA was extracted using a fully automatic extractor. Then, 14 high-risk genotypes of HPV were detected by polymerase chain reaction. The characteristics of HPV infection, distribution of high-risk genotypes, infection types and thinprep cytologic test (TCT) classification at different age groups were analysed.
Results
Among the 40,693 samples, 3899 were infected with HPV, with an infection rate of 9.6%. Accordingly, HPV infection rates gradually increased with age, and statistically significant differences were observed among age groups (χ2 = 74.03, P < 0.01). The infection rates of high-risk HPV52, HPV58 and HPV16 were in the top three and increased with age. Single infection was dominant (84.7%), followed by double infections (12.7%). The cervical cytology of 3899 HPV-positive people can be classified into negative for intraepithelial lesion and malignancy (NILM, 88.0%), atypical squamous cells of undetermined significance (ASC-US, 6.6%), atypical squamous cells—cannot exclude high-grade squamous intraepithelial lesion (ASC-H, 1.4%), low-grade squamous intraepithelial lesion (LSIL, 3.2%) and high-grade squamous intraepithelial lesion (HSIL, 0.8%). HPV16 infection rate increased with increasing severity of cervical cytology (χ2trend = 43.64, P < 0.01), whereas the infection rates of HPV52 (χ2trend = 13.89, P < 0.01) and HPV58 (χ2trend = 13.50, P < 0.01) showed opposite trends.
Conclusion
The infection rate of female HPV high-risk screening in this region was 9.6% and mainly involved single infections. In addition, HPV16, HPV52 and HPV58 were closely related to the severity of cervical cytology. Effective screening, vaccination and education are needed. The 9-valent vaccine will be effective in reducing cervical pre-invasive disease. It would also be reasonable to state that the rising trend in HPV infection and high grade cytology with age emphasises the need to target older women with screening. Vaccination of younger women (aged ≤ 25) will lay the foundation for better cancer outcomes in the future.
Collapse
|
7
|
Zhang J, Yang D, Cui X, Liu G, Cui Z, Wang C, Piao H. Performance of human papillomavirus E6/E7 mRNA assay for primary cervical cancer screening and triage: Population-based screening in China. Front Cell Infect Microbiol 2022; 12:935071. [PMID: 36105144 PMCID: PMC9465014 DOI: 10.3389/fcimb.2022.935071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023] Open
Abstract
ObjectiveCervical cancer screening is very important in the prevention and treatment of cervical cancer. In China, the cervical screening strategy needs to be improved. To explore a suitable cervical screening strategy in China, we evaluated the performance of the human papillomavirus (HPV) E6/E7 mRNA (Aptima HPV (AHPV)) assay in primary screening and different triage strategies for women undergoing routine cervical screening.MethodsA total of 10,002 women aged 35 to 65 years of age were recruited in Liaoning Province and Qingdao City, China. Specimens were tested by liquid-based cytology (LBC) and the AHPV assay, and women who tested positive on any test were referred for colposcopy. Genotyping was performed on all high-risk HPV (HR-HPV)-positive samples. Test characteristics were calculated based on histological review.ResultsWe identified 109 women with high-grade squamous intraepithelial lesion or worse (HSIL+), including six with cervical cancer. The sensitivity of AHPV was clearly higher than that of LBC (92.7 [95% CI: 87.2, 97.2] vs. 67.9 [95% CI: 59.6, 76.1], p < 0.001). The specificity of AHPV was 93.0 (95% CI: 92.5, 93.5), which was lower than that of LBC (95.2 [95% CI: 94.8, 95.6], p < 0.001). There was no statistical difference between the positive predictive value of AHPV and LBC (13.5 [95% CI: 11.2, 16.2] vs. 14.3 [95% CI: 11.4, 17.6], p = 0.695). The difference of area under the curve (AUC) values between the AHPV test (0.928 [95% CI: 0.904, 0.953]) and LBC test (0.815 [95% CI: 0.771, 0.860]) in detecting HSIL+ was statistically significant (p < 0.001). Finally, among the three triage strategies, both the sensitivity (73.4 [95% CI: 65.1, 81.7]) and AUC (0.851 [95% CI: 0.809, 0.892]) of AHPV genotyping with reflex LBC triage were the greatest.ConclusionIn summary, the AHPV assay is both specific and sensitive for detecting HSIL+ and may be suitable for use in primary cervical cancer screening in China. AHPV genotyping with reflex LBC triage may be a feasible triage strategy.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Di Yang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Xiaoli Cui
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Guangcong Liu
- Department of Epidemiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Zhumei Cui
- Department of Gynecology, Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
- *Correspondence: Haozhe Piao, ; Chunyan Wang, ; Zhumei Cui,
| | - Chunyan Wang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
- *Correspondence: Haozhe Piao, ; Chunyan Wang, ; Zhumei Cui,
| | - Haozhe Piao
- Department of Neurosurgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
- *Correspondence: Haozhe Piao, ; Chunyan Wang, ; Zhumei Cui,
| |
Collapse
|