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Gisca T, Munteanu IV, Vasilache IA, Melinte-Popescu AS, Volovat S, Scripcariu IS, Balan RA, Pavaleanu I, Socolov R, Carauleanu A, Vaduva C, Melinte-Popescu M, Adam AM, Adam G, Vicoveanu P, Socolov D. A Prospective Study on the Progression, Recurrence, and Regression of Cervical Lesions: Assessing Various Screening Approaches. J Clin Med 2024; 13:1368. [PMID: 38592206 PMCID: PMC10931951 DOI: 10.3390/jcm13051368] [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: 01/25/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The prediction of cervical lesion evolution is a challenge for clinicians. This prospective study aimed to determine and compare the predictive accuracy of cytology, HPV genotyping, and p16/Ki67 dual staining alone or in combination with personal risk factors in the prediction of progression, regression, or persistence of cervical lesions in human papillomavirus (HPV)-infected patients; (2) Methods: This prospective study included HPV-positive patients with or without cervical lesions who underwent follow-up in a private clinic. We calculated the predictive performance of individual tests (cervical cytology, HPV genotyping, CINtecPlus results, and clinical risk factors) or their combination in the prediction of cervical lesion progression, regression, and persistence; (3) Results: The highest predictive performance for the progression of cervical lesions was achieved by a model comprising a Pap smear suggestive of high-grade squamous intraepithelial lesion (HSIL), the presence of 16/18 HPV strains, a positive p16/Ki67 dual staining result along with the presence of at least three clinical risk factors, which had a sensitivity (Se) of 74.42%, a specificity of 97.92%, an area under the receiver operating curve (AUC) of 0.961, and an accuracy of 90.65%. The prediction of cervical lesion regression or persistence was modest when using individual or combined tests; (4) Conclusions: Multiple testing or new biomarkers should be used to improve HPV-positive patient surveillance, especially for cervical lesion regression or persistence prediction.
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Affiliation(s)
- Tudor Gisca
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania (I.-S.S.); (I.P.); (R.S.); (P.V.); (D.S.)
| | - Iulian-Valentin Munteanu
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania;
| | - Ingrid-Andrada Vasilache
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania (I.-S.S.); (I.P.); (R.S.); (P.V.); (D.S.)
| | - Alina-Sinziana Melinte-Popescu
- Department of Mother and Newborn Care, Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania;
| | - Simona Volovat
- Department of Medical Oncology, University of Medicine and Pharmacy ‘Grigore T Popa’, 700115 Iasi, Romania
| | - Ioana-Sadyie Scripcariu
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania (I.-S.S.); (I.P.); (R.S.); (P.V.); (D.S.)
| | - Raluca-Anca Balan
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Ioana Pavaleanu
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania (I.-S.S.); (I.P.); (R.S.); (P.V.); (D.S.)
| | - Razvan Socolov
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania (I.-S.S.); (I.P.); (R.S.); (P.V.); (D.S.)
| | - Alexandru Carauleanu
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania (I.-S.S.); (I.P.); (R.S.); (P.V.); (D.S.)
| | - Constantin Vaduva
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania;
| | - Marian Melinte-Popescu
- Department of Internal Medicine, Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania;
| | - Ana-Maria Adam
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania;
| | - Gigi Adam
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania
| | - Petronela Vicoveanu
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania (I.-S.S.); (I.P.); (R.S.); (P.V.); (D.S.)
| | - Demetra Socolov
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania (I.-S.S.); (I.P.); (R.S.); (P.V.); (D.S.)
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Ouh YT, Kim HY, Yi KW, Lee NW, Kim HJ, Min KJ. Enhancing Cervical Cancer Screening: Review of p16/Ki-67 Dual Staining as a Promising Triage Strategy. Diagnostics (Basel) 2024; 14:451. [PMID: 38396493 PMCID: PMC10888225 DOI: 10.3390/diagnostics14040451] [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: 01/09/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Cervical cancer, primarily caused by high-risk human papillomavirus (HR-HPV) types 16 and 18, is a major global health concern. Persistent HR-HPV infection can progress from reversible precancerous lesions to invasive cervical cancer, which is driven by the oncogenic activity of human papillomavirus (HPV) genes, particularly E6 and E7. Traditional screening methods, including cytology and HPV testing, have limited sensitivity and specificity. This review explores the application of p16/Ki-67 dual-staining cytology for cervical cancer screening. This advanced immunocytochemical method allows for simultaneously detecting p16 and Ki-67 proteins within cervical epithelial cells, offering a more specific approach for triaging HPV-positive women. Dual staining and traditional methods are compared, demonstrating their high sensitivity and negative predictive value but low specificity. The increased sensitivity of dual staining results in higher detection rates of CIN2+ lesions, which is crucial for preventing cervical cancer progression. However, its low specificity may lead to increased false-positive results and unnecessary biopsies. The implications of integrating dual staining into contemporary screening strategies, particularly considering the evolving landscape of HPV vaccination and changes in HPV genotype prevalence, are also discussed. New guidelines and further research are necessary to elucidate the long-term effects of integrating dual staining into screening protocols.
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Affiliation(s)
| | | | | | | | | | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan-si 15355, Gyeonggi-do, Republic of Korea; (Y.-T.O.); (H.Y.K.); (K.W.Y.); (N.-W.L.); (H.-J.K.)
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Ferreira AL, Dibe ND, de Paiva BR, Portari EA, Dock DCDA, Ferreira NVC, Gomes SC, Russomano FB, de Andrade CV. Cervical Intraepithelial Neoplasia grade 2 biopsy: Do p16INK4a and Ki-67 biomarkers contribute to the decision to treat? A cross-sectional study. SAO PAULO MED J 2023; 142:e2022527. [PMID: 37646766 PMCID: PMC10452003 DOI: 10.1590/1516-3180.2022.0527.r2.280423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/08/2023] [Accepted: 04/28/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Managing cervical intraepithelial neoplasia grade 2 (CIN2) is challenging, considering the CIN2 regression rate, perinatal risks associated with excisional procedures, and insufficient well-established risk factors to predict progression. OBJECTIVES To determine the ability of p16INK4a and Ki-67 staining in biopsies diagnosed with CIN2 to identify patients with higher-grade lesions (CIN3 or carcinoma). DESIGN AND SETTING Cross-sectional study conducted at a referral center for treating uterine cervical lesions. METHODS In 79 women, we analyzed the correlation of p16INK4a and Ki-67 expression in CIN2 biopsies with the presence of a higher-grade lesions, as determined via histopathology in surgical specimens from treated women or via two colposcopies and two cytological tests during follow-up for untreated women with at least a 6-month interval. The expression of these two biomarkers was verified by at least two independent pathologists and quantified using digital algorithms. RESULTS Thirteen (16.8%) women with CIN2 biopsy exhibited higher-grade lesions on the surgical excision specimen or during follow-up. p16INK4a expression positively and negatively predicted the presence of higher-grade lesions in 17.19% and 86.67% patients, respectively. Ki-67 expression positively and negatively predicted the presence of higher-grade lesions in 40% and 88.24% patients, respectively. CONCLUSIONS Negative p16INK4a and Ki67 immunohistochemical staining can assure absence of a higher-grade lesion in more than 85% of patients with CIN2 biopsies and can be used to prevent overtreatment of these patients. Positive IHC staining for p16INK4a and Ki-67 did not predict CIN3 in patients with CIN2 biopsies.
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Affiliation(s)
- Amanda Leal Ferreira
- MSc. Biomedical and PhD Student, Laboratory of Diagnosis Pathology and Cytopathology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Nasle Domingues Dibe
- MD. Gynecologist, Laboratory of Diagnosis Pathology and Cytopathology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Bruna Rodrigues de Paiva
- MD. Postgraduate Student in Nutrology, Laboratory of Diagnosis Pathology and Cytopathology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Elyzabeth Avvad Portari
- MD, MSc, PhD. Pathologist, Researcher in Laboratory of Diagnosis Pathology and Cytopathology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Dione Corrêa de Araújo Dock
- MD. Physician and Pathologist, Laboratory of Diagnosis Pathology and Cytopathology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Nilma Valéria Caldeira Ferreira
- BSc. Immunohistochemistry Technician, Laboratory of Diagnosis Pathology and Cytopathology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Saint Clair Gomes
- BSc, PhD. Researcher in Clinical Research Unit, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Fábio Bastos Russomano
- MD, MSc, PhD. Gynecologist, Center for the Clinical and Surgical Care of Women, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
| | - Cecília Vianna de Andrade
- MD, MSc, PhD. Pathologist, Laboratory of Diagnosis Pathology and Cytopathology, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil
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Øvestad IT, Dalen I, Andersland MS, Vintermyr OK, Moltu P, Berland JM, Janssen EAM, Haugland HK. Triaging HPV-Positive Cervical Samples with p16 and Ki-67 Dual Stained Cytology within an Organized Screening Program-A Prospective Observational Study from Western Norway. Int J Mol Sci 2023; 24:ijms24087158. [PMID: 37108319 PMCID: PMC10138375 DOI: 10.3390/ijms24087158] [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: 02/10/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
The implementation of high-risk human papillomavirus testing (hrHPV testing) as a screening method in substitute for cytology has evoked the need for more sensitive and less objective tests for the triage of HPV-positive women. In a cohort of 1763 HPV-positive women, the potential of immunocytochemical p16 and Ki-67 dual staining as compared to cytology, alone or in combination with HPV partial genotyping, was tested for triage of women attending a cervical cancer screening program. Performance was measured using sensitivity, specificity, and positive and negative predictive values. Comparisons were assessed using logistic regression models and the McNemar test. Dual staining was evaluated in a prospectively collected study cohort of 1763 HPV-screened women. For triage of CIN2+ and CIN3+, NPV and sensitivity, 91.8% and 94.2% versus 87.9% and 89.7%, respectively, were significantly higher using dual staining together with HPV 16/18 positive, as compared to cytology (p < 0.001). The specificities, however, were lower for dual staining as compared to cytology. Conclusions: Dual staining is safer for decision-making regarding HPV-positive women's need for follow-up with colposcopy and biopsy, as compared to cytology.
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Affiliation(s)
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Marie S Andersland
- Department of Pathology, Haukeland University Hospital, 5053 Bergen, Norway
| | - Olav K Vintermyr
- Department of Pathology, Haukeland University Hospital, 5053 Bergen, Norway
- Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Pia Moltu
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Jannicke M Berland
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Emilius A M Janssen
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Technology, University of Stavanger, 4021 Stavanger, Norway
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Detection of Complement C1q B Chain Overexpression and Its Latent Molecular Mechanisms in Cervical Cancer Tissues Using Multiple Methods. Int J Genomics 2022; 2022:8775330. [PMID: 36313902 PMCID: PMC9613392 DOI: 10.1155/2022/8775330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/05/2022] [Indexed: 11/28/2022] Open
Abstract
Aim The aim of this study is to demonstrate the expression and clinicopathological significance of complement C1q B chain (C1QB) in cervical cancer. Methods In total, 120 cervical cancer tissues, as well as 20 samples each of high-grade squamous intraepithelial lesions (HSILs), low-grade squamous intraepithelial lesions (LSILs), and benign cervical tissue, were collected to evaluate the expression of C1QB protein via immunohistochemical staining. We conducted an integrated analysis of C1QB mRNA expression in cervical cancer using public microarrays and RNA-seq data sets by calculating standard mean differences (SMDs). Simultaneously, we explored the relations of C1QB with clinicopathological parameters and the expression of P16, Ki-67, and P53. Results The expression of C1QB protein was higher in cervical cancer samples than that in benign cervical tissue, LSIL, and HSIL samples (p < 0.05). A combined SMD of 0.65 (95% CI: [0.52, 0.79], p < 0.001) revealed upregulation of C1QB mRNA in cervical cancer. C1QB expression may also be related to the depth of infiltration, lymphovascular invasion, and perineural invasion in cervical cancer (p < 0.05). We also found that C1QB protein expression was positively correlated with P16 and Ki-67 expression in cervical cancer (p < 0.05). The gene set enrichment analysis showed that C1QB may participate in apoptosis and autophagy. A relationship was predicted between C1QB expression and drug sensitivity to cisplatin, paclitaxel, and docetaxel. Conclusion We confirmed the overexpression of C1QB in cervical cancer at both mRNA and protein levels for the first time. C1QB may serve as an oncogene in the tumorigenesis of cervical cancer, but this possibility requires further study.
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Genotyping and Cytology Triage of High-Risk HPV DNA Positive Women for Detection of Cervical High-Grade Lesions. J Low Genit Tract Dis 2022; 27:12-18. [PMID: 36205321 DOI: 10.1097/lgt.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A demonstration project of primary human papillomavirus (HPV) testing was initiated in 2011 among more than 23,000 women attending routine cervical cancer screening. We examined the additional diagnostic performance of HPV genotyping for detecting disease in women with abnormal cytology. METHODS Women aged 30 to 65 years were originally screened for HPV using Hybrid Capture II test. Women with positive results were triaged using conventional cytology, and those with atypical squamous cells of undetermined significance or worse (≥ASC-US) were referred to colposcopy. We retrospectively genotyped (Roche cobas 4800 HPV system [Roche Molecular Systems Inc, Pleasanton, CA]) cervical specimens that were HPV+ with Hybrid Capture II test and extracted women's medical history postbaseline screening. We calculated positive predictive values (PPVs) and 95% confidence intervals (CIs) of triage tests to detect histologically confirmed cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) within the first year of follow-up among women positive for HPV16, HPV18, and HPV16 and/or HPV18 as well as among those negative for HPVs 16 and 18. RESULTS Of 1,396 HPV-positive women, 1,092 (78%) were classified as normal, 136 (10%) had CIN1, 80 (6%) had CIN2, 81 (6%) had CIN3, and 7 women had cancer throughout the entire follow-up period. Seventy CIN2+ cases were detected within the first year of follow-up. The PPV for detecting CIN2+ was 20.9% (63/239; 95% CI = 16.4-25.9) for ASC-US+ cytology. In women with ASC-US+, PPVs were 31.2% (24/77; 95% CI = 21.1-42.7) for HPV16+, 27.8% (5/18; 95% CI = 9.7-53.5) for HPV18+, 30.8% (28/91; 95% CI = 21.5-41.3) for HPV16+ and/or HPV18+ women, and 16.6% (35/211; 95% CI = 11.8-22.3) in women testing negative for HPVs 16 and 18. CONCLUSION Partial genotyping as an additional triage strategy to cytology can markedly improve clinical diagnostic performance.
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The Role of p16/Ki-67 Immunostaining, hTERC Amplification and Fibronectin in Predicting Cervical Cancer Progression: A Systematic Review. BIOLOGY 2022; 11:biology11070956. [PMID: 36101337 PMCID: PMC9312145 DOI: 10.3390/biology11070956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/11/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
Human papillomaviruses (HPVs) are common sexually transmitted infectious agents responsible for several anogenital and head and neck cancers. Cervical cancer (CC) is the fourth leading cause of death in women with cancer. The progression of a persistent HPV infection to cancer takes 15–20 years and can be preventable through screening. Cervical cytology (Pap smear) is the standard screening test for CC and precancerous lesions. For ASC-US and ASC-H lesions, a combination of Pap smear and HR-HPV analysis is recommended as a triage step before colposcopy. However, these tests cannot predict progression to CC. For this purpose, we summarized current scientific data on the role of p16/Ki-67 immunohistostaining, telomerase and fibronectin in predicting progression to CC. p16 and p16/Ki-67 dual staining (DS) were more specific than HR-HPV DNA testing for the detection of CIN2+/CIN3+ in women with ASC-US and LSIL. Similarly, hTERC FISH analysis significantly improved the specificity and positive predictive value of HPV DNA testing in differentiating CIN2+ from CIN2 cytological samples. In conclusion, p16 IHC, p16/Ki-67 DS and hTERC FISH amplification are all valid adjunctive biomarkers which significantly increase the sensitivity and specificity of cervical dysplasia diagnosis, especially when combined with HPV DNA testing. However, considering the global socioeconomic background, we can postulate that p16 and p16/ Ki-67 IHC can be used as a next step after positive cytology for ASC-US or LSIL specimens in low-income countries, instead of HPV DNA testing. Alternatively, if HPV DNA testing is covered by insurance, p16 or p16/Ki-67 DS and HPV DNA co-testing can be performed. In middle- and high-income countries, hTERC amplification can be performed as an adjunctive test to HPV DNA testing in women with ASC-US and LSIL.
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Gilbert L, Ratnam S, Jang D, Alaghehbandan R, Schell M, Needle R, Ecobichon-Morris A, Wadhawan A, Costescu D, Elit L, Wang P, Zahariadis G, Chernesky M. Comparison of CINtec PLUS cytology and cobas HPV test for triaging Canadian patients with LSIL cytology referred to colposcopy: A two-year prospective study. Cancer Biomark 2021; 34:347-358. [PMID: 35001877 PMCID: PMC9535599 DOI: 10.3233/cbm-210366] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES & METHODS: CINtec PLUS and cobas HPV tests were compared for triaging patients referred to colposcopy with a history of LSIL cytology in a 2-year prospective study. Cervical specimens were tested once at enrollment, and test positivity rates determined. Test performance was ascertained with cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3 or worse (CIN3+) serving as clinical endpoints. RESULTS: In all ages, (19–76 years, n= 598), 44.3% tested CINtec PLUS positive vs. 55.4% HPV positive (p< 0.001). To detect CIN2+ (n= 99), CINtec PLUS was 81.8% sensitive vs. 93.9% for HPV testing (p= 0.009); genotype 16/18-specific sensitivity was 46.5%. Specificity was 52.9% vs. 36.6%, respectively (p< 0.001). In all ages, to detect CIN3+ (n= 44), sensitivity was 93.2% for both tests; genotype 16/18-specific sensitivity was 52.3%. Specificity was 48.4% for CINtec PLUS vs. 31.1% for HPV testing (p< 0.001). In patients < 30 years, CINtec was 91.7% sensitive vs 95.8% for HPV testing (p= 0.549). CONCLUSIONS: CINtec PLUS or cobas HPV test could serve as a predictor of CIN3+ with high sensitivity in patients referred to colposcopy with a history of LSIL regardless of age while significantly reducing the number of LSIL referral patients requiring further investigations and follow-up in colposcopy clinics.
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Affiliation(s)
- Laura Gilbert
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | - Sam Ratnam
- Faculty of Medicine, Memorial University, St. John's, Canada.,McMaster University, St. Joseph's Healthcare, Hamilton, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Dan Jang
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | | | - Miranda Schell
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Rob Needle
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | | | - Arnav Wadhawan
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | - Dustin Costescu
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Laurie Elit
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Peter Wang
- Faculty of Medicine, Memorial University, St. John's, Canada
| | - George Zahariadis
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | - Max Chernesky
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
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Onyango CG, Ogonda L, Guyah B, Shiluli C, Ganda G, Orang'o OE, Patel K. Novel biomarkers with promising benefits for diagnosis of cervical neoplasia: a systematic review. Infect Agent Cancer 2020; 15:68. [PMID: 33292364 PMCID: PMC7670699 DOI: 10.1186/s13027-020-00335-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cervical cancer screening is slowly transitioning from Pappanicolaou cytologic screening to primary Visual Inspection with Acetic Acid (VIA) or HPV testing as an effort to enhance early detection and treatment. However, an effective triage tests needed to decide who among the VIA or HPV positive women should receive further diagnostic evaluation to avoid unnecessary colposcopy referrals is still lacking. Evidence from experimental studies have shown potential usefulness of Squamous Cell Carcinoma Antigen (SCC Ag), Macrophage Colony Stimulating Factor (M-CSF), Vascular Endothelial Growth Factor (VEGF), MicroRNA, p16INKa / ki-67, HPV E6/E7/mRNA, and DNA methylation biomarkers in detecting premalignant cervical neoplasia. Given the variation in performance, and scanty review studies in this field, this systematic review described the diagnostic performance of some selected assays to detect high-grade cervical intraepithelial neoplasia (CIN2+) with histology as gold standard. METHODS We systematically searched articles published in English between 2012 and 2020 using key words from PubMed/Medline and SCOPUS with two reviewers assessing study eligibility, and risk of bias. We performed a descriptive presentation of the performance of each of the selected assays for the detection of CIN2 + . RESULTS Out of 298 citations retrieved, 58 articles were included. Participants with cervical histology yielded CIN2+ proportion range of 13.7-88.4%. The diagnostic performance of the assays to detect CIN2+ was; 1) SCC-Ag: range sensitivity of 78.6-81.2%, specificity 74-100%. 2) M-CSF: sensitivity of 68-87.7%, specificity 64.7-94% 3) VEGF: sensitivity of 56-83.5%, specificity 74.6-96%. 4) MicroRNA: sensitivity of 52.9-67.3%, specificity 76.4-94.4%. 5) p16INKa / ki-67: sensitivity of 50-100%, specificity 39-90.4%. 6) HPV E6/E7/mRNA: sensitivity of 65-100%, specificity 42.7-90.2%, and 7) DNA methylation: sensitivity of 59.7-92.9%, specificity 67-98%. CONCLUSION Overall, the reported test performance and the receiving operating characteristics curves implies that implementation of p16ink4a/ki-67 assay as a triage for HPV positive women to be used at one visit with subsequent cryotherapy treatment is feasible. For the rest of assays, more robust clinical translation studies with larger consecutive cohorts of women participants is recommended.
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Affiliation(s)
- Calleb George Onyango
- Department of Biomedical Sciences and Technology, Maseno University, P.O Box Private Bag, Maseno, Kenya.
| | - Lilian Ogonda
- Department of Biomedical Sciences and Technology, Maseno University, P.O Box Private Bag, Maseno, Kenya
| | - Bernard Guyah
- Department of Biomedical Sciences and Technology, Maseno University, P.O Box Private Bag, Maseno, Kenya
| | - Clement Shiluli
- Department of Biomedical Sciences and Technology, Maseno University, P.O Box Private Bag, Maseno, Kenya
| | - Gregory Ganda
- Department of Clinical Services, Division of Gynecology / Oncology, Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), P.O Box 849, Kisumu, Kenya
| | - Omenge Elkanah Orang'o
- Department of Reproductive Health, Division of Gynecology / Oncology, Moi University, P. O Box 4606, Eldoret, Kenya
| | - Kirtika Patel
- Department of Immunology, Moi University, P.O Box 4606, Eldoret, Kenya
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