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Cassani C, Dominoni M, Pasquali MF, Gardella B, Spinillo A. The role of multiple high-risk human papillomavirus infection on the persistence recurrence of high-grade cervical lesions after standard treatment: A systematic review and a meta-analysis. Acta Obstet Gynecol Scand 2024; 103:1028-1035. [PMID: 38477097 PMCID: PMC11103134 DOI: 10.1111/aogs.14827] [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: 10/27/2023] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The role of multiple high-risk human papillomavirus (HR-HPV) infections on the occurrence of persistence/recurrence of high-grade squamous intraepithelial lesion (HSIL) after conization/surgery for cervical intraepithelial neoplasia was evaluated. MATERIAL AND METHODS A systematic search of Pubmed/Medine, Scopus, Cochrane databases from inception to June 30, 2023 was performed. Three reviewers independently screened the abstracts of the selected studies and extracted data from full-text articles. The data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the OSQE method. PROSPERO registration number CRD42023433022. RESULTS Out of 1606 records screened, 22 full text articles met the inclusion criteria. A total of 8321 subjects treated (loop electrosurgical excision, laser or surgery) because of HSIL were followed-up and included in the meta-analysis. The pooled prevalence of overall persistence and/or recurrence was 17.6 (95% CI: 12.3-23.5) in multiple and 14.3 (95% CI: 10.1-19.2) in single HR-HPV infections detected shortly before or at surgery. The pooled rate of multiple HR-HPV infections was 25% (95% CI: 20.4-30). The odds ratio of histologically confirmed HSIL persistence and/or recurrence was significantly higher (OR: 1.38, 95% CI:1.08-1.75, p = 0.01, heterogeneity = 39%) among multiple than single HR-HPV infections. Increased risk of HSIL persistence/recurrence was more marked among studies with multiple HR-HPVs prevalence ≥25% (12 studies, N = 3476) (OR: 1.47, 95% CI: 1.18-1.84, heterogeneity = 0%) and in those evaluating true histologically confirmed recurrence after at least 6 months of negative follow-up (9 studies, N = 5073) (OR: 1.67, 95% CI: 1.17-2.37, heterogeneity = 37%). Multiple HR-HPVs infection detected during follow-up visits had no effect on the risk of recurrence although the number of included studies was small (4 studies, N = 1248) (OR: 0.98, 95% CI: 0.68-1.39, heterogeneity = 0%). The risk of bias was rated as high in 10 and low-moderate in 12 studies, respectively. In subgroup analysis, the risk of bias of the included studies (low/moderate vs. high), had a small, although not significant effect on the odds ratios of persistence/recurrence of HSIL (OR: 1.57, 95% CI: 1.23-2 for low-moderate risk of bias and OR: 1.06, 95% CI: 0.65-1.75 for high risk of bias; p-value for subgroup differences = 0.17). CONCLUSIONS Multiple HR-HPVs infections at the time of standard treatment of HSIL entail a small but significant increased risk of persistence/recurrence of HSIL and should be taken into account in the follow-up plan.
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Affiliation(s)
- Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Marianna Francesca Pasquali
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Arsenio Spinillo
- Department of Clinical, Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
- Department Obstetrics and GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly
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Bruno MT, Valenti G, Ruggeri Z, Incognito GG, Coretti P, Montana GD, Panella MM, Mereu L. Correlation of the HPV 16 Genotype Persistence in Women Undergoing LEEP for CIN3 with the Risk of CIN2+ Relapses in the First 18 Months of Follow-Up: A Multicenter Retrospective Study. Diagnostics (Basel) 2024; 14:509. [PMID: 38472983 DOI: 10.3390/diagnostics14050509] [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: 01/31/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE Specific hr-HPV genotypes have different natural histories and different oncogenic capacity. This study aimed to investigate the risk of CIN2+ recurrence of the individual genotypes and evaluate how the duration of HPV persistence influences the risk of developing recurrent 16 cervical dysplasia of high grade (CIN2+). METHODS Data from patients with persistent HPV infection after primary conization were retrospectively extracted. Kaplan-Meier proportional hazards models were used to evaluate associations between the duration of HPV persistence and the risk of developing recurrent CIN2+. Kruskal-Wallis testing with Dunn's multiple comparison test was used to test whether there was a statistically significant difference in the time to development of tumor recurrences between different genotypes. RESULTS Overall, 333 patients met the inclusion criteria. In 285 cases the HPV infection was persistent, in 48 cases (18%) it was transient, i.e., different genotypes after LEEP. Overall were diagnosed 39 relapses (13.7%), 79.5% (31/39 cases) were due to genotype 16, 20.5% (8/39) were linked to the other genotypes. Persistence of genotype 16 showed a 7-fold increased risk of developing a CIN2+ relapse, OR = 7.08 (95%CI: 3.12-16.08). Furthermore, the majority of relapses (38/39) occurred within 24 months of persistence with a cut-off represented by 18 months (p = 0.001) in which the relapse rate is maximum and the most frequently found genotype was the 16th with 31 (79.5%) cases of recurrence. Kruskal-Wallis test with Dunn's multiple comparisons has shown statistically significant difference in the time of development of CIN2 relapses among HPV16 and other genotypes. (p < 0.05). Kaplan-meier analysis has shown statistically significant difference between the time to CIN2+ relapse onset in patients with HPV 16 infection and patients with other hrHPV genotypes. (p < 0.05) Conclusions: the study results suggest that persistent HPV infection after LEEP with the same HR genotype present before surgery represents one of the most important predictive factors of the risk of CIN2+ recurrence. The persistence of HPV16 for the first 18 months strongly correlates with the risk of developing a CIN2+ recurrence.
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Affiliation(s)
- Maria Teresa Bruno
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy
| | - Gaetano Valenti
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy
- Humanitas, Gynaecologic Oncology Unit, 95125 Catania, Italy
| | - Zaira Ruggeri
- Cervical Cancer Screening Unit, Level II, ASP Messina, 98123 Messina, Italy
| | - Giosuè Giordano Incognito
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
| | - Paola Coretti
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
| | - Giuseppe Dario Montana
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
| | - Marco Marzio Panella
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy
| | - Liliana Mereu
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
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Practical Model for Residual/Recurrent Cervical Intraepithelial Lesions in Patients with Negative Margins after Cold-Knife Conization. J Clin Med 2022; 11:jcm11195634. [PMID: 36233503 PMCID: PMC9573483 DOI: 10.3390/jcm11195634] [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: 08/10/2022] [Revised: 09/04/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: This study aimed to identify reliable risk factors for residual/recurrent cervical intraepithelial lesions in patients with negative margins after cold-knife conization. Methods: A total of 2352 women with HSILs (high-grade squamous intraepithelial lesions) with negative margins who underwent cold-knife conization between January 2014 and December 2020 were included; in total, 1411 women were assigned to the development cohort, and 941 women were assigned to the validation cohort. Multivariate logistic regression was used to build four predictive models based on the different combinations of follow-up data (Model A: preoperative factors; Model B: first-follow-up data; Model C: second-follow-up data; Model D: data from both follow-ups). The accuracy, sensitivity, specificity, false-positive rate (FPR), false-negative rate (FNR), and area under the receiver operating characteristic curve (AUC) were evaluated on the validation cohort. The predictive power of risk factors was further validated using six machine learning algorithms. Results: Model D demonstrated the highest AUC of 0.91 (95% CI, 0.87 to 0.96) in the validation cohort, whereas Models A, B, and C achieved AUCs of 0.69 (95% CI, 0.59 to 0.78), 0.88 (95% CI, 0.80 to 0.95), and 0.89 (95% CI, 0.81 to 0.97) respectively. The six machine learning methods achieved consistent results. Kaplan-Meier (KM) survival curves demonstrated that our models could effectively stratify patients with all models (p < 0.05 for all models). Conclusion: Our model, which is based on preoperative and follow-up factors, can serve as a complementary screening procedure for the early detection or prediction of recurrence after cold-knife conization in HSIL patients.
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Zhang Y, Su Y, Tang Y, Qin L, Shen Y, Wang B, Zhou Y, Zhang M, Zhang T. Management of patients with positive margin after conization for high-grade cervical intraepithelial lesions. Lasers Surg Med Suppl 2022; 54:1099-1106. [PMID: 35811501 DOI: 10.1002/lsm.23585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of patients with positive margin in comparison to regular follow-up, and a repeat cervical conization. MATERIALS AND METHODS A retrospective analysis was conducted using 83 patients with pathologically confirmed high-grade cervical intraepithelial neoplasia (CIN) with a positive margin after conization. The management methods and patient prognosis were analyzed and compared. RESULTS Thirty-five, 33, and 15 patients were treated for regular follow-up, ALA-PDT, and a repeat cervical conization, respectively. About 33.3% (5/15) patients had residual lesions of low-grade CIN and above after recognization. The clinical characteristics of patients in the three groups were similar. The residual lesion rates of patients selected for follow-up, ALA-PDT, and recognization were 34.3% (12/35), 9.1% (3/33), and 0% (0/15), respectively, at 6-month follow-up (p = 0.004). The HPV clearance rates were 31.3%, 66.7%, and 84.6%, respectively (p = 0.01). Further analysis showed that a positive margin in the inscribed margin of the cervical canal (p = 0.022) and persistent HR-HPV positive tests after initial conization (p = 0.003) significantly increased the risk of residual disease. At 2-year follow-up, the recurrence rates of lesions were 3.3% and 26.1% in the ALA-PDT and follow-up groups, respectively (p = 0.021). Notably, the recurrence rates were not significantly different between the ALA-PDT and recognization groups (3.3% vs. 6.7%) (p = 0.561). CONCLUSION ALA-PDT is an effective treatment for patients with a positive margin after cervical conization for high-grade CIN. Compared with regular follow-up, ALA-PDT can reduce residual and recurrence rate. Moreover, there was no significant difference in the efficacy between AlA-PDT and recognization.
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Affiliation(s)
- Yingcui Zhang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuehui Su
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yujie Tang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lihong Qin
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Shen
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bingjie Wang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Zhou
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhen Zhang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Zhang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Sand FL, Frederiksen K, Kjaer SK. Risk of recurrent disease following conization of cervical intraepithelial neoplasia grade 3 according to post-conization HPV status and surgical margins. Gynecol Oncol 2022; 165:472-477. [DOI: 10.1016/j.ygyno.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022]
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Carcea F, Vavoulidis E, Petousis S, Papandreou P, Siarkou CM, Nasioutziki M, Papanikolaou A, Dinas K, Daniilidis A. Diagnostic performance of HPV E6/E7 mRNA testing towards HPV-DNA testing and p16/Ki67 immunostaining as a biomarker of high-risk HPV recurrence in Greek women surgically treated for their cervical lesions. J Obstet Gynaecol Res 2021; 47:3607-3617. [PMID: 34374179 DOI: 10.1111/jog.14976] [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: 04/11/2021] [Revised: 07/11/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the diagnostic performance of E6/E7 HPV-mRNA overexpression towards HPV-DNA testing and p16/Ki67 immunocytochemistry in a post-op population to verify if this biomarker can be effectively used as indicator of successful cervical intraepithelial neoplasia (CIN) treatment. METHODS Our study retrospectively analyzed 197 patients of our Colposcopy Clinic between January 2013 and September 2020 coming with an abnormal Pap smear suggestive for colposcopy, and after a series of follow-ups including liquid-based cytology (LBC) and punch-biopsy sampling, there were surgically treated. LBC was used for cytology and molecular analysis of the three HPV-related biomarkers. RESULTS Six months after treatment, 93% of the HPV-mRNA-positive women became negative while this applied to only 80.2% of the HPV-DNA-positive women. HPV persistence was 6.9% at 6-12 months after treatment. The comparison among cytology, colposcopy, HPV-DNA test, and HPV-mRNA test after treatment revealed that the last one is the only with a strong correlation with actual severity (histology during treatment) (ρ = 0.345, p = 0.006) implying that clinical cases with more severe CIN may have higher chances of unsuccessful treatment. HPV-mRNA test had higher sensitivity (100%), specificity (96.88%), and positive predictive value (45.45%) for CIN2+ recurrent lesions when compared with HPV-DNA testing (80%, 82.81%, 10.81% respectively) and p16/Ki67 immunocytochemistry (80%, 95.83%, 33.33% respectively) while their negative predictive values were similar. CONCLUSIONS E6/E7 mRNA detection has higher diagnostic values for the prediction of treatment failure compared with HPV-DNA testing and p16/Ki67 immunocytochemistry, and as an outcome could be used as predictive indicator of CIN-treatment status.
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Affiliation(s)
- Fausto Carcea
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Panagiotis Papandreou
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Chrysoula Margioula Siarkou
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Maria Nasioutziki
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Alexios Papanikolaou
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Angelos Daniilidis
- 2nd Department of Obstetrics and Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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Kawano K, Tsuda N, Nasu H, Tasaki S, Park J, Tasaki K, Terada A, Nishio S, Ushijima K. Human papillomavirus genotyping predicts residual/recurrent disease after local treatment for cervical intraepithelial neoplasia better than viral DNA testing. J Obstet Gynaecol Res 2021; 47:3628-3633. [PMID: 34254407 DOI: 10.1111/jog.14931] [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: 05/12/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 12/01/2022]
Abstract
AIM Type-specific persistent infection (TSPI) of human papillomavirus (HPV) is reportedly associated with a high risk of residual/recurrent disease after local treatment for cervical intraepithelial neoplasia (CIN). This study aimed to evaluate whether HPV genotyping is more accurate in detecting residual/recurrent disease than HPV DNA testing and identify which HPV genotype can predict a high risk of residual/recurrent disease. METHODS We retrospectively reviewed patient outcomes and results of HPV DNA testing and genotyping at 6-12 months after local treatment for CIN2/3 for 439 women. We investigated residual/recurrent disease occurrence according to the TSPI and new infections. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of the two testing methods for predicting residual/recurrent diseases were also evaluated. RESULTS Eighty-five (19.4%) patients were positive for HPV DNA testing after treatment, of which 74 (87.1%) had TSPI. Residual/recurrent disease was identified in 34 (7.7%) patients, of which 30 were positive for HPV DNA testing and had TSPI of HPV16, 18, 31, 33, 52, and 58 (six HPV genotypes). The sensitivity and NPV of HPV DNA testing and TSPI were equal at 88.2% and 98.9%, respectively. The specificity and PPV of TSPI were higher than those of HPV DNA testing (89.1% vs. 86.4%, 40.5% vs. 35.2%, respectively). Furthermore, the TSPI of the six HPV genotypes further improved specificity (90.6%) and PPV (44.1%) with the same sensitivity and NPV. CONCLUSION HPV genotyping is more useful than HPV DNA testing for determining TSPI, especially of the six HPV genotypes.
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Affiliation(s)
- Kouichiro Kawano
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Naotake Tsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroki Nasu
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Shingo Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Jongmyung Park
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Kazuto Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Atsumu Terada
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
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Ge Y, Liu Y, Cheng Y, Liu Y. Predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical conization. Medicine (Baltimore) 2021; 100:e26359. [PMID: 34232170 PMCID: PMC8270570 DOI: 10.1097/md.0000000000026359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/31/2021] [Indexed: 01/04/2023] Open
Abstract
This study was to identify the predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN) after cervical conization.Totally 415 patients with CIN ≥ II who underwent loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) were included in this retrospective study. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the association between postoperative recurrence and clinicopathological data.After the mean follow-up of (21.48 ± 5.82) months, 90 (21.69%) out of 415 cases were subjected to recurrence after cervical conization. The influencing factors for postoperative recurrence included times of full-term birth, history of preterm birth, history of abortion, positive margin, cone length, width, depth, smoking, and history of complicating diseases (P < .05). Multivariate Cox model indicated the positive margin (HR = 2.144, 95% CI: 1.317-3.492, P < .05), history of preterm birth (HR = 4.515, 95% CI: 1.598-12.754, P < .05), history of complicating diseases (HR = 3.552, 95% CI: 1.952-6.462, P < .05) were independent risk factors for recurrence after cervical conization. The restricted cubic diagram showed that the cone depth >0.5 cm was a protective factor for postoperative recurrence.For the patients with high-grade CIN after cervical conization, positive margins, histories of preterm birth, and complicating diseases were associated with increased risk of recurrence, but cone depth (>0.5 cm) with lower risk of recurrence.
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Affiliation(s)
- Yan Ge
- Department of Gynecology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou No.1 People's Hospital, Xuzhou, P.R. China
| | - Yongli Liu
- Department of Gynecology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou No.1 People's Hospital, Xuzhou, P.R. China
| | - Yun Cheng
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yanbo Liu
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
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Bottari F, Iacobone AD, Radice D, Preti EP, Preti M, Franchi D, Piana AF, Sandri MT, Passerini R. Anyplex II HPV test in detection and follow-up after surgical treatment of CIN2+ lesions. J Med Virol 2021; 93:6340-6346. [PMID: 33565607 DOI: 10.1002/jmv.26862] [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: 08/27/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
Human papillomavirus (HPV) tests differ for technology, targets, and information on the genotype and viral load. In this study, we evaluated the performance of the Seegene Anyplex II HPV HR (Anyplex) assay in the detection of cervical intraepithelial lesions (CIN) and as a test-of-cure in the follow-up after surgical treatment. One hundred and sixty-seven women referred to the European Institute of Oncology, Milan, for surgical treatment of CIN2+ were enrolled. A cervical sample was taken before treatment and at the first follow-up visit: on these samples, Qiagen Hybrid Capture 2 (HC2), Roche Linear Array HPV Test (Linear Array), cytology and histology were performed at baseline, HC2, and cytology at follow-up. Anyplex genotyping HPV test was performed on a post aliquot from liquid-based cytology specimens when available. The concordance between Anyplex and HC2 was 93.6% at baseline and 76.7% at follow-up (3-9 months after treatment), respectively. The concordance between Anyplex and Linear Array was evaluable only at baseline (92.9%). No recurrence occurred in women without the persistence of the same genotype at follow-up. Seven women relapsed: six had persistence of the same genotypes (five HPV16, one HPV33, and one HPV39), while one tested negative not only with Anyplex but also with HC2 for the persistence of low-risk genotype infection (HPV73 only detected by Linear Array). Anyplex test represents a valid option for HPV detection and genotyping in order to stratify women at risk of high-grade lesions at baseline and to monitor patients treated for CIN2+ lesions during follow-up.
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Affiliation(s)
- Fabio Bottari
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy.,Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Anna Daniela Iacobone
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Turin, Italy
| | - Dorella Franchi
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Fausto Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Rita Passerini
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
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Zhang Q, Dong B, Chen L, Lin T, Tong Y, Lin W, Lin H, Gao Y, Lin F, Sun P. Evaluation of PCR-Reverse Dot Blot Human Papillomavirus Genotyping Test in Predicting Residual/Recurrent CIN 2+ in Posttreatment Patients in China. Cancer Manag Res 2020; 12:2369-2379. [PMID: 32308477 PMCID: PMC7132552 DOI: 10.2147/cmar.s237490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/13/2020] [Indexed: 02/01/2023] Open
Abstract
Objective To assess the clinical value of the PCR-reverse dot blot human papillomavirus genotyping test during follow-up of patients with CIN grade 2 or worse (CIN 2+). Methods Four hundred patients with CIN 2+ receiving treatment from January 2008 to January 2017 were included in our study. Postoperative follow-up procedures comprised HPV examination and cervical cytology every 3–6 months for the first 2 years and then followed up every 6–12 months. A pathology examination was performed when there was a positive funding for HPV 16/18 or an abnormal ThinPrep cytology test (TCT) with or without positive for HR-HPV according to the American Society for Coloscopy and Cervical Pathology (ASCCP) guidelines. Results The median follow-up period was 27.10±12.47 months (ranging from 3 to 50 months). During follow-up, 12.00% (48/400) of the women developed residual/recurrent disease. The highest risk in CIN 2+ and CIN 3+ residual/recurrence was HPV-16/-18 (hazard ratio (HR)=12.898, 95% CI= 6.849–24.289; HR= 20.726, 95% CI= 9.64–44.562, respectively). Among the different follow-up methods, type-specific (TP) HR-HPV persistent infection showed the highest cumulative incidence risk (CIR) (84.62%, 95% CI=73.29–95.94) and HR (5.38, 95% CI= 2.596–11.149) during the 4-year follow-up period. At the CIN 2+ and CIN 3+ endpoints, TP-HPV testing had relatively high sensitivity (84.62%, 95% CI=73.29–95.94 and 89.28%, 95% CI= 77.83–100.00, respectively) and specificity (78.07%, 95% CI= 72.70–83.44 and 75.73%, 95% CI= 70.30–81.17, respectively). However, at the CIN 2+/CIN 3+ endpoint, TCT follow-up had a sensitivity of 60.42%/62.16% (95% CI=46.58–72.25/46.54–77.79) and specificity of 90.18%/88.72% (95% CI=86.95–93.41/85.35–92.10). Conclusion TP HR-HPV follow-up can provide a reliable and sensitive clinical reference for CIN 2+ postoperative patients.
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Affiliation(s)
- Qiaoyu Zhang
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Binhua Dong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Lihua Chen
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Tingting Lin
- Department of Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Yao Tong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Wenyu Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Haifeng Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yuqin Gao
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Fen Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.,Department of Gynecology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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11
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Human Papillomavirus Genotyping Compared With a Qualitative High-Risk Human Papillomavirus Test After Treatment of High-Grade Cervical Intraepithelial Neoplasia: A Systematic Review. Obstet Gynecol 2020; 134:452-462. [PMID: 31403602 PMCID: PMC6727902 DOI: 10.1097/aog.0000000000003409] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is moderately high-quality evidence to support the improved clinical utility of human papillomavirus (HPV) genotyping compared with qualitative HPV positivity to follow-up after treatment of high-grade cervical intraepithelial neoplasia. To systematically examine human papillomavirus (HPV) genotyping compared with qualitative high-risk HPV result during follow-up after treatment of high-grade cervical intraepithelial neoplasia (CIN), for risk estimation of posttreatment high-grade CIN.
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12
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Shah UJ, Nasiruddin M, Dar SA, Khan MKA, Akhter MR, Singh N, Rabaan AA, Haque S. Emerging biomarkers and clinical significance of HPV genotyping in prevention and management of cervical cancer. Microb Pathog 2020; 143:104131. [PMID: 32169490 DOI: 10.1016/j.micpath.2020.104131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/10/2020] [Accepted: 03/06/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer is a growing and serious problem world-wide in women, but more acute in developing countries especially in Indian subcontinent. The main causative agent for the disease is Human Papilloma Virus (HPV). The history of the cervical cancer goes back to eighteenth century as the HPV infection is reported since 1800s. Presently, the genetic structure of HPV is well defined. Several screening tests including cytology and visual based screening and high risk HPV testing are available. Also available are various clinical and commercial diagnostic tests. However due to the lack of awareness and population-based screening programs, the morbidity and mortality rate is alarmingly high. There are new emerging biomarkers including E6/E7 mRNA, p16ink4a, markers of aberrant S-phase induction, chromosomal abnormalities and miRNAs along with advanced genotyping methods. These markers have clinical significance and are helpful in disease prevention and management. Further, recent advancement in the field of metagenomics has increased the prospects of identifying newer microbes, viruses hitherto reported thus far in the context of HPV infection. Analysis of HPV cases using modern tools including genotyping using more powerful biomarkers is envisaged to enhance the prospects of early diagnosis, better prognosis, more reliable treatment and eventual management of the disease.
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Affiliation(s)
- Ushma Jaykamal Shah
- MedGenome Labs Ltd., Kailash Cancer Hospital and Research Center, Muni Seva Ashram, P.O. Goraj, Tal. Waghodia, Dist. Vadodara, 391760, Gujarat, India
| | - Mohammad Nasiruddin
- Anand Diagnostic Laboratory (A Neuberg Associate), Neuberg Anand Reference Laboratory, Anand Tower, 54, Bowring Hospital Road, Shivajinagar, Bangalore - 560001, India.
| | - Sajad Ahmad Dar
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Md Khurshid Alam Khan
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, Chennai, 600048, Tamil Nadu, India
| | - Mohammad Riyaz Akhter
- MedGenome Labs Ltd., 3rd Floor, Narayana Nethralaya Building, Narayana Health City, # 258/A, Bommasandra, Hosur Road, Bangalore, 560099, Karnataka, India
| | - Nidhi Singh
- Department of Obstetrics and Gynecology, Prasad Institute of Medical Sciences, Lucknow, 226401, Uttar Pradesh, India
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Saudi Aramco, Dhahran, 31311, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia.
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13
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HPV DNA Detection for Post-treatment Surveillance of Premalignant and Malignant Lesions of Cervix. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-019-0361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Bruno MT, Cassaro N, Garofalo S, Boemi S. HPV16 persistent infection and recurrent disease after LEEP. Virol J 2019; 16:148. [PMID: 31775792 PMCID: PMC6882012 DOI: 10.1186/s12985-019-1252-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background About 23% of patients develop CIN2+ after LEEP treatment due to residual or recurrent lesions. The majority of patients with HPV infection were HPV negative before treatment, but 16,4% were still HPV 16 positive after treatment, indicating that conization do not necessarily clear HPV infection rapidly. The aim of this retrospective study was to evaluate the possible correlation existing between the appearance of recurring high-grade lesions and the viral genotype 16, and other risk factors such as residual disease. Methods One hundred eighty-two HPV positive patients underwent LEEP for CIN2+. The follow-up post treatment was carried out every 6 months. Abnormal results during follow-up were confirmed histologically and considered recurrent high-grade intraepithelial cervical lesions (CIN2/CIN3 or CIS). Statistical analysis was performed by using the SPSS software package for Windows (version 15.0, SPSS, Chicago, IL, USA). Descriptive statistics are expressed as frequency, arithmetic mean, standard deviation (S.D.) and percentages. We calculated significance (P < 0.5) with the Easy Fischer Test. We calculated the Odds Ratio (OR) of women with peristent HPV 16 infection and positive margin, to have a recurrence. Results In our study, the rate of persistent infection from HPV 16, after LEEP, was 15.9% (29/182) with 94% (17/18) of the recurring disease occurring within 18 months of follow up. From this study it was found that the persistence of genotype 16 is associated with a greater rate of relapse post-conization of CIN 2+ lesions, with respect to other genotypes. Our study further supports those studies that demonstrate that the risk for residual disease or relapse is not to be overlooked, also when the margins are negative, but persistent HPV infection is present. In our case study, 40% of relapses were in women with negative margin, but with persistent HPV 16 infection. Even more so, the margins involved in HPV16 positive subjects is another prediction factor for relapse. Conclusions Our results show the importance of genotyping and that persistent HPV 16 infection should be considered a risk factor for the development of residual/recurrent CIN 2/3.
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Affiliation(s)
- Maria Teresa Bruno
- Department of General Surgery and Medical Surgery Specialities, Gynecological Clinic of the University of Catania, Policlinico. Via S. Sofia78, Catania, Italy. .,Gynecological Oncology, Humanitas, Catania, Italy.
| | - Nazzario Cassaro
- Department of General Surgery and Medical Surgery Specialities, Gynecological Clinic of the University of Catania, Policlinico. Via S. Sofia78, Catania, Italy
| | - Salvatore Garofalo
- Department of General Surgery and Medical Surgery Specialities, Gynecological Clinic of the University of Catania, Policlinico. Via S. Sofia78, Catania, Italy
| | - Sara Boemi
- Department of General Surgery and Medical Surgery Specialities, Gynecological Clinic of the University of Catania, Policlinico. Via S. Sofia78, Catania, Italy
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15
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Origoni M, Cristoforoni P, Mariani L, Costa S, Preti M, Sandri MT, Preti EP, Ghelardi A, Perino A. [HPV vaccination: not only female adolescents and not only prophylactic. Review and position paper of the Italian HPV Study Group (IHSG)]. ACTA ACUST UNITED AC 2019; 71:442-459. [PMID: 31741364 DOI: 10.23736/s0026-4784.19.04443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
HPV vaccination has been introduced in clinical practice in recent years and represents the most effective strategy of primary prevention of cervical carcinoma and of female genital preneoplastic conditions. One of the major issues of the subject is represented by vaccination coverage of the target population. Since its introduction, HPV vaccine efficacy has been progressively demonstrated also towards extragenital HPV-correlated conditions and in males too. Moreover, even subjects of older age groups or subjects who already had HPV infections have been demonstrated to received benefits from vaccination, due to improvements of their immunological response. Recently, vaccine efficacy has also been investigated in terms of adjuvant administration after treatments of preneoplastic or benign conditions of the female lower genital tract caused by HPVs; preliminary results indicate an interesting and promising field of application. On this basis, in this article an analysis of the state of the art has been performed, with specific regard to the Italian scenario and with the focus of future perspectives of implementation of the HPV vaccination policy. From the available evidences, the Italian HPV Study Group recommends the extension of systematic HPV vaccination to males too, to adult subjects and also after conservative treatment of genital HPV correlated conditions.
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Affiliation(s)
- Massimo Origoni
- Dipartimento di Ginecologia e Ostetricia, Università Vita Salute San Raffaele, Milano, Italia -
| | | | | | | | - Mario Preti
- Dipartimento di Ginecologia e Ostetricia, Università di Torino, Torino, Italia
| | | | | | | | - Antonio Perino
- Dipartimento di Ginecologia e Ostetricia, Università di Palermo, Palermo, Italia
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Hillemanns P, Friese K, Dannecker C, Klug S, Seifert U, Iftner T, Hädicke J, Löning T, Horn L, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Sroczynski G, Sauerbrei W, Beckmann MW, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Kaufmann A, Petry KU, Schäfer APA, Pawlita M, Weis J, Mehnert A, Fehr M, Grimm C, Reich O, Arbyn M, Kleijnen J, Wesselmann S, Nothacker M, Follmann M, Langer T, Jentschke M. Prevention of Cervical Cancer: Guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017) - Part 2 on Triage, Treatment and Follow-up. Geburtshilfe Frauenheilkd 2019; 79:160-176. [PMID: 30792546 PMCID: PMC6379166 DOI: 10.1055/a-0828-7722] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
Aims Annual opportunistic screening for cervical carcinoma has been done in Germany since 1971. The creation of this S3 guideline meets an important need, outlined in the National Cancer Plan, with regard to screening for cervical cancer, as this guideline aims to provide important information and support for planned organized screening for cervical cancer in Germany. Methods With the financial support of German Cancer Aid, 21 professional societies developed evidence-based statements and recommendations (classified using the GRADE system) for the screening, management and treatment of precancerous conditions of the cervix. Two independent scientific institutes compiled systematic reviews for this guideline. Recommendations The second part of this short summary deals with the triage, treatment and follow-up care of cervical dysplasia. With regard to those women who do not participate in screening, the guideline authors recommend sending out repeat invitation letters or an HPV self-collection kit. Colposcopy should be carried out for further investigation if cytology findings are Pap II-p and HPV test results are positive or if the results of an HPV 16 or HPV 18 screening test are positive. A single abnormal Pap smear should be triaged and investigated using HPV testing or p16/Ki67 dual staining.
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Affiliation(s)
- Peter Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany
| | - Stefanie Klug
- Lehrstuhl für Epidemiologie, Technische Universität München, München, Germany
| | - Ulrike Seifert
- Tumorepidemiologie, Universitäts KrebsCentrum (UCC), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Thomas Iftner
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Juliane Hädicke
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Thomas Löning
- Institut für Pathologie, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Lars Horn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dietmar Schmidt
- Institut für Pathologie, Referenzzentrum für Gynäkopathologie, Mannheim, Germany
| | - Hans Ikenberg
- CytoMol - MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - Manfred Steiner
- Facharzt für Frauenheilkunde und Geburtshilfe, Ihringen, Germany
| | - Ulrich Freitag
- Facharzt für Frauenheilkunde und Geburtshilfe, Wismar, Germany
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.,Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Willi Sauerbrei
- Institut für Med. Biometrie und Statistik (IMBI), Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Karsten Münstedt
- Frauenklinik, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Achim Schneider
- Medizinisches Versorgungszentrum im Fürstenberg-Karree, Berlin, Germany
| | - Andreas Kaufmann
- Klinik für Gynäkologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Joachim Weis
- Klinik für Tumorbiologie, Klinik für Onkologische Rehabilitation - UKF Reha gGmbH, Freiburg, Germany
| | - Anja Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Mathias Fehr
- Gynäkologie & Geburtshilfe in Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | | | - Olaf Reich
- Privatklinik Graz Ragnitz, Graz, Austria
| | - Marc Arbyn
- Cancer Center, Sciensano, Brüssel, Belgium
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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Akram Husain R, Rajakeerthana R, Sreevalsan A, Prema Jayaprasad P, Ahmed SS, Ramakrishnan V. Prevalence of human papilloma virus with risk of cervical cancer among south Indian women: A genotypic study with meta-analysis and molecular dynamics of HPV E6 oncoprotein. INFECTION GENETICS AND EVOLUTION 2018; 62:130-140. [PMID: 29698769 DOI: 10.1016/j.meegid.2018.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/18/2018] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
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18
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Effect of High-Risk Human Papillomavirus but Normal Cytology at Test of Cure on Achieving Colposcopy Standards. J Low Genit Tract Dis 2018; 22:110-114. [DOI: 10.1097/lgt.0000000000000373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Arbyn M, Redman CWE, Verdoodt F, Kyrgiou M, Tzafetas M, Ghaem-Maghami S, Petry KU, Leeson S, Bergeron C, Nieminen P, Gondry J, Reich O, Moss EL. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol 2017; 18:1665-1679. [PMID: 29126708 DOI: 10.1016/s1470-2045(17)30700-3] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Incomplete excision of cervical precancer is associated with therapeutic failure and is therefore considered as a quality indicator of clinical practice. Conversely, the risk of preterm birth is reported to correlate with size of cervical excision and therefore balancing the risk of adequate treatment with iatrogenic harm is challenging. We reviewed the literature with an aim to reveal whether incomplete excision, reflected by presence of precancerous tissue at the section margins, or post-treatment HPV testing are accurate predictors of treatment failure. METHODS We did a systematic review and meta-analysis to assess the risk of therapeutic failure associated with the histological status of the margins of the tissue excised to treat cervical precancer. We estimated the accuracy of the margin status to predict occurrence of residual or recurrent high-grade cervical intraepithelial neoplasia of grade two or worse (CIN2+) and compared it with post-treatment high-risk human papillomavirus (HPV) testing. We searched for published systematic reviews and new references from PubMed-MEDLINE, Embase, and CENTRAL and did also a new search spanning the period Jan 1, 1975, until Feb 1, 2016. Studies were eligible if women underwent treatment by excision of a histologically confirmed CIN2+ lesion, with verification of presence or absence of CIN at the resection margins; were tested by cytology or HPV assay between 3 months and 9 months after treatment; and had subsequent follow-up of at least 18 months post-treatment including histological confirmation of the occurrence of CIN2+. Primary endpoints were the proportion of positive section margins and the occurrence of treatment failure associated with the marginal status, in which treatment failure was defined as occurrence of residual or recurrent CIN2+. Information about positive resection margins and subsequent treatment failure was pooled using procedures for meta-analysis of binomial data and analysed using random-effects models. FINDINGS 97 studies were eligible for inclusion in the meta-analysis and included 44 446 women treated for cervical precancer. The proportion of positive margins was 23·1% (95% CI 20·4-25·9) overall and varied by treatment procedure (ranging from 17·8% [12·9-23·2] for laser conisation to 25·9% [22·3-29·6] for large loop excision of the transformation zone) and increased by the severity of the treated lesion. The overall risk of residual or recurrent CIN2+ was 6·6% (95% CI 4·9-8·4) and was increased with positive compared with negative resection margins (relative risk 4·8, 95% CI 3·2-7·2). The pooled sensitivity and specificity to predict residual or recurrent CIN2+ was 55·8% (95% CI 45·8-65·5) and 84·4% (79·5-88·4), respectively, for the margin status, and 91·0% (82·3-95·5) and 83·8% (77·7-88·7), respectively, for high-risk HPV testing. A negative high-risk HPV test post treatment was associated with a risk of CIN2+ of 0·8%, whereas this risk was 3·7% when margins were free. INTERPRETATION The risk of residual or recurrent CIN2+ is significantly greater with involved margins on excisional treatment; however, high-risk HPV post-treatment predicts treatment failure more accurately than margin status. FUNDING European Federation for Colposcopy and Institut national du Cancer (INCA).
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium.
| | | | - Freija Verdoodt
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Kyrgiou
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Menelaos Tzafetas
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Sadaf Ghaem-Maghami
- Division of Reproductive Biology, Department Cancer and Surgery, Imperial College, London, UK
| | - Karl-Ulrich Petry
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Simon Leeson
- Department of Gynaecology and Obstetrics, Betsi Cadwaladr University Health Board, Bangor, Gwyndd, UK
| | | | - Pekka Nieminen
- Department of Gynaecology and Obstetrics, Helsinki University Hospital, Helsinki, Finland
| | - Jean Gondry
- Service de gynécologie et obstétrique, CHU d'Amiens-Picardie, Amiens, France
| | - Olaf Reich
- Department of Gynaecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - Esther L Moss
- Department of Cancer Studies, University of Leicester, Leicester, UK
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20
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Friebe K, Klapdor R, Hillemanns P, Jentschke M. The Value of Partial HPV Genotyping After Conization of Cervical Dysplasias. Geburtshilfe Frauenheilkd 2017; 77:887-893. [PMID: 28845053 DOI: 10.1055/s-0043-115395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/31/2017] [Accepted: 06/29/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION In this retrospective study partial genotyping of human papilloma viruses (HPV) using the Abbott RealTime HighRisk HPV Test (RealTime) was compared with simple HPV detection (Qiagen Hybrid Capture 2 Test; hc2) for recurrence prediction at the first follow-up examination after conization of cervical intraepithelial neoplasia (CIN). METHODS 144 women who had undergone conization for CIN between January 2007 and December 2013 were included. HPV status was determined preoperatively and at first follow-up using hc2 in 103 women and RealTime in 41 women. Recurrent or persistent CIN was assumed when CIN2+ was confirmed histologically or on comparable cytology findings. RESULTS Of the 144 women with complete data 12 (8.3%) had a recurrence after conization. HPV persistence at follow-up correlated significantly with recurrence (hc2: p = 0.003; RealTime: p = 0.003) and both sensitivity and specificity were high (hc2 = 100 and 78.4% respectively; RealTime = 75.0 and 83.9%). Whereas isolated HPV testing had a relatively low positive predictive value for recurrence (hc2 16%; RealTime 54.5%), this rose to 80% with HPV 16 detection at follow-up. CONCLUSION At follow-up after conization of CIN the combination of high risk HPV detection and partial genotyping of HPV 16 constitutes excellent diagnostic criteria for recurrence/persistence of CIN.
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Affiliation(s)
- Kristin Friebe
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Rüdiger Klapdor
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Peter Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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21
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Hoffman SR, Le T, Lockhart A, Sanusi A, Dal Santo L, Davis M, McKinney DA, Brown M, Poole C, Willame C, Smith JS. Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review. Int J Cancer 2017; 141:8-23. [PMID: 28124442 DOI: 10.1002/ijc.30623] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/25/2016] [Accepted: 12/13/2016] [Indexed: 01/01/2023]
Abstract
A systematic review of the literature was conducted to determine the estimates of and definitions for human papillomavirus (HPV) persistence in women following treatment of cervical intra-epithelial neoplasia (CIN). A total of 45 studies presented data on post-treatment HPV persistence among 6,106 women. Most studies assessed HPV persistence after loop excision (42%), followed by conization (7%), cryotherapy (11%), laser treatment (4%), interferon-alpha, therapeutic vaccination, and photodynamic therapy (2% each) and mixed treatment (38%). Baseline HPV testing was conducted before or at treatment for most studies (96%). Follow-up HPV testing ranged from 1.5 to 80 months after baseline. Median HPV persistence tended to decrease with increasing follow-up time, declining from 27% at 3 months after treatment to 21% at 6 months, 15% at 12 months, and 10% at 24 months. Post-treatment HPV persistence estimates varied widely and were influenced by patient age, HPV-type, detection method, treatment method, and minimum HPV post-treatment testing interval. Loop excision and conization appeared to outperform cryotherapy procedures in terms of their ability to clear HPV infection. This systematic review provides evidence for the substantial heterogeneity in post-treatment HPV DNA testing practices and persistence estimates.
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Affiliation(s)
- Sarah R Hoffman
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Tam Le
- UNC School of Medicine, Chapel Hill, NC
| | - Alexandre Lockhart
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Ayodeji Sanusi
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Leila Dal Santo
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Meagan Davis
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Dana A McKinney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Meagan Brown
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Charles Poole
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Corinne Willame
- Business & Decision Life Science on behalf of GlaxoSmithKline Vaccines, Wavre, Belgium
| | - Jennifer S Smith
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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22
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Garutti P, Borghi C, Bedoni C, Bonaccorsi G, Greco P, Tognon M, Martini F. HPV-based strategy in follow-up of patients treated for high-grade cervical intra-epithelial neoplasia: 5-year results in a public health surveillance setting. Eur J Obstet Gynecol Reprod Biol 2016; 210:236-241. [PMID: 28068597 DOI: 10.1016/j.ejogrb.2016.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/20/2016] [Accepted: 12/16/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) DNA testing is used increasingly for measuring the outcome of treatment for high-grade cervical intra-epithelial neoplasia (CIN2+). However, there is no international consensus regarding the number of tests and follow-up visits necessary in the post-treatment surveillance. A negative HPV DNA test result may permit relaxing the intensive post-treatment surveillance, but this possibility has not been standardized by all institutions to date. STUDY DESIGN In 2008, the surveillance programme covering the Emilia-Romagna region in northern Italy adopted the HPV DNA test as a routine tool in the follow-up of women treated for CIN2+. Data from a prospective 5-year study are reported herein. Three hundred and ten patients treated for CIN2+ with a loop electrosurgical excision procedure underwent HPV DNA testing, cytology and colposcopy at 6 months post treatment. If all three tests were negative, women were tested at 18 months with cytology and colposcopy. If any of the three tests were positive, women were tested at 12, 18 and 24 months with cytology and colposcopy. When appropriate, a colposcopy-directed biopsy or CIN2+ retreatment was performed. After 18-24 months, the patients were tested annually with cytology for 3 years. RESULTS None of the 172 (55%) women who were HPV negative at 6 months were found to have residual/recurrent CIN2+ during the surveillance period. In contrast, among the 138 (45%) HPV-positive women, 17 cases of residual/recurrent CIN2+ (17/138; 12.3%) were identified between 6 and 24 months. CONCLUSION HPV DNA testing at six months after treatment for CIN2+ effectively identifies women who are disease free (HPV negative), and for whom a single follow-up at 18 months is sufficient.
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Affiliation(s)
- P Garutti
- Department of Obstetrics and Gynaecology, S. Anna University Hospital, Cona, Ferrara, Italy
| | - C Borghi
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - C Bedoni
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - G Bonaccorsi
- Department of Obstetrics and Gynaecology, S. Anna University Hospital, Cona, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - P Greco
- Department of Obstetrics and Gynaecology, S. Anna University Hospital, Cona, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - M Tognon
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - F Martini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
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23
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Choi YJ, Park JS. Clinical significance of human papillomavirus genotyping. J Gynecol Oncol 2016; 27:e21. [PMID: 26768784 PMCID: PMC4717226 DOI: 10.3802/jgo.2016.27.e21] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/07/2015] [Accepted: 10/30/2015] [Indexed: 12/21/2022] Open
Abstract
Cervical cancer is the fourth most common cancer in women worldwide, and the human papillomavirus (HPV) is the main causative agent for its development. HPV is a heterogeneous virus, and a persistent infection with a high-risk HPV contributes to the development of cancer. In recent decades, great advances have been made in understanding the molecular biology of HPV, and HPV’s significance in cervical cancer prevention and management has received increased attention. In this review, we discuss the role of HPV genotyping in cervical cancer by addressing: clinically important issues in HPV virology; the current application of HPV genotyping in clinical medicine; and potential future uses for HPV genotyping.
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Affiliation(s)
- Youn Jin Choi
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Sup Park
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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24
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Pirtea L, Grigoraş D, Matusz P, Pirtea M, Moleriu L, Tudor A, Ilina R, Secoşan C, Horhat F, Mazilu O. Age and HPV type as risk factors for HPV persistence after loop excision in patients with high grade cervical lesions: an observational study. BMC Surg 2016; 16:70. [PMID: 27716233 PMCID: PMC5053130 DOI: 10.1186/s12893-016-0185-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 09/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent infections with high risk human papillomaviruses (HR-HPV) cause virtually all cervical cancers. METHODS An observational study was conducted aiming to estimate the rate of HPV infection persistence after LEEP in patients with high grade squamous intraepithelial lesions (HSIL). Moreover, the study investigated if persistence is age related. For this reason a total of 110 patients were included between January 2010 and June 2015. RESULTS At 6 months after LEEP the overall HPV infection persistence rate was 40.9 %, at 12 months 20 % and at 18 months 11.8 %. Type 16 showed the highest persistence rate: 27.3 % at 6 months, 12.7 % at 12 months and 10 % at 18 months after LEEP. The persistence for HPV type 16 at 6 months after LEEP was significantly higher in the group > =36.5 years old compared to the persistence rate in the group <36.5 years old (p = 0.0027, RR = 2.75, 95 %ϵ(1.34; 5.64)) (see Table 3). CONCLUSIONS LEEP does not completely eradicate HPV infection. HPV persistence rate after LEEP is higher in infections with type 16 and in women older than 36.5 years.
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Affiliation(s)
- Laurențiu Pirtea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
| | - Dorin Grigoraş
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
| | - Petru Matusz
- Department of Anatomy, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
| | - Marilena Pirtea
- Department of Obstetrics and Gynecology, County Hospital Timişoara, Timișoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
| | - Lavinia Moleriu
- Department of Informatics and Biostatistics, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
| | - Anca Tudor
- Department of Informatics and Biostatistics, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
| | - Răzvan Ilina
- Department of Surgery, University of Medicine and Pharmacy "Victor Babeş", str. Dimitrie Cantemir, nr. 1, Zip Code 300001, Timişoara, Romania. .,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania.
| | - Cristina Secoşan
- Department of Obstetrics and Gynecology, County Hospital Timişoara, Timișoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
| | - Florin Horhat
- Department of Microbiology, University of Medicine and Pharmacy "Victor Babeş", Timişoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
| | - Octavian Mazilu
- Department of Surgery, University of Medicine and Pharmacy "Victor Babeş", str. Dimitrie Cantemir, nr. 1, Zip Code 300001, Timişoara, Romania.,County Hospital Timișoara, Hector street, number 1, Timișoara, Romania
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25
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Baskaran K, Kumar PK, Karunanithi S, Sethupathy S, Thamaraiselvi B, Swaruparani S. Detection of High-Risk Human Papillomaviruses in the Prevention of Cervical Cancer in India. Asian Pac J Cancer Prev 2016; 16:8187-90. [PMID: 26745058 DOI: 10.7314/apjcp.2015.16.18.8187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Human papillomaviruses (HPVs) are small, non-enveloped, double-stranded DNA viruses that infect epithelial tissues. Specific genotypes of human papillomavirus are the single most common etiological agents of cervical intraepithelial lesions and cervical cancer. Cervical cancer usually arises at squamous metaplastic epithelium of transformation zone (TZ) of the cervix featuring infection with one or more oncogenic or high-risk HPV (HR- HPV) types. A hospital- based study in a rural set up was carried out to understand the association of HR-HPV with squamous intraepithelial lesions (SILs) and cervical cancer. In the present study, HR-HPV was detected in 65.7% of low-grade squamous intraepithelial lesions (LSILs), 84.6% of high-grade squamous intraepithelial lesions (HSILs) and 94% of cervical cancer as compared to 10.7% of controls. The association of HPV infection with SIL and cervical cancer was analyzed with Chi square test (p<0.001). The significant association found confirmed that detection of HR-HPV is a suitable candidate for early identification of cervical precancerous lesions and in the prevention of cervical cancer in India.
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Affiliation(s)
- Krishnan Baskaran
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, India E-mail :
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26
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Depuydt CE, Thys S, Beert J, Jonckheere J, Salembier G, Bogers JJ. Linear viral load increase of a single HPV-type in women with multiple HPV infections predicts progression to cervical cancer. Int J Cancer 2016; 139:2021-32. [PMID: 27339821 DOI: 10.1002/ijc.30238] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/01/2016] [Accepted: 06/06/2016] [Indexed: 01/21/2023]
Abstract
Persistent high-risk human papillomavirus (HPV) infection is strongly associated with development of high-grade cervical intraepithelial neoplasia or cancer (CIN3+). In single type infections, serial type-specific viral-load measurements predict the natural history of the infection. In infections with multiple HPV-types, the individual type-specific viral-load profile could distinguish progressing HPV-infections from regressing infections. A case-cohort natural history study was established using samples from untreated women with multiple HPV-infections who developed CIN3+ (n = 57) or cleared infections (n = 88). Enriched cell pellet from liquid based cytology samples were subjected to a clinically validated real-time qPCR-assay (18 HPV-types). Using serial type-specific viral-load measurements (≥3) we calculated HPV-specific slopes and coefficient of determination (R(2) ) by linear regression. For each woman slopes and R(2) were used to calculate which HPV-induced processes were ongoing (progression, regression, serial transient, transient). In transient infections with multiple HPV-types, each single HPV-type generated similar increasing (0.27copies/cell/day) and decreasing (-0.27copies/cell/day) viral-load slopes. In CIN3+, at least one of the HPV-types had a clonal progressive course (R(2) ≥ 0.85; 0.0025copies/cell/day). In selected CIN3+ cases (n = 6), immunostaining detecting type-specific HPV 16, 31, 33, 58 and 67 RNA showed an even staining in clonal populations (CIN3+), whereas in transient virion-producing infections the RNA-staining was less in the basal layer compared to the upper layer where cells were ready to desquamate and release newly-formed virions. RNA-hybridization patterns matched the calculated ongoing processes measured by R(2) and slope in serial type-specific viral-load measurements preceding the biopsy. In women with multiple HPV-types, serial type-specific viral-load measurements predict the natural history of the different HPV-types and elucidates HPV-genotype attribution.
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Affiliation(s)
- Christophe E Depuydt
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, Antwerp, Belgium
| | - Sofie Thys
- Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | - Johan Beert
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, Antwerp, Belgium.,Intermediate Structure for Human Body Material, AML, Sonic Healthcare, Antwerp, Belgium
| | - Jef Jonckheere
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, Antwerp, Belgium
| | - Geert Salembier
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, Antwerp, Belgium
| | - Johannes J Bogers
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, Antwerp, Belgium.,Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
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27
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The association between p16 and Ki-67 immunohistostaining and the progression of cervical intraepithelial neoplasia grade 2. Int J Gynaecol Obstet 2016; 134:45-8. [PMID: 27233813 DOI: 10.1016/j.ijgo.2015.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/07/2015] [Accepted: 03/24/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the frequency of p16- and Ki-67-positive cells on immunohistostaining among women with progression, persistence, or regression of cervical intraepithelial neoplasia grade 2 (CIN2). METHODS A retrospective study was conducted of women with CIN2 diagnosed by histology who were treated at a university hospital in Japan during 2004-2011. The immunostaining patterns for p16 and Ki-67 were analyzed and compared between patients with disease progression, persistence, or regression. Kaplan-Meier analysis was used to evaluate the progression rates stratified by immunostaining, and multivariate analysis of risk factors for progression was performed using the Cox proportional hazards model. RESULTS The analysis included 59 women with progression, 35 women with persistence, and 28 women with regression. Deep p16 expression (staining in more than half of the cervical intraepithelial compartment) and positive Ki-67 staining in more than 50% of cells were significantly more common among women with progression than among those with regression. The risk factors for progression of CIN2 were deep p16 expression (P<0.001) and a Ki-67 ratio of more than 50% (P<0.001). CONCLUSION Among women with CIN2, positive immunohistostaining for p16 and Ki-67 was strongly associated with disease progression.
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28
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Abstract
High-risk human papillomaviruses (HPVs) cause essentially all cervical cancers, most anal and oropharyngeal cancers, and some vaginal, vulvar, and penile cancers. Improved understanding of the pathogenesis of infection and the availability of newer tests are changing the approach to screening and diagnosis. Molecular tests to detect DNA from the most common high-risk HPVs are FDA approved for use in conjunction with cytology in cervical cancer screening programs. More-specific tests that detect RNA from high-risk HPV types are now also available. The use of molecular tests as the primary screening tests is being adopted in some areas. Genotyping to identify HPV16 and -18 has a recommended role in triaging patients for colposcopy who are high-risk HPV positive but have normal cytology. There are currently no recommended screening methods for anal, vulvar, vaginal, penile, or oropharyngeal HPV infections. HPV testing has limited utility in patients at high risk for anal cancer, but p16 immunohistochemistry is recommended to clarify lesions in tissue biopsy specimens that show moderate dysplasia or precancer mimics. HPV testing is recommended for oropharyngeal squamous cell tumors as a prognostic indicator. Ongoing research will help to improve the content of future guidelines for screening and diagnostic testing.
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Affiliation(s)
- Eileen M Burd
- Emory University School of Medicine, Department of Pathology and Laboratory Medicine, and Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA
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29
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Clinical significance of a negative loop electrosurgical excision procedure biopsy in patients with biopsy-confirmed high-grade cervical intraepithelial neoplasia. J Low Genit Tract Dis 2016; 19:103-9. [PMID: 25105718 DOI: 10.1097/lgt.0000000000000061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to determine which clinical factors can predict this phenomenon and to better understand the clinical significance of negative loop electrosurgical excision procedure (LEEP) findings through long-term follow-up. METHODS We identified 559 patients with biopsy-confirmed cervical intraepithelial neoplasia grade 2 or 3 (CIN 2, 3) who were treated by LEEP between February 2001 and December 2010. Preconization clinical characteristics, as well as high-risk human papillomavirus (hrHPV) status, were analyzed as possible predictors of an absence of a lesion in the specimen. The clinical significance of an absence of a lesion in the specimen, as well as other factors, was evaluated by Cox hazard regression analysis in terms of recurrence. RESULTS No lesion on the LEEP specimen was found in 102 (18.2%) of 559 patients with CIN 2,3 on punch biopsy. Punch biopsy status of CIN 2, low HPV viral load (<100 relative light units [RLU]), and negative or positive HPV infection other than type 16 were significantly related to no lesion in the LEEP specimen. Postoperative HPV persistence (≥10 RLU) and same-type HPV detection were significantly related to recurrent disease of CIN 2+ (p < .001). The recurrence of patients with no lesion in LEEP did not statistically differ from that of patients with a lesion in the LEEP specimen (p = .390). CONCLUSIONS The absence of a lesion in the LEEP specimen is very common. A negative LEEP is associated with a persistence/recurrence rate similar to that of positive LEEP. We recommend that the follow-up for patients with no lesion in the LEEP specimen should be the same as that for patients with a lesion.
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30
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Mariani L, Sandri MT, Preti M, Origoni M, Costa S, Cristoforoni P, Bottari F, Sideri M. HPV-Testing in Follow-up of Patients Treated for CIN2+ Lesions. J Cancer 2016; 7:107-14. [PMID: 26722366 PMCID: PMC4679387 DOI: 10.7150/jca.13503] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/01/2015] [Indexed: 11/08/2022] Open
Abstract
Persistent positivity of HPV-DNA testing is considered a prognostic index of recurrent disease in patients treated for CIN2+. HPV detection, and particularly genotyping, has an adequate high rate of sensitivity and specificity (along with an optimal reproducibility), for accurately predicting treatment failure, allowing for an intensified monitoring activity. Conversely, women with a negative HPV-test 6 months after therapy have a very low risk for residual/recurrent disease, which leads to a more individualized follow-up schedule, allowing for a gradual return to the normal screening scheme. HPV testing should be routinely included (with or without cytology) in post-treatment follow-up of CIN2+ patients for early detection of recurrence and cancer progression. HPV genotyping methods, as a biological indicator of persistent disease, could be more suitable for a predictive role and risk stratification (particularly in the case of HPV 16/18 persistence) than pooled HPV-based testing. However, it is necessary to be aware of the performance of the system, adhering to strict standardization of the process and quality assurance criteria.
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Affiliation(s)
- Luciano Mariani
- 1. HPV-UNIT, Regina Elena National Cancer Institute of Rome, Italy
| | - Maria Teresa Sandri
- 2. Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Mario Preti
- 3. Department of Obstetrics and Gynecology - University of Turin, Italy
| | - Massimo Origoni
- 4. Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Fabio Bottari
- 2. Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Mario Sideri
- 1. HPV-UNIT, Regina Elena National Cancer Institute of Rome, Italy
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31
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Kudoh A, Sato S, Itamochi H, Komatsu H, Nonaka M, Sato S, Chikumi J, Shimada M, Oishi T, Kigawa J, Harada T. Human papillomavirus type-specific persistence and reappearance after successful conization in patients with cervical intraepithelial neoplasia. Int J Clin Oncol 2015; 21:580-7. [PMID: 26614089 DOI: 10.1007/s10147-015-0929-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/09/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the relationship between pre- and postoperative high-risk human papillomavirus (hrHPV) genotypes and hrHPV type-specific persistence and reappearance of abnormal cytology after successful conization. METHODS A retrospective analysis was performed of 211 patients who were undergoing conization after hrHPV genotype testing at Tottori University Hospital between July 2009 and June 2013. Of the 211 women, 129 underwent pre- and postoperative hrHPV genotype testing and were diagnosed with cervical intraepithelial neoplasia (CIN) grades 1-3 with negative margins. RESULTS The postoperative pathological diagnosis was CIN 1 in 8 patients, CIN 2 in 12, CIN 3 in 108 and adenocarcinoma in situ in 1 patient. Before conization, the most frequent hrHPV genotypes were HPV16 (n = 52; 40.3 %), followed by HPV52 (n = 32; 24.8 %) and HPV58 (n = 28; 21.7 %), while HPV18 was detected in 6 cases (4.7 %). Of the 23 postoperative hrHPV-positive cases, the same genotypes were detected in 10 cases while a different genotype was detected in 11 cases; type did not affect the frequency of persistent postoperative infection. The 3-year cumulative risk for the reappearance of abnormal cytology was significantly higher in postoperative hrHPV-positive patients than in postoperative hrHPV-negative patients (31.6 vs 9.7 %, P = 0.0014). A high-grade squamous intraepithelial lesion (HSIL) was observed during the follow-up period in one patient with persistent HPV16 infection. CONCLUSIONS Postoperative hrHPV infection was a significant positive predictor for the reappearance of abnormal cytology and HPV16 infection-induced HSIL after treatment. Therefore, our study suggests that hrHPV genotype testing may be useful to follow-up CIN patients.
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Affiliation(s)
- Akiko Kudoh
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan
| | - Shinya Sato
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan
| | - Hiroaki Itamochi
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan. .,Depertment of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City, Iwate, 020-8505, Japan.
| | - Hiroaki Komatsu
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan
| | - Michiko Nonaka
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan
| | - Seiya Sato
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan.,Depertment of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City, Iwate, 020-8505, Japan
| | - Jun Chikumi
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan
| | - Muneaki Shimada
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan
| | - Tetsuro Oishi
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan
| | - Junzo Kigawa
- Matsue City Hospital, 32-1 Noshira, Matsue-City, Shimane, 690-8509, Japan
| | - Tasuku Harada
- Depertment of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City, Tottori, 683-8504, Japan
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32
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Cuschieri K, Bhatia R, Cruickshank M, Hillemanns P, Arbyn M. HPV testing in the context of post-treatment follow up (test of cure). J Clin Virol 2015; 76 Suppl 1:S56-S61. [PMID: 26525202 DOI: 10.1016/j.jcv.2015.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/06/2015] [Accepted: 10/10/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women treated for cervical lesions are at higher risk of subsequent disease compared to the general population. Consequently, post treatment surveillance strategies are required to ensure the success of treatment, so called "test of cure". The high sensitivity and negative predictive value of HPV assays can enhance post-treatment strategies. OBJECTIVES To provide an overview of the current data on test of cure strategies with a particular focus on HPV testing and to identify knowledge gaps and areas for further research. RESULTS HPV testing is sensitive for the detection of residual or recurrent disease post treatment for CIN2+ and is more sensitive than cytology alone. Co-testing increases sensitivity, marginally and there is a lack of consensus regarding the efficiency and safety to release negative women. Most test of cure studies have applied HPV DNA tests and post treatment positivity rates vary widely depending on assay and potentially, treatment type. CONCLUSIONS Globally, an increasing number of test of cure algorithms now incorporate HPV testing although there is heterogeneity of practice with respect to assay, number of post treatment tests, testing intervals, follow up time. While type specific persistence identified through genotyping may identify those at greater risk of disease there is no consensus as to how this may be applied, clinically. Data on HPV testing in women treated for glandular lesions would be welcome as would the performance of different HPV assays and associated biomarkers in this context.
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Affiliation(s)
- Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian, Scotland, UK.
| | - Ramya Bhatia
- HPV Research Group, Division of Pathology, University of Edinburgh, Scotland, UK
| | - Margaret Cruickshank
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, NHS Grampian, Scotland, UK
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, University of Hannover, Germany
| | - Marc Arbyn
- Unit of Cancer Epidemiology & Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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Onuki M, Matsumoto K, Sakurai M, Ochi H, Minaguchi T, Satoh T, Yoshikawa H. Posttreatment human papillomavirus testing for residual or recurrent high-grade cervical intraepithelial neoplasia: a pooled analysis. J Gynecol Oncol 2015; 27:e3. [PMID: 26463429 PMCID: PMC4695453 DOI: 10.3802/jgo.2016.27.e3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/29/2015] [Accepted: 08/19/2015] [Indexed: 02/08/2023] Open
Abstract
Objective We conducted a pooled analysis of published studies to compare the performance of human papillomavirus (HPV) testing and cytology in detecting residual or recurrent diseases after treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3). Methods Source articles presenting data on posttreatment HPV testing were identified from the National Library of Medicine (PubMed) database. We included 5,319 cases from 33 articles published between 1996 and 2013. Results The pooled sensitivity of high-risk HPV testing (0.92; 95% confidence interval [CI], 0.90 to 0.94) for detecting posttreatment CIN 2 or worse (CIN 2+) was much higher than that of cytology (0.76; 95% CI, 0.71 to 0.80). Co-testing of HPV testing and cytology maximized the sensitivity (0.93; 95% CI, 0.87 to 0.96), while HPV genotyping (detection of the same genotype between pre- and posttreatments) did not improve the sensitivity (0.89; 95% CI, 0.82 to 0.94) compared with high-risk HPV testing alone. The specificity of high-risk HPV testing (0.83; 95% CI, 0.82 to 0.84) was similar to that of cytology (0.85; 95% CI, 0.84 to 0.87) and HPV genotyping (0.83; 95% CI, 0.81 to 0.85), while co-testing had reduced specificity (0.76; 95% CI, 0.75 to 0.78). For women with positive surgical margins, high-risk HPV testing provided remarkable risk discrimination between test-positives and test-negatives (absolute risk of residual CIN 2+ 74.4% [95% CI, 64.0 to 82.6] vs. 0.8% [95% CI, 0.15 to 4.6]; p<0.001). Conclusion Our findings recommend the addition of high-risk HPV testing, either alone or in conjunction with cytology, to posttreatment surveillance strategies. HPV testing can identify populations at greatest risk of posttreatment CIN 2+ lesions, especially among women with positive section margins.
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Affiliation(s)
- Mamiko Onuki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Manabu Sakurai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Ochi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takeo Minaguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Long-Term Clinical Outcome after Treatment for High-Grade Cervical Lesions: A Retrospective Monoinstitutional Cohort Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:984528. [PMID: 26180819 PMCID: PMC4477134 DOI: 10.1155/2015/984528] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/05/2014] [Accepted: 03/10/2015] [Indexed: 01/28/2023]
Abstract
Background. The aim of this retrospective observational study of women treated for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was to assess the long-term risk of residual/recurrent high-grade CIN. Materials and Methods. We evaluated 760 women treated by loop electrosurgical excision procedure (684) or conization (76) between 2000 and 2009, and followed up to June 30, 2014 (median follow-up 6.7 years, range 4–14). Visits every 6 months for the first year after treatment and yearly for up to the following 10 years included cytology, colposcopy when indicated, and HPV testing (search and typing). Results. CIN2+ or vaginal intraepithelial neoplasia grade 2 or worse (VAIN2+) was detected in 67 cases (8.8%), 39 at first follow-up and 28 after one/more negative visits. The risk of CIN2+ was higher in case of positive margins (odds ratio (OR) 8.04, 95% CI 4.31–15.0), type 3 transformation zone (OR for CIN3 27.7, 95% CI 2.07–36.9), CIN3+ excision (OR 6.02, 95% CI 1.73–20.9), and positive high-risk HPV test at first follow-up (OR for HPV16: 20.6, 95% CI 6.8–62.6; OR for other hrHPV types: 18.3, 95% CI 5.9–57.0). Conclusion. Residual/recurrent high-grade CIN occurred in <9% cases, and the risk was associated with transformation zone type, lesion grade, margins status, and hrHPV test result at 6–12 months of follow-up.
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Origoni M, Cristoforoni P, Carminati G, Stefani C, Costa S, Sandri MT, Mariani L, Preti M. E6/E7 mRNA testing for human papilloma virus-induced high-grade cervical intraepithelial disease (CIN2/CIN3): a promising perspective. Ecancermedicalscience 2015; 9:533. [PMID: 26015802 PMCID: PMC4435751 DOI: 10.3332/ecancer.2015.533] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Indexed: 11/15/2022] Open
Abstract
Since the introduction of biomolecular testing for the identification of high-risk human papillomavirus DNA (hrHPV-DNA) in cervical cancer preventive strategies, many interesting aspects have emerged in this field; firstly, HPV-DNA testing has been demonstrated to have better sensitivity than conventional cytology in several settings: screening, triage of ASC-US and in follow-up after treatment. Despite this, some limitations of these new technologies have also been underlined: the major issue is the low specificity of the tests, which cannot discriminate between regressive and progressive infections. Thus, recent research has moved the attention towards novel markers of progression that could more precisely detect cases at real risk of cancer development. In view of the fact that progression to cancer is dependable of the E6/E7 proteins integration and transforming action, the overexpression of E6/E7 transcripts has been seen as a valuable marker of this risk. This review aims to summarise the literature data on this topic and to provide a clear view of the emerging perspectives.
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Affiliation(s)
- Massimo Origoni
- Department of Gynaecology & Obstetrics, Vita Salute San Raffaele University, School of Medicine, Milano 20132, Italy
| | | | - Guia Carminati
- Department of Gynaecology & Obstetrics, Vita Salute San Raffaele University, School of Medicine, Milano 20132, Italy
| | - Chiara Stefani
- Department of Gynaecology & Obstetrics, Vita Salute San Raffaele University, School of Medicine, Milano 20132, Italy
| | | | - Maria Teresa Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milano 20141, Italy
| | - Luciano Mariani
- HPV-UNIT, Regina Elena National Cancer Institute, Roma 00144, Italy
| | - Mario Preti
- Unit of Preventive Gynaecology, European Institute of Oncology, Milano 20141, Italy
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Gosvig CF, Huusom LD, Deltour I, Andersen KK, Duun-Henriksen AK, Madsen EM, Petersen LK, Elving L, Schouenbourg L, Iftner A, Svare E, Iftner T, Kjaer SK. Role of human papillomavirus testing and cytology in follow-up after conization. Acta Obstet Gynecol Scand 2015; 94:405-11. [DOI: 10.1111/aogs.12601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/27/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Camilla F. Gosvig
- Unit of Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Lene D. Huusom
- Unit of Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Isabelle Deltour
- Section of Environment and Radiation; International Agency for Research on Cancer; Lyon France
| | - Klaus K. Andersen
- Unit of Statistics, Bioinformatics and Registry; Danish Cancer Society Research Center; Copenhagen Denmark
| | | | - Ellen Merete Madsen
- Department of Obstetrics and Gynecology; Frederiksberg Hospital; Copenhagen Denmark
| | - Lone K. Petersen
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Lisbeth Elving
- Department of Obstetrics and Gynecology; Hvidovre Hospital; Copenhagen Denmark
| | - Lars Schouenbourg
- Department of Obstetrics and Gynecology; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - Angelika Iftner
- Experimental Virology Section; Universitaetsklinikum Tuebingen; Tuebingen Germany
| | - Edith Svare
- Private Gynecological Clinic; Elsinore Denmark
| | - Thomas Iftner
- Experimental Virology Section; Universitaetsklinikum Tuebingen; Tuebingen Germany
| | - Susanne K. Kjaer
- Unit of Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
- Department of Obstetrics and Gynecology; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
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37
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Posttreatment Assessment of Women at Risk of Developing High-Grade Cervical Disease. J Low Genit Tract Dis 2014; 18:338-43. [DOI: 10.1097/lgt.0000000000000012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hybrid Capture II testing for high-risk human papillomavirus DNA in the follow-up of women treated for high-grade cervical intraepithelial neoplasia. J Low Genit Tract Dis 2014; 17:308-14. [PMID: 23552206 DOI: 10.1097/lgt.0b013e31826cd7c1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to estimate and compare the validity of high-risk human papillomavirus DNA (HR-HPV DNA) testing using Hybrid Capture II with and without Pap cytological examination in the detection of incident high-grade cervical intraepithelial neoplasia (CIN 2+) after treatment. MATERIALS AND METHODS A total of 1,608 women undergoing ablative or excisional treatment were recruited to the study between May 2001 and June 2005, of whom 985 women were treated for CIN 2+. High-risk HPV DNA tests and Pap smears were performed once in every 6 months for 24 months after treatment. RESULTS A total of 888 women were eligible for analysis. High-grade cervical intraepithelial neoplasia was detected in 22 women (2.5%) for the 24 months after treatment. The sensitivity for CIN 2+ detection with cytological diagnosis ranged from 43% to 100%, from 67% to 100% for HR-HPV DNA test, and from 67% to 100% for both tests combined. The specificity of cytological diagnosis ranged from 94% to 97%, from 75% to 84% for HR-HPV DNA test, and from 80% to 82% for both tests combined. The positive predictive value for cytological diagnosis ranged from 8% to 30%, from 4% to 14% for HR-HPV DNA test, and from 4% to 11% for both tests combined. The negative predictive value was 99% or greater for cytological diagnosis alone, HR-HPV DNA test alone, or for both tests combined. CONCLUSIONS As histologically proven CIN 2+ after treatment for this group of women was low, adding HR-HPV DNA testing to Pap smear did not increase the detection of CIN 2+ or enhance the negative predictive value of cytological diagnosis alone.
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Rositch AF, Soeters HM, Offutt-Powell TN, Wheeler BS, Taylor SM, Smith JS. The incidence of human papillomavirus infection following treatment for cervical neoplasia: a systematic review. Gynecol Oncol 2014; 132:767-79. [PMID: 24412508 DOI: 10.1016/j.ygyno.2013.12.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/21/2013] [Accepted: 12/31/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To systematically review the published literature in order to estimate the incidence and describe the variability of human papillomavirus (HPV) infection in women following treatment for cervical neoplasia. METHODS Several scientific literature databases (e.g. PubMed, ISI Web of Science) were searched through January 31, 2012. Eligible articles provided data on (i) baseline HPV infection status within 6 months prior to or at time of treatment (pre-treatment); and (ii) HPV test results for women's first visit after treatment occurring within 36 months (post-treatment). We abstracted and summarized the post-treatment incidence of newly detected HPV genotypes that were not present at pre-treatment, overall and stratified by study and other population characteristics. RESULTS A total of 25 studies were included, reporting post-treatment HPV incidence in nearly 2000 women. Mean patient age ranged from 31 to 43 years (median 36). Most studies used cervical exfoliated cell specimens to test for HPV DNA (n=20; 80%), using polymerase chain reaction (n=21; 84%). Cervical neoplasia treatment included loop electrical excision procedure (n=11; 44%); laser conization (n=2; 8%); laser ablation, surgical conization, cryotherapy, alpha-interferon (n=1; 4% each); or multiple treatment regimens (n=8; 32%). Follow-up times post-treatment ranged from 1.5 to 36 months (median 6). More than half of studies (n=17; 68%) estimated the incidence of any HPV type following treatment, while 7 (28%) focused specifically on high-risk (HR) HPV. HPV incidence after treatment varied widely, ranging from 0 to 47% (interquartile range: 0%-15%) in up to 3 years of follow-up after treatment. Lower HPV incidence was observed among studies that included relatively younger women, used laser conization, focused on HR-HPV rather than overall HPV infection, and had a lower proportion of recurrent cervical disease. CONCLUSIONS These modest summary incidence estimates from the published literature can guide clinicians, epidemiologists and health economists in developing best practices for post-treatment cervical cancer prevention.
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Affiliation(s)
- Anne F Rositch
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Heidi M Soeters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Tabatha N Offutt-Powell
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Bradford S Wheeler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sylvia M Taylor
- GlaxoSmithKline Vaccines, Global Vaccine Development, Wavre, Belgium
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Linberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Söderlund-Strand A, Kjellberg L, Dillner J. Human papillomavirus type-specific persistence and recurrence after treatment for cervical dysplasia. J Med Virol 2013; 86:634-41. [PMID: 24123176 DOI: 10.1002/jmv.23806] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 01/08/2023]
Abstract
Human papillomavirus (HPV) infection is a necessary factor in the cervical cancer development. Also after treatment for cervical dysplasia, HPV can be present and promote the recurrence of cervical disease. In the present study, the aim was to perform a long-term follow-up on the ability of HPV testing with genotyping, as compared with cytology, to predict recurrence of high-grade cervical intraepithelial neoplasia and to evaluate the effectiveness of treatment with loop electrosurgical excision procedure (LEEP) conization. Cervical samples for HPV DNA testing and cytological analysis were obtained from 178 women with abnormal smears referred for treatment with LEEP conization. These women were scheduled for HPV DNA testing and Pap smears before and 3, 6, 12, 24, and 36 months after treatment. Three years after treatment 3.1% (N = 4) of women were still persistently HPV-positive with the same type as had been detected at treatment. Recurrent or residual cervical intraepithelial neoplasia II+ in histopathology was found among 9 (5.1%) women during follow-up. All of these women had type-specific HPV-persistence (sensitivity 100% [95% CI 63-100%] and specificity 94.7% [89.8-97.4%]), but only 7/9 had abnormal cytology (sensitivity 77.8% [40.2-96.1%] and specificity 94.7% [89.8-97.4%]). No recurrent or residual disease was found among women with any other patterns of HPV positivity (e.g., type change or fluctuating positivity) (sensitivity 0% [95% CI 0-37.1%] and specificity 80.5% [73.5-86.0%]). In conclusion, only type-specific HPV persistence predicted recurrent or residual disease, and HPV genotyping appears useful to improve the specificity when using HPV testing in post-treatment follow-up.
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Affiliation(s)
- Anna Söderlund-Strand
- Department of Clinical Microbiology, Jan Waldenströms Gata 59, Skåne University Hospital (SUS), Malmö, Sweden
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Baldauf JJ, Averous G, Baulon E, Thoma V, Talha-Vautravers A, Sananes N, Akladios Y. Neoplasias intraepiteliales del cuello uterino. EMC - GINECOLOGÍA-OBSTETRICIA 2013; 49:1-23. [DOI: 10.1016/s1283-081x(13)65435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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The Clinical Role of HPV Testing in Primary and Secondary Cervical Cancer Screening. Obstet Gynecol Int 2013; 2013:610373. [PMID: 23935630 PMCID: PMC3713364 DOI: 10.1155/2013/610373] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/14/2013] [Indexed: 11/24/2022] Open
Abstract
Traditional population-based cervical screening programs, based on cytology, have successfully reduced the burden of cervical cancer. Nevertheless limitations remain and new screening methods are emerging. Despite vaccination against the 2 most oncogenic types (HPV 16/18), cervical cancer screening will have to continue as an essential public health strategy. As the acquisition of an HR-HPV infection is critical in the progression to (pre-)cancerous cervical lesions, recent research has focused on HR-HPV detection. The sensitivity of HPV testing in primary and secondary prevention outweighs that of cytology, at the cost of slightly lower specificity. Although most of the HR-HPV infections are cleared after conization, new evidence from numerous studies encourages the implementation of HR-HPV testing and genotyping to improve posttreatment surveillance. An HR-HPV test 6 months after conization is a promising useful clinical marker to detect persistence and prevent progression. This review highlights the clinical role of HPV testing in primary and secondary cervical cancer screening.
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Baldauf JJ, Averous G, Baulon E, Thoma V, Talha-Vautravers A, Sananes N, Akladios Y. Néoplasies intraépithéliales du col. EMC - GYNÉCOLOGIE 2013; 8:1-21. [DOI: 10.1016/s0246-1064(12)54837-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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High-risk human papillomavirus testing versus cytology in predicting post-treatment disease in women treated for high-grade cervical disease: A systematic review and meta-analysis. Gynecol Oncol 2012; 125:500-7. [DOI: 10.1016/j.ygyno.2012.01.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/06/2012] [Accepted: 01/12/2012] [Indexed: 01/24/2023]
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