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Su Y, Zheng T, Bi Z, Jia X, Li Y, Kuang X, Yang Y, Chen Q, Lin H, Huang Y, Huang S, Qiao Y, Wu T, Zhang J, Xia N. Pattern of multiple human papillomavirus infection and type competition: An analysis in healthy Chinese women aged 18-45 years. Hum Vaccin Immunother 2024; 20:2334474. [PMID: 38619081 PMCID: PMC11020552 DOI: 10.1080/21645515.2024.2334474] [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: 01/22/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
To assess the pattern of multiple human papillomavirus infection to predict the type replacement postvaccination. A total of 7372 women aged 18-45y from a phase III trial of an Escherichia coli-produced HPV-16/18 vaccine were analyzed at enrollment visit before vaccination. Hierarchical multilevel logistic regression was used to evaluate HPV vaccine type and nonvaccine-type interactions with age as a covariate. Binary logistic regression was construed to compare multiple infections with single infections to explore the impact of multiple-type infections on the risk of cervical disease. Multiple HPV infections were observed in 25.2% of HPV-positive women and multiple infections were higher than expected by chance. Statistically significant negative associations were observed between HPV16 and 52, HPV18 and HPV51/52/58, HPV31 and HPV39/51/52/53/54/58, HPV33 and HPV52/58, HPV58 and HPV52, HPV6 and HPV 39/51/52/53/54/56/58. Multiple HPV infections increased the risk of CIN2+ and HSIL+, with the ORs of 2.27(95%CI: 1.41, 3.64) and 2.26 (95%CI: 1.29, 3.95) for multiple oncogenic HPV infection separately. However, no significant evidence for the type-type interactions on risk of CIN2+ or HSIL+. There is possibility of type replacement between several pairs of vaccine and nonvaccine HPV type. Multiple HPV infection increased the risk of cervical disease, but coinfection HPV types seem to follow independent disease processes. Continued post-vaccination surveillance for HPV 51/52/58 types and HPV 39/51 types separately was essential after the first and second generation of HPV vaccination implementation in China.
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Affiliation(s)
- Yingying Su
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Tingquan Zheng
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Zhaofeng Bi
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Xinhua Jia
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Yufei Li
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Xuefeng Kuang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Yuan Yang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Qi Chen
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Hongyan Lin
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Yue Huang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Shoujie Huang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Youlin Qiao
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Ting Wu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Jun Zhang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
| | - Ningshao Xia
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, Xiamen, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, Xiamen University, Xiamen, China
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Bruno MT, Valenti G, Cavallaro AG, Palermo I, Aiello T, Farina J, Panella MM, Mereu L. Extended Genotyping to Stratify the Risk of CIN2+ in Women with Persistent HPV Infection, Negative Cytology and Type 3 Transformation Zone. Cancers (Basel) 2024; 16:1816. [PMID: 38791895 PMCID: PMC11119326 DOI: 10.3390/cancers16101816] [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: 04/23/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Persistent human papillomavirus (HPV) infection is recognized as a major risk factor for cervical cancer. Women with persistent HPV and negative cytology are at greater risk of CIN2+ than women with negative infection. The diagnosis becomes more complicated when the woman has a type 3 transformation zone at colposcopy. The aim of this study was to determine the prevalence of CIN2+ in women with persistent HPV, negative cytology and TZ3; how to stratify the risk of CIN2+; and what the best diagnostic strategy is, given TZ3. METHODS In a multicenter retrospective cohort study, we enrolled women with negative cytology and TZ3 among the 213 women referred for colposcopy for persistent HPV. The average age of the women was 53 years; in particular, 83% were postmenopausal women. In the presence of a TZ3, the entire transformation zone cannot be explored, making colposcopy and targeted biopsy useless and inadequate, with great risks of underdiagnosis or missed diagnosis. Women with TZ3 underwent diagnostic LEEP to ensure correct diagnoses. RESULTS The study highlighted 19% (16/84) of CIN2+ lesions, a higher frequency of non-HPV 16/18 genotypes (76.2%), and 50% of CIN2+ lesions being due to non-HPV 16/18 genotypes. Furthermore, more than half of the women (80.9%) had normal histopathological results in the LEEP sample. CONCLUSION Women with viral persistence, negative cytology, and TZ3 have a 19% risk of CIN2+; genotyping helps stratify risk, but extensive genotyping is necessary instead of partial genotyping (16/18), referring to a population of women over 50 years old in which the prevalence of genotypes 16,18 decreases and the prevalence of other genotypes increases; diagnostic LEEP is excessive (only 16 cases of CIN2+ out of 48 cases treated), even though 83% of women had viral clearance after LEEP; p16/Ki67 double staining could be a potential risk marker, which would only highlight women at risk of CIN2+ to undergo LEEP. To individualize the diagnostic workup and treatment and minimize the risk of under diagnosis and overtreatment, future studies should explore the use of extended genotyping and new biomarkers for individual risk stratification.
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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; (A.G.C.); (M.M.P.); (L.M.)
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy
| | - Gaetano Valenti
- Humanitas, Gynaecologic Oncology Unit, 95100 Catania, Italy;
| | - Antonino Giovanni Cavallaro
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (A.G.C.); (M.M.P.); (L.M.)
| | - Ilenia Palermo
- Virology Unit, Rodolico Polyclinic, 95123 Catania, Italy;
| | - Tiziana Aiello
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (A.G.C.); (M.M.P.); (L.M.)
| | - Jessica Farina
- Section of Anatomic Pathology, Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Via Santa Sofia 78, 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; (A.G.C.); (M.M.P.); (L.M.)
- 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; (A.G.C.); (M.M.P.); (L.M.)
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Gebreegziabher ZA, Semagn BE, Kifelew Y, Abebaw WA, Tilahun WM. Cervical cancer screening and its associated factors among women of reproductive age in Kenya: further analysis of Kenyan demographic and health survey 2022. BMC Public Health 2024; 24:741. [PMID: 38459446 PMCID: PMC10921781 DOI: 10.1186/s12889-024-18148-y] [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: 09/10/2023] [Accepted: 02/19/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Although cervical cancer screening is one of the most effective strategies to reduce the incidence and mortality of cervical cancer, the percentage of cervical cancer screening in low- and middle-income counties is low. In Kenya, the current nationwide prevalence and associated factors for the detection of cervical cancer is unknown. Therefore, this study aimed to assess the prevalence and associated factors for the detection of cervical cancer screening among women of reproductive age in Kenya using the Kenyan Demographic and Health Survey 2022. METHODS This study used the most recent Kenyan Demographic and Health Survey data (2022) with a total weighted sample of 16,901 women. A mixed effects logistic regression analysis was performed and in the multivariable analysis, variables with a p-value below 0.05 were considered statistically significant. The strength of the association was evaluated using adjusted odds ratios along with their corresponding 95% confidence intervals. RESULTS The prevalence of cervical cancer screening in Kenya was 16.81%(95% CI: 16.24, 17.38%). Having a history of abortion (AOR = 1.33, 95% CI: 1.171.50, 1.43), using modern contraceptive methods (AOR = 1.57, 95% CI: 1.25, 1.95), media exposure (AOR = 1.31, 95%CI: 1.03, 1.65), primary education (AOR = 1.56, 95%CI: 1.09, 2.22), secondary education (AOR = 21.99, 95% CI: 1.1.38, 2.87), higher education (AOR = 2..50, 95% CI: 1.71, 3.65), visiting health facility within the past 12 months (AOR = 1.61, 95%CI: 1.46, 1.79), positive HIV status (AOR: 3.50, 95% CI: 2.69, 4.57), being from a community with a higher proportion of educated individuals (AOR = 1.37, 95%CI: 1.13, 1.65) and being from a community with high proportion of poor individuals (AOR = 0.72, 9 5%CI: 0.60-0.87)) were significantly associated with cervical cancer screening. CONCLUSION In Kenya, the prevalence of cervical cancer screening was found to be low. A history of abortion, use of modern contraceptives, exposure to the media, visits to health facilities in the past 12 months, HIV status, level of education, community educational level, and community wealth were identified as significant associated factors for cervical cancer screening. Therefore, it is recommended to implement targeted public health interventions that focus on these identified factors to improve the adoption of cervical cancer screening in Kenya.
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Affiliation(s)
- Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Birhan Ewunu Semagn
- Department of Public Health, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yitagesu Kifelew
- Department of Statistics, College of Natural and Computational Science, Oda Bultum University, Chiro, Ethiopia
| | - Wondwosen Abey Abebaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Haqshenas G, Molano M, Phillips S, Balgovind P, Garland SM, Hawkes D, Brotherton JM, Machalek DA, Murray G. Evaluation of Seegene Anyplex II Performance for Detection of Human Papillomavirus Genotypes in Formalin-Fixed, Paraffin-Embedded Cervical Cancer Specimens. Arch Pathol Lab Med 2024; 148:353-358. [PMID: 37226838 DOI: 10.5858/arpa.2022-0317-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 05/26/2023]
Abstract
CONTEXT.— Detection of human papillomavirus (HPV) in formalin-fixed, paraffin-embedded (FFPE) tissues may identify the cause of lesions and has value for the development of new diagnostic assays and epidemiologic studies. Seegene Anyplex II assays are widely used for HPV screening, but their performance using FFPE samples has not been fully explored. OBJECTIVE.— To validate Anyplex II HPV HR Detection (Anyplex II, Seegene) using FFPE samples. DESIGN.— We used 248 stored DNA extracts from cervical cancer FFPE samples collected during 2005-2015 that tested HPV positive using the RHA kit HPV SPF10-LiPA25, v1 (SPF10, Labo Biomedical Products) HPV genotyping assay, manufacturer-validated for FFPE samples. RESULTS.— Of the selected 248 samples, 243 were used in our analysis. Consistent with SPF10 genotyping results, Anyplex II detected all 12 oncogenic types and had an overall HPV detection rate of 86.4% (210 of 243 samples). Anyplex II and SPF10 showed very high agreement for the detection of the 2 most important oncogenic genotypes: HPV 16 (219 of 226; 96.9%; 95% CI, 93.7-98.75) and HPV 18 (221 of 226; 97.8%; 95% CI, 94.9-99.3). CONCLUSIONS.— Overall results showed that both platforms produced comparable HPV genotyping results, indicating the suitability of Anyplex II for FFPE samples. The Anyplex II assay has the added convenience of being an efficient, single-well semiquantitative polymerase chain reaction assay. Further optimization of Anyplex II may enhance its performance using FFPE samples by improving the detection limit.
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Affiliation(s)
- Gholamreza Haqshenas
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
| | - Monica Molano
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
| | - Samuel Phillips
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- Murdoch Children's Research Institute, Melbourne, Australia (Haqshenas, Phillips, Balgovind, Garland, Murray)
| | - Prisha Balgovind
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- Murdoch Children's Research Institute, Melbourne, Australia (Haqshenas, Phillips, Balgovind, Garland, Murray)
| | - Suzanne M Garland
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- Murdoch Children's Research Institute, Melbourne, Australia (Haqshenas, Phillips, Balgovind, Garland, Murray)
| | - David Hawkes
- Biochemistry and Pharmacology (Hawkes)
- the Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia (Hawkes, Brotherton)
- the Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia (Hawkes)
| | - Julia Ml Brotherton
- the School of Population and Global Health (Brotherton), University of Melbourne, Melbourne, Australia
| | - Dorothy A Machalek
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- The Kirby Institute, University of New South Wales, Sydney, Australia (Machalek)
| | - Gerald Murray
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- Murdoch Children's Research Institute, Melbourne, Australia (Haqshenas, Phillips, Balgovind, Garland, Murray)
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Sláma J, Dvořák V, Trnková M, Skřivánek A, Hrabcová K, Ovesná P, Nováčková M. Is phased implementation of HPV testing and triage with dual staining the way to transform organized cytology screening? Eur J Cancer Prev 2024; 33:168-176. [PMID: 37751376 PMCID: PMC10833184 DOI: 10.1097/cej.0000000000000844] [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: 08/05/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The substantial material and legislative investments in establishing and maintaining cytological screening in the Czech Republic represent barriers to a direct transition to primary HPV screening. Therefore, the LIBUSE project was implemented to test the efficacy of phasing in HPV DNA testing as a co-test to cytology in routine screening of women >30 years of age. METHODS Women aged 30 to 60 years who underwent regular annual Pap smears were co-tested for HPV DNA with selective 16/18 genotyping at 3-year intervals. All HPV 16/18-positive cases and/or cases with a severe abnormality in cytology were sent for colposcopy; HPV non-16/18-positive cases and LSILs were graded using p16/Ki67 dual-stain cytology, and positive cases were sent for colposcopy. RESULTS Overall, 2409 patients were included. After the first combined screening (year 'zero') visit, 7.4% of women were HPV-positive and 2.0% were HPV16/18-positive; only 8 women had severe Pap smear abnormalities. Triage by dual staining was positive in 21.9% of cases (28/128). Biopsy confirmed 34 high-grade precancer lesions. At the second combined visit (year 'three'), the frequency of HPV infection (5.3% vs. 7.4%) frequency of HPV16/18 (1.1% vs. 2.0%), referrals for colposcopy (35 vs. 83), and biopsy verified high-grade lesions (5 vs. 34) were significantly lower (all P ≤ 0.001). CONCLUSION The addition of HPV DNA testing with selective genotyping of HPV16/18 to existing cytology screening significantly increased the safety of the program. The gradual introduction of HPV testing was well received by healthcare professionals and patients, and can facilitate transformation of the cytology-based screening. ClinicalTrials.gov Identifier: NCT05578833.
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Affiliation(s)
- Jiří Sláma
- Department of Obstetrics, Gynecology and Neonatology, General University Hospital, 1 Medical Faculty, Charles University, Prague
| | | | | | | | | | - Petra Ovesná
- Institute of Biostatistics and Analyses, Brno, Czech Republic
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Harper DM, Yu TM, Fendrick AM. Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results. O&G OPEN 2024; 1:e001. [PMID: 38533459 PMCID: PMC10964775 DOI: 10.1097/og9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To model the potential number of cancers prevented and life-years saved over a range of adherence rates to cervical cancer screening, surveillance follow-up, and follow-up colposcopy that may result from removing financial barriers to these essential clinical services. METHODS A previously validated decision-analytic Markov microsimulation model was used to evaluate the increase in adherence to screening, surveillance, and colposcopy after an abnormal cervical cancer screening result. For each incremental increase in adherence, we modeled the number of cervical cancer cases avoided, the stages at which the cancers were detected, the number of cervical cancer deaths avoided, and the number of life-years gained. RESULTS Compared with current adherence rates, the model estimated that an optimized scenario of perfect screening, surveillance, and colposcopy adherence per 100,000 women currently eligible for screening in the United States was 128 (95% CI, 66-199) fewer cervical cancers detected (23%), 62 (95% CI, 7-120) fewer cervical cancer deaths (20%), and 2,135 (95% CI, 1,363-3,057) more life-years saved. Sensitivity analysis revealed that any increase in adherence led to clinically meaningful health benefits. CONCLUSION The consequences of not attending routine screening or follow-up after an abnormal cervical cancer screening result are associated with preventable cervical cancer morbidity and premature mortality. Given the potential for the removal of consumer cost sharing to increase the use of necessary follow-up after abnormal screening results and to ultimately reduce cervical cancer morbidity and mortality, public and private payers should remove cost barriers to these essential services.
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Affiliation(s)
- Diane M Harper
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - Tiffany M Yu
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - A Mark Fendrick
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
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Kang WD, Ju UC, Kim SM. Human papillomavirus genotyping for predicting disease progression in women with biopsy-negative or cervical intraepithelial neoplasia grade 1 of low-grade intraepithelial lesion cytology. Int J Gynecol Cancer 2023:ijgc-2023-004902. [PMID: 38123190 DOI: 10.1136/ijgc-2023-004902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Our study used human papillomavirus (HPV) genotyping to assess the disease occurrence probability in women with a low-grade squamous intraepithelial lesion (LSIL) without histologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+). METHODS This study investigated CIN2+ incidence in 1986 women from January 2005 to August 2016, including 1123 with LSIL who were histology-proven negative and 863 with LSIL who were histology-proven CIN1. Baseline high-risk HPV (HR-HPV) status was determined using the hybrid capture II assay (HC2), and HR-HPV genotype was determined using the HPV DNA chip test (HDC). RESULTS Among 1986 women, the HC2 yielded positive results in 1529 (77.0%), while the HDC identified 1624 (81.8%). Thus, the overall HDC and HC2 agreement was 93.2%. Overall, 169 (8.5%) patients developed CIN2+. The 5-year cumulative CIN2+ incidence rates for HPV-16, HPV-18, HPV-31, and HPV-33 were 11.8%, 9.9%, 16.3%, and 16.1%, respectively. Multivariate analysis revealed that HPV-16 (HR 1.637, 95% CI 1.064 to 2.520, p=0.025), HPV-31 (HR 1.845, 95% CI 1.051 to 3.238, p=0.033), and HPV-33 (HR 2.272, 95% CI 1.235 to 4.183, p=0.008) were significantly associated with CIN2+ development. CONCLUSION Among women with LSIL, those who test positive for HPV-16, HPV-31, or HPV-33 may require more rigorous follow-up because of a higher CIN2+ risk.
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Affiliation(s)
- Woo Dae Kang
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea (the Republic of)
| | - U Chul Ju
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea (the Republic of)
| | - Seok Mo Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea (the Republic of)
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Jain M, Yadav D, Jarouliya U, Chavda V, Yadav AK, Chaurasia B, Song M. Epidemiology, Molecular Pathogenesis, Immuno-Pathogenesis, Immune Escape Mechanisms and Vaccine Evaluation for HPV-Associated Carcinogenesis. Pathogens 2023; 12:1380. [PMID: 38133265 PMCID: PMC10745624 DOI: 10.3390/pathogens12121380] [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: 10/01/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Human papillomavirus (HPV) is implicated in over 90% of cervical cancer cases, with factors like regional variability, HPV genotype, the population studied, HPV vaccination status, and anatomical sample collection location influencing the prevalence and pathology of HPV-induced cancer. HPV-16 and -18 are mainly responsible for the progression of several cancers, including cervix, anus, vagina, penis, vulva, and oropharynx. The oncogenic ability of HPV is not only sufficient for the progression of malignancy, but also for other tumor-generating steps required for the production of invasive cancer, such as coinfection with other viruses, lifestyle factors such as high parity, smoking, tobacco chewing, use of contraceptives for a long time, and immune responses such as stimulation of chronic stromal inflammation and immune deviation in the tumor microenvironment. Viral evasion from immunosurveillance also supports viral persistence, and virus-like particle-based prophylactic vaccines have been licensed, which are effective against high-risk HPV types. In addition, vaccination awareness programs and preventive strategies could help reduce the rate and incidence of HPV infection. In this review, we emphasize HPV infection and its role in cancer progression, molecular and immunopathogenesis, host immune response, immune evasion by HPV, vaccination, and preventive schemes battling HPV infection and HPV-related cancers.
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Affiliation(s)
- Meenu Jain
- Department of Microbiology, Viral Research and Diagnostic Laboratory, Gajra Raja Medical College, Gwalior 474009, Madhya Pradesh, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea;
| | - Urmila Jarouliya
- SOS in Biochemistry, Jiwaji University, Gwalior 474011 Madhya Pradesh, India;
| | - Vishal Chavda
- Department of Pathology, Stanford School of Medicine, Stanford University Medical Center, Palo Alto, CA 94305, USA;
| | - Arun Kumar Yadav
- Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India;
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj 44300, Nepal;
| | - Minseok Song
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea;
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9
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Qu W, Sui L, Li Y. Vaccine escape challenges virus prevention: The example of two vaccine-preventable oncogenic viruses. J Med Virol 2023; 95:e29184. [PMID: 37943176 DOI: 10.1002/jmv.29184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/06/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
Over the years, the pace of developing vaccines for HBV and HPV has never stopped. After more than 30 years of application, the HBV vaccine has reduced 80% of hepatocellular carcinoma (HCC). However, vaccine escape variants occur under selective pressure induced by widespread vaccination and antiviral therapy, which results in fulminant infection and horizontal transmission. Several mechanisms have been studied to explain HBV vaccine escape, including vaccine escape mutations (VEMs) in the major hydrophilic region, which leads to a decrease in the binding ability to neutralize antibodies and is the primary escape mechanism, protein conformational and N-linked glycosylation sites changes caused by VEMs, differences in genotype distribution, gene recombination, and some temporarily unknown reasons. However, effective solutions are still being explored. The HPV vaccine has also been proven to prevent 70%-90% of cervical cancer worldwide. Cases of HPV infection after being vaccinated have been observed in clinical practice. However, few researchers have paid attention to the mechanism of HPV vaccine escape. Thus, we reviewed the literature on vaccine escape of both HBV and HPV to discuss the mechanism of the virus escaping from vaccine protection and possible solutions to this problem. We analyzed the gap between studies of HPV and HBV and made prospects for further research in HPV vaccine escape.
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Affiliation(s)
- Wenjie Qu
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Long Sui
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yanyun Li
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Trujillo-Cirilo L, Weiss-Steider B, Vargas-Angeles CA, Corona-Ortega MT, Rangel-Corona R. Immune microenvironment of cervical cancer and the role of IL-2 in tumor promotion. Cytokine 2023; 170:156334. [PMID: 37598478 DOI: 10.1016/j.cyto.2023.156334] [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: 08/11/2022] [Revised: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
The tumor microenvironment (TME) is a heterogeneous mixture of resident and tumor cells that maintain close communication through their secretion products. The composition of the TME is dynamic and complex among the different types of cancer, where the immune cells play a relevant role in the elimination of tumor cells, however, under certain circumstances they contribute to tumor development. In cervical cancer (CC) the human papilloma virus (HPV) shapes the microenvironment in order to mediate persistent infections that favors transformation and tumor development. Interleukin-2 (IL-2) is an important TME cytokine that induces CD8+ effector T cells and NKs to eliminate tumor cells, however, IL-2 can also suppress the immune response through Treg cells. Recent studies have shown that CC cells express the IL-2 receptor (IL-2R), that are induced to proliferate at low concentrations of exogenous IL-2 through alterations in the JAK/STAT pathway. This review provides an overview of the main immune cells that make up the TME in CC, as well as the participation of IL-2 in the tumor promotion. Finally, it is proposed that the low density of IL-2 produced by immunocompetent cells is used by tumor cells through its IL-2R as a mechanism to proliferate simultaneously depleting this molecule in order to evade immune response.
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Affiliation(s)
- Leonardo Trujillo-Cirilo
- Laboratory of Cellular Oncology, Research Unit Cell Differentiation and Cancer, L-4 P.B. FES Zaragoza, National University of Mexico, Av., Guelatao No. 66 Col. Ejercito de Oriente, Iztapalapa, C.P. 09230 Mexico City, Mexico.
| | - Benny Weiss-Steider
- Laboratory of Cellular Oncology, Research Unit Cell Differentiation and Cancer, L-4 P.B. FES Zaragoza, National University of Mexico, Av., Guelatao No. 66 Col. Ejercito de Oriente, Iztapalapa, C.P. 09230 Mexico City, Mexico
| | - Carlos Adrian Vargas-Angeles
- Laboratory of Cellular Oncology, Research Unit Cell Differentiation and Cancer, L-4 P.B. FES Zaragoza, National University of Mexico, Av., Guelatao No. 66 Col. Ejercito de Oriente, Iztapalapa, C.P. 09230 Mexico City, Mexico
| | - Maria Teresa Corona-Ortega
- Laboratory of Cellular Oncology, Research Unit Cell Differentiation and Cancer, L-4 P.B. FES Zaragoza, National University of Mexico, Av., Guelatao No. 66 Col. Ejercito de Oriente, Iztapalapa, C.P. 09230 Mexico City, Mexico
| | - Rosalva Rangel-Corona
- Laboratory of Cellular Oncology, Research Unit Cell Differentiation and Cancer, L-4 P.B. FES Zaragoza, National University of Mexico, Av., Guelatao No. 66 Col. Ejercito de Oriente, Iztapalapa, C.P. 09230 Mexico City, Mexico
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11
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Lee RY, Koo JY, Kim NI, Kim SS, Nam JH, Choi YD. Usefulness of the human papillomavirus DNA chip test as a complementary method for cervical cytology. Cytojournal 2023; 20:34. [PMID: 37810438 PMCID: PMC10559486 DOI: 10.25259/cytojournal_40_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 05/08/2022] [Indexed: 10/10/2023] Open
Abstract
Objectives As a convenient and economical method of screening cervical cancer and precancerous pathologies, the Papanicolaou smear (Pap smear) has been most widely used. Nevertheless, it requires cytological changes for making diagnoses and reportedly has a high false-negative rate. In this study, the usefulness of the human papillomavirus (HPV) DNA chip test as a complementary method that can compensate for the defect of the Pap smear was investigated. Material and Methods Of the 6516 patients who simultaneously underwent a Pap smear and an HPV DNA chip test at Chonnam National University Hospital between January 2015 and December 2016, 1897, an initial PAP smear-negative patients who had undergone an additional Pap smear during their 2-year follow-up period were selected for this study. Of the subject patients, 281 underwent a cervical biopsy. Results The Pap smear follow-up of an initial Pap smear-negative subjects showed 53 (75.7%) HPV high-risk positive cases in the cytology low-grade lesion group (70 cases) and 46 (97.8%) HPV high-risk positive cases in the cytology high-grade lesion group (47 cases). The 281 biopsy cases included 67 biopsy low-grade lesion cases and 74 biopsy high-grade lesion cases, of which there were 45 (67.2%) and 67 (90.5%) HPV high-risk positive cases, respectively. The follow-up cytology on the high-risk HPV-positive subjects showed that the ratio of their high-grade lesions was 260.8 times greater than that of the high-risk HPV-negative subjects (OR = 260.8 and 95% CI: 36.1 and 1886.1); and their biopsy showed that the ratio of their high-grade lesions was 102.7 times greater than that of the HPV-negative subjects (OR = 102.7 and 95% CI: 14.0 and 753.3). Conclusion The complementary use of the HPV DNA chip test may be useful in increasing the accuracy of screening examinations for the early diagnosis of uterine cervix cancer when combined with the Pap smear.
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Affiliation(s)
- Rae-Young Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Joo-Yeon Koo
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Nah-Ihm Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Sun Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong-Hee Nam
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
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12
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Hoyer H, Stolte C, Böhmer G, Hampl M, Hagemann I, Maier E, Denecke A, Hirchenhain C, Patzke J, Jentschke M, Gerick A, Heller T, Hippe J, Wunsch K, Schmitz M, Dürst M. Evaluation of CIN2/3 Lesion Regression in GynTect ® DNA Methylation-Marker-Negative Patients in a Longitudinal Study. Cancers (Basel) 2023; 15:3951. [PMID: 37568767 PMCID: PMC10417134 DOI: 10.3390/cancers15153951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Cervical intraepithelial neoplasia (CIN) grade 2/3 has a high spontaneous regression rate, especially among women ≤29 years of age. To reduce overtreatment, reliable prognostic biomarkers would be helpful. The main aim of this study was to analyze the negative predictive value of the methylation marker panel GynTect® for lesion regression. In this prospective, multicenter, longitudinal observational proof-of-concept study, women aged ≤29 years with histologically confirmed CIN2 (n = 24) or CIN3 (n = 36) were closely monitored without treatment for up to 24 or 12 months, respectively. The outcome was either regression, persistence, or progression of the lesion. For each patient, a single baseline sample (V0) for cytology, hrHPV detection and methylation analysis was taken. In a primary analysis, the negative predictive value (NPV) of a GynTect®-negative test result at V0 for regression was determined. We tested the null hypothesis NPV ≤ 70% against the alternative hypothesis NPV ≥ 90%. Twelve of the eighteen GynTect®-negative CIN2 patients showed regression (NPV = 67%, 90% CI 44-85%, p = 0.53). Of the 27 GynTect®-negative CIN3 lesions, 15 regressed (NPV = 56%, 90% CI 38-72%, p = 0.92). Although the majority of GynTect®-negative lesions regressed, the postulated NPV of ≥90% was not observed. Thus, the clinical relevance for an implementation of the GynTect® assay for patients undergoing watchful waiting remains questionable. Further studies with longer observation periods should be undertaken.
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Affiliation(s)
- Heike Hoyer
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, 07743 Jena, Germany;
| | - Claudia Stolte
- Institut für Zytologie und Dysplasie (IZD), 30159 Hannover, Germany; (C.S.); (G.B.)
| | - Gerd Böhmer
- Institut für Zytologie und Dysplasie (IZD), 30159 Hannover, Germany; (C.S.); (G.B.)
| | - Monika Hampl
- Frauenklinik, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany;
| | - Ingke Hagemann
- Abts+Partner Partnerschaftsgesellschaft, 24103 Kiel, Germany;
| | | | | | - Christine Hirchenhain
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Technische Universität Dresden, 01307 Dresden, Germany;
| | | | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover (MHH), 30625 Hannover, Germany;
| | - Axel Gerick
- Praxis Dr. Axel Gerick, 52072 Aachen, Germany;
| | - Tabitha Heller
- Zentrum für Klinische Studien (ZKS), Universitätsklinikum Jena, 07747 Jena, Germany;
| | - Juliane Hippe
- Ongnostics GmbH, 07749 Jena, Germany; (J.H.); (K.W.); (M.S.)
| | - Kristina Wunsch
- Ongnostics GmbH, 07749 Jena, Germany; (J.H.); (K.W.); (M.S.)
| | - Martina Schmitz
- Ongnostics GmbH, 07749 Jena, Germany; (J.H.); (K.W.); (M.S.)
| | - Matthias Dürst
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, 07747 Jena, Germany
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13
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Ittiamornlert P, Jareemit N, Phianpiset R, Kuljarusnont S, Hanamornroongruang S, Horthongkham N, Khajorndumrongcherdkul P, Ruengkhachorn I. High-risk human papillomavirus genotyping in women with atypical squamous cells of undetermined significance. Sci Rep 2023; 13:12134. [PMID: 37495771 PMCID: PMC10372087 DOI: 10.1038/s41598-023-39206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023] Open
Abstract
We conducted a prospective study to evaluate the prevalence of high-risk human papillomavirus (hr-HPV) positivity in women with atypical squamous cells of undetermined significance (ASC-US). Additionally, we assessed the association of hr-HPV positivity with the pathology of high-grade squamous intraepithelial lesions or worse (HSIL+) and the risk of subsequent detection of squamous intraepithelial lesions. A total of 376 women were included, with 242 (64.4%) exhibiting hr-HPV positivity. The predominant HPV genotypes were 16, 52 and 58. Factors associated with the immediate detection of HSIL+ pathology included a colposcopic impression of high-grade lesions, hr-HPV positivity, HPV 16 positivity, HPV 18 positivity, HPV 58 positivity, age less than 40 years, and biopsy of two or more pieces. However, only the first three factors were statistically significant in multivariate analysis. Among the 291 women who continued surveillance for 6 months or more, the median follow-up period was 41.8 months (interquartile range [IQR] 26.5-54.0). The prevalence of subsequent HSIL in women with hr-HPV positivity versus negativity was 3.6% versus 0.98%, respectively. The median time to the subsequent detection of SIL was 28.7 months (IQR 14.9-41.7). In conclusion, women with ASC-US in our study had a high proportion of hr-HPV positivity. Type-specific HPV testing could play a pivotal role in the development of specific management protocols for women with ASC-US.Clinical trial registration: https://thaiclinicaltrials.org , TCTR20161017002.
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Affiliation(s)
- Pornporm Ittiamornlert
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Nida Jareemit
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Rattiya Phianpiset
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sompop Kuljarusnont
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | | | - Navin Horthongkham
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornnida Khajorndumrongcherdkul
- Division of Obstetrics and Gynaecological Nursing, Department of Nursing Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Irene Ruengkhachorn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Rad A, Sørbye SW, Tiwari S, Løchen ML, Skjeldestad FE. Risk of Intraepithelial Neoplasia Grade 3 or Worse (CIN3+) among Women Examined by a 5-Type HPV mRNA Test during 2003 and 2004, Followed through 2015. Cancers (Basel) 2023; 15:3106. [PMID: 37370716 DOI: 10.3390/cancers15123106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The study's purpose was to evaluate the performance of a five-type HPV mRNA test to predict cervical intraepithelial neoplasia grade 3 or worse (CIN3+) during up to 12 years of follow-up. METHODS Overall, 19,153 women were recruited by gynecologists and general practitioners in different parts of Norway between 2003 and 2004. The study population comprised 9582 women of these women, aged 25-69 years with normal cytology and a valid five-type HPV mRNA test at baseline. Follow-up for CIN3+ through 2015 was conducted in the Norwegian Cervical Cancer Screening Programme. RESULTS The cumulative incidence of CIN3+ by baseline status for HPV mRNA-positive and mRNA-negative women were 20.8% and 1.1%, respectively (p < 0.001). Age did not affect the long-term ability of the HPV mRNA test to predict CIN3+ during follow-up. CONCLUSION The low long-term risk of CIN3+ among HPV mRNA-negative women and the high long-term risk among HPV mRNA-positive women strengthen the evidence that the five-type HPV mRNA test is an appropriate screening test for women of all ages. Our findings suggest that women with a negative result may extend the screening interval up to 10 years.
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Affiliation(s)
- Amir Rad
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | | | - Sweta Tiwari
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Finn Egil Skjeldestad
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
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15
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Bruno MT, Guaita A, Boemi S, Mazza G, Sudano MC, Palumbo M. Performance of p16/Ki67 Immunostaining for Triage of Elderly Women with Atypical Squamous Cells of Undetermined Significance. J Clin Med 2023; 12:jcm12103400. [PMID: 37240506 DOI: 10.3390/jcm12103400] [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: 03/02/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The p16/Ki67 technique has been poorly studied in postmenopausal women with ASC-US cytology. The objective of this study was to compare the accuracy of p16/Ki67 staining, HPV testing and HPV 16 genotyping for the identification of CIN2 + lesions in postmenopausal women with ASC-US cytology. METHOD A total of 324 postmenopausal women with positive ASC-US were included. The women underwent HPV test, colposcopy, and biopsy. The slides were discolored and then stained with the CINtec Plus Kit for p16/Ki67. The HPV test results were classified as HPV16 +, hrHPV+ (other hrHPV genotypes), or HPV negative. RESULTS The p16/Ki67 sensitivity for CIN2+ was 94.5%, the specificity 86.6%, PPV of 59% and NPV of 95.9%. The HPV test showed a sensitivity of 96.4% for CIN2+, a specificity of 62.8%, a PPV of 35% and a NPV of 98.8%. In postmenopausal women, the prevalence of genotype 16 decreases in favor of the other high-risk genotypes. CONCLUSION Given the low sensitivity of cytology and the low percentage of HPV16-positive cancers among elderly women, triage via cytology and genotyping is not the best strategy; double staining cytology shows high profiles of sensibility and specificity for CIN2+ in ASCUS postmenopausal women.
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Affiliation(s)
- Maria Teresa Bruno
- Department of General Surgery and Medical Surgery Specialties, Gynecological Clinic, University of Catania, 95100 Catania, Italy
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95100 Catania, Italy
| | - Arianna Guaita
- Department of Statistics, Sapienza University of Roma, 00185 Rome, Italy
| | - Sara Boemi
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95100 Catania, Italy
| | - Gabriele Mazza
- Department of General Surgery and Medical Surgery Specialties, Gynecological Clinic, University of Catania, 95100 Catania, Italy
| | - Maria Chiara Sudano
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95100 Catania, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgery Specialties, Gynecological Clinic, University of Catania, 95100 Catania, Italy
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16
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Hernández-Aguado JJ, de La Fuente-Valero J, Ramírez Mena M, Ortega-Medina L, Vidart Aragón JA, Galán JC. Comparative pilot study about HPV test with partial genotyping in primary screening versus other strategies for cervical cancer population screening, CRYGEN 16/18 study. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:262-268. [PMID: 35963773 DOI: 10.1016/j.eimce.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 05/06/2023]
Abstract
INTRODUCTION The early detection of cervical cancer requires the implementation of molecular screening programmes for human papillomavirus (HPV). However, there are discrepancies in the optimization of screening protocols. The performance of 10 primary screening strategies based on molecular, cytological or combined techniques is now evaluated. MATERIAL AND METHODS A blind, prospective, and interventional study was designed in 1.977 35-year-old women. The molecular determination was carried out by the Cobas 4800 HPV platform. Cytological analysis were performed on the same samples without knowledge of the result of the molecular assay. All women in whom HPV-16/HPV-18 was detected or presented cytological alteration together with detection of other high-risk genotypes (HPVhr) were referred to colposcopy. RESULTS The molecular assay detected the presence of HPVhr genotypes in 12.5% of the women, while only 8.1% of the cytologies were pathological. Among the patients referred to colposcopy, in 19.5% high-grade lesions were observed, being HPV-16 present in 65.3% of them. In six of these high-grade lesions (associated with HPV-16 in all cases), cytology was reported as normal. The follow-up one year later, of women with normal cytology and HPVhr detection a HSIL/CIN2+ lesion was detected (associated to HPV-33). In the comparative study with other strategies, the protocol called CRYGEN 16/18 yielded the best balance of sensitivity and specificity with the least referral to colposcopy. CONCLUSIONS Performing molecular detection of HPVhr with partial first-line genotyping of at least HPV-16, with direct referral to colposcopy, increases the detection rate of HSIL/CIN2+ lesions.
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Affiliation(s)
| | | | - Mar Ramírez Mena
- Servicio de Ginecología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Luis Ortega-Medina
- Servicio de Anatomía Patológica, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Juan Carlos Galán
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain; CIBER Epidemiología Salud Pública (CIBERESP), Madrid, Spain.
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Mathematical Modelling of Cervical Precancerous Lesion Grade Risk Scores: Linear Regression Analysis of Cellular Protein Biomarkers and Human Papillomavirus E6/E7 RNA Staining Patterns. Diagnostics (Basel) 2023; 13:diagnostics13061084. [PMID: 36980391 PMCID: PMC10047622 DOI: 10.3390/diagnostics13061084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
The current practice of determining histologic grade with a single molecular biomarker can facilitate differential diagnosis but cannot predict the risk of lesion progression. Cancer is caused by complex mechanisms, and no single biomarker can both make accurate diagnoses and predict progression risk. Modelling using multiple biomarkers can be used to derive scores for risk prediction. Mathematical models (MMs) may be capable of making predictions from biomarker data. Therefore, this study aimed to develop MM–based scores for predicting the risk of precancerous cervical lesion progression and identifying precancerous lesions in patients in northern Thailand by evaluating the expression of multiple biomarkers. The MMs (Models 1–5) were developed in the test sample set based on patient age range (five categories) and biomarker levels (cortactin, p16INK4A, and Ki–67 by immunohistochemistry [IHC], and HPV E6/E7 ribonucleic acid (RNA) by in situ hybridization [ISH]). The risk scores for the prediction of cervical lesion progression (“risk biomolecules”) ranged from 2.56–2.60 in the normal and low–grade squamous intraepithelial lesion (LSIL) cases and from 3.54–3.62 in cases where precancerous lesions were predicted to progress. In Model 4, 23/86 (26.7%) normal and LSIL cases had biomolecule levels that suggested a risk of progression, while 5/86 (5.8%) cases were identified as precancerous lesions. Additionally, histologic grading with a single molecular biomarker did not identify 23 cases with risk, preventing close patient monitoring. These results suggest that biomarker level–based risk scores are useful for predicting the risk of cervical lesion progression and identifying precancerous lesion development. This multiple biomarker–based strategy may ultimately have utility for predicting cancer progression in other contexts.
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18
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Stoler MH, Wright TC, Parvu V, Yanson K, Cooper CK, Andrews JA. Detection of high-grade cervical neoplasia using extended genotyping: Performance data from the longitudinal phase of the Onclarity trial. Gynecol Oncol 2023; 170:143-152. [PMID: 36682092 DOI: 10.1016/j.ygyno.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The Onclarity cervical cancer screening trial was designed to establish the clinical validity of the Onclarity HPV assay for extended genotyping (xGT) during detection of high-grade cervical neoplasia grades 2 or 3 (≥CIN2 or ≥CIN3). Here, three-year follow up data is presented to evaluate the overall efficacy of these screening strategies, compared to the baseline data. METHODS At baseline 29,513 women, ≥25 years, had evaluable cytology and valid high-risk HPV results. Women with atypical squamous cells-undetermined significance or worse cytology or a positive HPV test were referred for colposcopy/biopsy. Participants that did not reach the study end point (treatment for ≥CIN2) continued into the longitudinal phase that included the same protocol as baseline. RESULTS The three-year cumulative incident risk (CIR) for ≥CIN3 in HPV-negative women was 0.15% [95%CI: 0.06, 0.26] and for HPV- and cytology-negative women was 0.12% [95% CI: 0.03,0.23]. HPV16 carried the highest baseline and three-year ≥CIN3 CIR, followed by HPV31 and HPV18. At least one year of genotype-specific persistence increased ≥CIN3 risk for xGT results compared to genotype non-persistence, HPV clearance, or new infection over the same time period. Risk-based screening with immediate colposcopy for HPV16/18/31 and further xGT triage resulted in better ≥CIN3 sensitivity (79.2% versus 72.3%; relative difference of 6.9 [95%CI: 3.3, 10.4]) and a lower colposcopy/≥CIN3 ratio (9.2 versus 11.2; relative difference of -1.9 [95%CI: -2.6, -1.3]) when compared to primary HPV16/18-based screening. CONCLUSIONS An HPV-negative result offers the same assurance of no disease over three years of follow up as that offered by a negative co-testing result. xGT facilitates risk-based screening and persistence tracking and can help optimize disease detection during screening without excessive colposcopic procedures.
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Affiliation(s)
- Mark H Stoler
- University of Virginia Health, Charlottesville, VA 22908, USA.
| | | | - Valentin Parvu
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, 7 Loveton Circle, Sparks, MD 21152, USA
| | - Karen Yanson
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, 7 Loveton Circle, Sparks, MD 21152, USA
| | - Charles K Cooper
- School of Systems Biology, Mail Stop 5B3 10900 University Blvd, Science and Tech Campus, Manassas, VA 20110, USA
| | - Jeffrey A Andrews
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, 7 Loveton Circle, Sparks, MD 21152, USA.
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19
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CIN2 + detection in high-risk HPV patients with no or minor cervical cytologic abnormalities: a clinical approach validated by machine learning. Arch Gynecol Obstet 2023; 307:881-890. [PMID: 36780042 PMCID: PMC9984503 DOI: 10.1007/s00404-023-06953-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/30/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE To evaluate the feasibility and diagnostic value of the combination of colposcopy, cytology and hrHPV (high-risk human papilloma virus) PCR (polymerase chain reaction) testing in patients with no or minor cytologic abnormalities and HPV high risk infection and to find the best predictors for the presence of CIN2 + in this patient collective. METHODS Three hundred and thirty-four hrHPV patients with normal cytology or minor cytologic abnormalities who had a colposcopic examination at the center of colposcopy at the university hospital Aachen in 2021 were enrolled in this retrospective cohort analysis. Multivariate logistic regression and a machine-learning technique (random forests, leave-one-out analysis) were used. RESULTS The overall risk for CIN2 + in hrHPV-positive patients with normal cytology was 7.7% (N = 18) (5% for CIN3 +), 18% (N = 16) (10.1% for CIN3 +) in patients with PAP IIp (ASC-US) and 62.5% (N = 5) (25% for CIN3 +) in patients with PAP IIg (AGC). Variables that show a statistically significant influence for the CIN-status are 'major change' as the result of colposcopy, transformation zone type T1, PAP IIg upon referral (AGC) and hrHPV category 1a (HPV 16/18) detection. Using machine learning (random forests) techniques, the main influencing variables were confirmed. A monotonously decreasing risk for CIN2 + from hrHPV category 1a to 3 (in accordance to the IACR guidelines) was found. CONCLUSION In the collective of hrHPV patients with no or minor cytologic abnormalities, the result of colposcopy and HPV PCR status are key predictors for the detection of CIN2 + with a monotonously decreasing risk for CIN2 + from hrHPV category 1a to 3.
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20
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IPVS policy statement on HPV nucleic acid testing guidance for those utilising/considering HPV as primary precancer screening: Quality assurance and quality control issues. J Clin Virol 2023; 159:105349. [PMID: 36584621 DOI: 10.1016/j.jcv.2022.105349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
We advise that only clinically validated HPV assays which have fulfilled internationally accepted performance criteria be used for primary cervical screening. Further, assays should be demonstrated to be fit for purpose in the laboratory in which they will ultimately be performed, and quality materials manuals and frameworks will be helpful in this endeavor. Importantly, there is a fundamental shortage of well validated, low-cost, low complexity HPV tests that have demonstrated utility in a near-patient setting; representing a significant challenge and focus for future development in order to reach the WHO's goal of eliminating cervical cancer.
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21
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Sheng B, Yao D, Du X, Chen D, Zhou L. Establishment and validation of a risk prediction model for high-grade cervical lesions. Eur J Obstet Gynecol Reprod Biol 2023; 281:1-6. [PMID: 36521399 DOI: 10.1016/j.ejogrb.2022.12.005] [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: 06/15/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To establish and validate a risk prediction model for cervical high-grade squamous intraepithelial lesions (HSIL). METHODS This retrospective study included patients who underwent cervical biopsies at the Cervical Disease Centre of Maternal and Child Hospital of Hubei Province between January 2021 and December 2021. RESULTS A total of 1630 patients were divided into the HSIL + cervical lesion group (n = 186) and the ≤ LSIL cervical lesions group (n = 1444). LSIL, ASC-H, HSIL and SCC, high-risk HPV, HPV16, HPV18/45, multiple HPV strains, acetowhite epithelium, atypical vessels, and mosaicity were independently associated with HSIL + lesions. These factors were used to establish a risk prediction model with a demonstrated area under the curve (AUC) of 0.851 and a C-index of 0.829. Calibration curve analysis showed that the model performed well, with a mean absolute error (MAE) of 0.005. The decision curve showed that the model created by combining the risk factors was more specific and sensitive than each predictive variable. CONCLUSION The model for predicting HSIL demonstrated promising predictive capability and might help identify patients requiring biopsy and treatment.
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Affiliation(s)
- Binyue Sheng
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China
| | - Dongmei Yao
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China.
| | - Xin Du
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China
| | - Dejun Chen
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China
| | - Limin Zhou
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China
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22
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Purut YE, Uçkan K. Could HPV Type 33 Be More Risky Than We Thought? Int J Surg Pathol 2023; 31:4-10. [PMID: 36471500 PMCID: PMC9896528 DOI: 10.1177/10668969221134692] [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: 12/12/2022]
Abstract
Objective: The distribution of human papilloma virus (HPV) genotypes varies by country and region. HPV is the most important risk factor for cervical cancer and HPV 16/18 is the most common genotype. Other high risk HPVs (hrHPVs) other than HPV 16 and 18 contribute significantly to invasive disease. In this study, we aimed to reveal the frequency of association of HPV 16, 18 and other high-risk-HPV types with CIN 2 + (CIN 2 and above) cervical lesions in patients with cervical intraepithelial neoplasia (CIN) and to support the literature especially on the management of high-risk-HPV types other than 16 and 18. Materials and Methods: This retrospective study, which was conducted on 264 patients and 202 patients after the exclusion criteria, was conducted in the gynecology oncology outpatient clinic of the tertiary care hospital between March 2020 and May 2022. HPV 16, HPV 18 and other high-risk-HPV types with negative cytology between the ages of 25-65 were compared by taking a biopsy accompanied by colposcopy performed by the same gynecologist. As a result of colposcopy, CIN2 + patients who underwent excisional procedure were distributed according to HPV type. During this procedure, the patients who were positive for more than one HPV type were considered positive for the group with all subtypes (For example, if the patient was type 31 and 33 positive, they were included in both the 31 and 33 positive groups). The genotype distribution in the high-risk-HPV group was examined. Results: Colposcopy results showed HPV 16 positivity in 43.3%, HPV 33 positivity in 30% and HPV 18 positivity in 10% of the patients with CIN2 + and above lesions. It was observed that the incidence of CIN2 + lesions in the patients with HPV 33 positive was higher than the incidence of a lower-grade lesion (such as CIN1, chronic cervicitis) (p < 0.05). While HPV 33 (r = 0.290, p < 0.000) results were positively correlated with CIN2 + and above lesions, there was a negative correlation with HPV 45 (r = - 0.172, p < 0.015) results (p < 0.05). It was observed that HPV 33 and HPV 45 positivity was a statistically significant variable in predicting the probability of CIN2 + lesions in colposcopy results. It was determined that a HPV 33 positive patient increased the probability of having a CIN2 + lesion by 4.999 times (p < 0.000). Conclusion: In the literature, the role of high-risk -HPV types other than HPV 16 and HPV 18 with negative cytology in the women at risk of cervical preinvasive lesions has still not been fully determined. According to the results of the stuy, especially in women infected with high-risk -HPV types other than HPV 16/18, the relationship between HPV 33 type and CIN 2 + lesions was found to be high, and it was seen that colposcopic biopsy should be performed immediately instead of follow-up after 1 year.
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Affiliation(s)
- Yunus Emre Purut
- SBU Van
Research and Training Hospital,
Gynecology-Oncology clinic, Van, Turkey
| | - Kazım Uçkan
- Department of Gynecology and Obstetrics, faculty of medicine,
Van Yüzüncü
Yıl University, Van, Turkey,Kazım Uçkan, Department of Gynecology and
Obstetrics, faculty of medicine, Van Yüzüncü Yıl University Van- Turkey.
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23
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Caruso CR, Yang Z. Molecular diagnostics of infectious disease: Detection and characterization of microbial agents in cytology samples. Diagn Cytopathol 2023; 51:68-82. [PMID: 36263664 DOI: 10.1002/dc.25064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cytology samples are widely used to diagnose various infectious diseases by detection and identification of causative infectious agents, including bacteria, fungi, and viruses. The role of cytopathology in infectious disease has expanded tremendously in the past decades with the advances in molecular techniques. Molecular diagnostic methods, compared to conventional methods, have shown improved patient outcome, reduction in cost, and shortened hospital stay times. The aim of this article is to review molecular testing in cytology samples for diagnosis of infectious diseases. METHODS The literature search for molecular testing in common cytology samples for diagnosis of infectious diseases was performed. The findings of the studies were summarized. The common cytology samples included in this article were gynecologic specimens, cerebrospinal fluid, bronchoalveolar lavage, and urine samples. CONCLUSIONS There are a number of molecular diagnostic tests that are available to be used in common cytology samples to detect infectious agents. Each test has its own advantages and limitations. It is our hope that upon reading this review article, the readers will have better understanding of molecular diagnostic testing of infectious diseases utilizing commonly sampled cytology specimens in daily practice.
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Affiliation(s)
- Carla R Caruso
- Department of Pathology and Anatomic Sciences, University of Missouri, Columbia, Missouri, USA
| | - Zhongbo Yang
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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24
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Dykens JA, Peterson CE, Holt HK, Harper DM. Gender neutral HPV vaccination programs: Reconsidering policies to expand cancer prevention globally. Front Public Health 2023; 11:1067299. [PMID: 36895694 PMCID: PMC9989021 DOI: 10.3389/fpubh.2023.1067299] [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: 10/11/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Human papillomavirus (HPV) infection is responsible for many cancers in both women and men. Cervical cancer, caused by HPV, is the fourth most common cancer among women worldwide, even though it is one of the most preventable cancers. Prevention efforts include HPV vaccination, however these programs remain nascent in many countries. In 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination including a goal to fully vaccinate 90% of girls with the HPV vaccine by the age of 15. However, very few countries have reached even 70% coverage. Increased vaccine availability in the future may allow the opportunity to vaccinate more people. This could add to the feasibility of introducing gender-neutral HPV vaccination programs. Adopting a gender-neutral HPV vaccine approach will reduce HPV infections transmitted among the population, combat misinformation, minimize vaccine-related stigma, and promote gender equity. We propose approaching programmatic research through a gender-neutral lens to reduce HPV infections and cancers and promote gender equality. In order to design more effective policies and programs, a better understanding of the perspectives of clients, clinicians, community leaders, and policy-makers is needed. A clear, multi-level understanding of these stakeholders' views will facilitate the development of target policy and programs aimed at addressing common barriers and optimizing uptake. Given the benefit of developing gender-neutral HPV vaccination programs to eliminate cervical cancer and address other HPV associated cancers, we must build knowledge through implementation research around this topic to inform policy-makers and funders for future policy shifts.
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Affiliation(s)
- J Andrew Dykens
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Center for Global Health, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Caryn E Peterson
- Center for Global Health, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Hunter K Holt
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Diane M Harper
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Obstetrics & Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Women's Studies, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI, United States
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25
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Piña-Sánchez P. Human Papillomavirus: Challenges and Opportunities for the Control of Cervical Cancer. Arch Med Res 2022; 53:753-769. [PMID: 36462952 DOI: 10.1016/j.arcmed.2022.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Viruses are the most abundant and genetically diverse entities on the planet, infect all life forms and have evolved with their hosts. To date, 263 viral species have been identified that infect humans, of which only seven are considered type I oncogenic. Human papillomavirus (HPV) is the main virus associated with cancer and is responsible for practically all cases of cervical carcinoma. Screening tests for early detection have been available since the 1960s. Undoubtedly, the entailment between knowledge of HPV biology and the natural history of cervical cancer has contributed to the significant advances that have been made for its prevention since the 21st century, with the development of prophylactic vaccines and improved screening strategies. Therefore, it is possible to eradicate invasive cervical cancer as a worldwide public health problem, as proposed by the WHO with the 90-70-90 initiative based on vaccination coverage, screening, and treatment, respectively. In addition, the emerging knowledge of viral biology generates opportunities that will contribute to strengthening prevention and treatment strategies in HPV-associated neoplasms.
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Affiliation(s)
- Patricia Piña-Sánchez
- Laboratorio Molecular de Oncología, Unidad de Investigación Oncológica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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26
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Bruno MT, Cassaro N, Mazza G, Guaita A, Boemi S. Spontaneous regression of cervical intraepithelial neoplasia 3 in women with a biopsy-cone interval of greater than 11 weeks. BMC Cancer 2022; 22:1072. [PMID: 36253767 PMCID: PMC9578209 DOI: 10.1186/s12885-022-10179-1] [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: 05/15/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although there is broad consensus that only a subset of CIN3 will progress to cancer, there is currently no surefire way to predict which CIN3 will regress. Understanding the natural history of CIN3 is important, and finding markers for progression or regression could improve treatment strategies. According to the guidelines of the American Society for Colposcopy and Cervical Pathology of 2006, positive CIN3 p16 in women should be managed with excisional treatment (LEEP). For ethical reasons we cannot fail to treat women with CIN3 in order to study their regression capacity so we conducted a retrospective study to evaluate the regression rate of CIN3 diagnosed with a biopsy by studying the histological result of the cone removed by LEEP. We also investigated age, HPV genotypes and biopsy-cone interval distance as possible regression factors. Methods We selected 171 women with a histological diagnosis of positive CIN3 p16 as an entry criterion. All patients underwent LEEP / biopsy. A histological diagnosis of the cone of CIN3 or higher was considered as persistence or progression, the diagnosis of CIN1 or lower was considered as regression of the lesion. We used out a logistic model to study the probability of spontaneous regression of CIN3 as a function of the patient’s age, the time elapsed between the biopsy and the cone (in weeks) and the HPV genotype. Results We found that the spontaneous regression rate of CIN3 was 15,8%, which was strongly associated with the biopsy-cone interval > 11 weeks. Genotype 16, the most represented, was present both in cases of regression (77.8%) and in persistence (83.3%). Regarding age, the estimated odds ratio of the probability of observing a regression in women over 25 years of age was 0.0045 times that of women under 25 years of age (CI: 0.00020, 0.036). Neither age nor viral genotype are significant as predictors of regression. Conclusion To wait at least 11 weeks from the biopsy before subjecting the woman to LEEP could prevent unnecessary LEEP procedures, considering also that from CIN3 to carcinoma it takes years before the neoplastic transformation takes place. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10179-1.
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Affiliation(s)
- Maria Teresa Bruno
- Department of General Surgery and Medical Surgery Specialties, Gynecological Clinic, University of Catania, Catania, Italy. .,Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, Catania, Italy.
| | - Nazario Cassaro
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, Catania, Italy.,Gynecological Oncology, Humanitas, Catania, Italy
| | - Gabriele Mazza
- Department of General Surgery and Medical Surgery Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Arianna Guaita
- Department of Statistics, Sapienza University of Roma, Rome, Italy
| | - Sara Boemi
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, Catania, Italy
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27
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Palmer M, Katanoda K, Saito E, Acuti Martellucci C, Tanaka S, Ikeda S, Sakamoto H, Machelek D, Ml Brotherton J, Hocking JS. Genotype prevalence and age distribution of human papillomavirus from infection to cervical cancer in Japanese women: A systematic review and meta-analysis. Vaccine 2022; 40:5971-5996. [PMID: 36085257 DOI: 10.1016/j.vaccine.2022.07.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/31/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND National HPV vaccination coverage in Japan is less than one percent of the eligible population and cervical cancer incidence and mortality are increasing. This systematic review and meta-analysis aimed to provide a comprehensive estimate of HPV genotype prevalence for Japan. METHODS English and Japanese databases were searched to March 2021 for research reporting HPV genotypes in cytology and histology samples from Japanese women. Summary estimates were calculated by disease stage from cytology only assessment - Normal, ASCUS, LSIL, HSIL and from histological assessment - CIN1, CIN2, CIN3/AIS, ICC (ICC-SCC, and ICC-ADC), and other. A random-effects meta-analysis was used to calculate summary prevalence estimates of any-HPV, high-risk (HR) and low-risk (LR) vaccine types, and vaccine genotypes (bivalent, quadrivalent, or nonavalent). This study was registered with PROSPERO: CRD42018117596. RESULTS A total of 57759 women with normal cytology, 1766 ASCUS, 3764 LSIL, 2017 HSIL, 3130 CIN1, 1219 CIN2, 869 CIN3/AIS, and 4306 ICC (which included 1032 ICC-SCC, and 638 ICC-ADC) were tested for HPV. The summary estimate of any-HPV genotype in women with normal cytology was 15·6% (95% CI: 12·3-19·4) and in invasive cervical cancer (ICC) was 85·6% (80·7-89·8). The prevalence of HR-HPV was 86·0% (95% CI: 73·9-94·9) for cytological cases of HSIL, 76·9% (52·1-94·7) for histological cases of CIN3/AIS, and 75·7% (68·0-82·6) for ICC. In women with ICC, the summary prevalence of bivalent vaccine genotypes was 58·5% (95% CI: 52·1-64·9), for quadrivalent genotypes was 58·6% (52·2-64·9) and for nonavalent genotypes was 71·5% (64·9-77·6), and of ICC cases that were HPV positive over 90% of infections are nonavalent vaccine preventable. There was considerable heterogeneity in all HPV summary estimates and for ICC, this heterogeneity was not explained by variability in study design, sample type, HPV assay type, or HPV DNA detection method, although studies published in the 1990s had lower prevalence estimates of any-HPV and HR HPV genotypes. INTERPRETATIONS HPV prevalence is high among Japanese women. The nonavalent vaccine is likely to have the greatest impact on reducing cervical cancer incidence and mortality in Japan.
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Affiliation(s)
- Matthew Palmer
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
| | - Kota Katanoda
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Eiko Saito
- Institute for Global Health Policy Research, National Center for Global Health Medicine, Tokyo, Japan
| | | | - Shiori Tanaka
- Department of Global Health Policy, Graduate School of Medicine, The University of Teokyo, Tokyo, Japan; Division of Prevention, Center for Public Health Sciences, National Cancer Center, Japan
| | - Sayaka Ikeda
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Haruka Sakamoto
- Department of Global Health Policy, Graduate School of Medicine, The University of Teokyo, Tokyo, Japan
| | | | - Julia Ml Brotherton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; Australian Centre for the Prevention of Cervical Cancer, Carlton, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia
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28
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Label-free and dual-mode biosensor for HPV DNA based on DNA/silver nanoclusters and G-quadruplex/hemin DNAzyme. Talanta 2022; 247:123554. [DOI: 10.1016/j.talanta.2022.123554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 12/15/2022]
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29
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Gargano JW, McClung N, Lewis RM, Park IU, Whitney E, Castilho JL, Pemmaraju M, Niccolai LM, Brackney M, Debess E, Ehlers S, Bennett NM, Scahill M, Cleveland AA, Querec TD, Unger ER, Markowitz LE. HPV type-specific trends in cervical precancers in the United States, 2008-2016. Int J Cancer 2022; 152:137-150. [PMID: 35904861 DOI: 10.1002/ijc.34231] [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: 11/10/2021] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022]
Abstract
Declines in cervical intraepithelial neoplasia grades 2-3 and adenocarcinoma in situ (CIN2+) observed among young women suggest impact from human papillomavirus (HPV) vaccination. To further evaluate vaccine impact including cross-protection and type replacement, we described high-risk (HR)-HPV type-specific cervical precancer incidence rates among women aged 20-39 years, 2008-2016. We analyzed cross-sectional population-based data on 18,344 cases of CIN2+ from a 5-site surveillance system. Diagnostic specimens were tested for individual HPV types, including 14 HR-HPV types (HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68). We estimated age-specific annual HR-HPV type-specific CIN2+ incidence per 100,000 screened women for individual types, vaccine HR-HPV types (HPV16/18) and non-vaccine HR-HPV types (non-HPV16/18). We evaluated trends using average annual percent changes (AAPC) and 95% confidence intervals (CI), and estimated total declines by comparing 2015-2016 to 2008-2009 using incidence rate ratios. Among 20-24-year-olds, HPV16/18-CIN2+ declined from 2008 through 2016 (AAPC: -21.3%, 95% CI: -28.1%, -13.8%), whereas no trend was observed for non-HPV16/18-CIN2+ (AAPC: -1.8%, 95% CI: -8.1%, 4.9%). After 2010, CIN2+ among 20-24-year-olds was more often caused by non-vaccine versus vaccine HR-HPV types. No significant declining trends were observed in older age groups. In 2015-2016 compared to 2008-2009, HPV16-CIN2+ declined 78%, HPV18-CIN2+ 72%, and HPV31-CIN2+ 51% among 20-24-year-olds; no increases were observed in type-specific CIN2+ incidence. Among 25-29-year-olds, HPV16-CIN2+ declined 18%; CIN2+ attributed to seven nonvaccine types increased significantly. No significant declines were observed in older groups. Significant declines in HPV16/18-CIN2+ in 20-24-year-olds and HPV16-CIN2+ in 25-29-year-olds corroborate impact of HPV vaccination. A declining trend in HPV31-CIN2+ is consistent with cross-protection from vaccination.
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Affiliation(s)
- Julia W Gargano
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Nancy McClung
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Rayleen M Lewis
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States.,Synergy America, Inc., Duluth, Georgia, United States
| | - Ina U Park
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, United States
| | - Erin Whitney
- California Emerging Infections Program, Oakland, California
| | - Jessica L Castilho
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Linda M Niccolai
- Connecticut Emerging Infections Program at Yale, New Haven, Connecticut, United States
| | - Monica Brackney
- Connecticut Emerging Infections Program at Yale, New Haven, Connecticut, United States
| | - Emilio Debess
- Oregon Department of Human Services, Portland, Oregon, United States
| | - Sara Ehlers
- Oregon Department of Human Services, Portland, Oregon, United States
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Mary Scahill
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Angela A Cleveland
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Troy D Querec
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Elizabeth R Unger
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Lauri E Markowitz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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30
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Meng L, Chen S, Shi G, He S, Wang Z, Shen J, Wang J, Sooranna SR, Zhao J, Song J. Use of Single Cell Transcriptomic Techniques to Study the Role of High-Risk Human Papillomavirus Infection in Cervical Cancer. Front Immunol 2022; 13:907599. [PMID: 35769468 PMCID: PMC9236134 DOI: 10.3389/fimmu.2022.907599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022] Open
Abstract
High-risk human papillomavirus (hrHPV) infection has been associated with a higher probability of progression to cervical cancer. However, several extensive studies have reported that the presence of hrHPV can lead to a better prognosis, but the mechanism of how this occurs is unclear. In this study, microbiological analysis was used to identify HPV infection as a factor for the prognosis of patients with cervical squamous cell carcinoma (CSCC). Comparing the interactions of HPV+ and HPV- malignant cells with immune cells as well as the trajectory of malignant cells either with or without HPV, we found that most of the HPV+ cells are well differentiated while HPV- cells appear to be hypo-fractionated. Using transcriptomic and immunostaining data, we validated a set of unfavourable molecules in the HPV- CSCC cells, including KRT16, ITGB1, CXCR1, VEGFA, CRCT1 and TNFRSF10B/DR5. This study provides a basis for the development of a rational post-operative follow-up programme and the development of an appropriate treatment plan for patients with cervical cancer.
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Affiliation(s)
- Lingzhang Meng
- Institute of Cardiovascular Sciences, Guangxi Academy of Medical Sciences, Nanning, China
- Center for Systemic Inflammation Research (CSIR), Youjiang Medical University for Nationalities, Baise, China
| | - Shengcai Chen
- Department of Obstetrics and Gynecology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Guiling Shi
- Department of Obstetrics and Gynecology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Siyuan He
- Center for Systemic Inflammation Research (CSIR), Youjiang Medical University for Nationalities, Baise, China
| | - Zechen Wang
- Center for Systemic Inflammation Research (CSIR), Youjiang Medical University for Nationalities, Baise, China
| | - Jiajia Shen
- Center for Systemic Inflammation Research (CSIR), Youjiang Medical University for Nationalities, Baise, China
| | - Jiajia Wang
- Center for Systemic Inflammation Research (CSIR), Youjiang Medical University for Nationalities, Baise, China
| | - Suren Rao Sooranna
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, London, United Kingdom
| | - Jingjie Zhao
- Life Science and Clinical Research Center, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- *Correspondence: Jian Song, ; Jingjie Zhao,
| | - Jian Song
- Institute of Cardiovascular Sciences, Guangxi Academy of Medical Sciences, Nanning, China
- Center for Systemic Inflammation Research (CSIR), Youjiang Medical University for Nationalities, Baise, China
- Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jian Song, ; Jingjie Zhao,
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31
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Smith MA, Sherrah M, Sultana F, Castle PE, Arbyn M, Gertig D, Caruana M, Wrede CD, Saville M, Canfell K. National experience in the first two years of primary human papillomavirus (HPV) cervical screening in an HPV vaccinated population in Australia: observational study. BMJ 2022; 376:e068582. [PMID: 35354610 PMCID: PMC8965648 DOI: 10.1136/bmj-2021-068582] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review the first two years of the primary human papillomavirus (HPV) cervical screening programme in an HPV vaccinated population. DESIGN Observational study. SETTING Australia. PARTICIPANTS 3 745 318 women with a primary HPV test between 1 December 2017 and 31 December 2019; most women aged <40 years had previously been offered vaccination against HPV16 and HPV18. INTERVENTIONS Primary HPV screening with referral if HPV16 or HPV18 (HPV16/18) positive and triage with liquid based cytology testing (threshold atypical squamous cells-cannot exclude high grade squamous intraepithelial lesion) for women who were positive for high risk HPV types other than 16/18. A 12 month follow-up HPV test was recommended in triaged women with a negative or low grade cytology result, with referral if they tested positive for any high risk HPV type at follow-up. MAIN OUTCOME MEASURES Proportion of women who had attended for their first HPV screening test, tested positive, and were referred for colposcopy; and short term risk of detecting cervical intraepithelial neoplasia (CIN) grade 2 or worse, CIN grade 3 or worse, or cancer. RESULTS 54.6% (n=3 507 281) of an estimated 6 428 677 eligible women aged 25-69 had undergone their first HPV test by the end of 2019. Among those attending for routine screening, positivity for HPV16/18 and for HPV types not 16/18 was, respectively, 2.0% and 6.6% in women aged 25-69 (n=3 045 844) and 2.2% and 13.3% in highly vaccinated cohorts of women aged 25-34 (n=768 362). Colposcopy referral (ages 25-69 years) was 3.5%, increasing to an estimated 6.2% after accounting for women who had not yet had a 12 month repeat test. Cervical cancer was detected in 0.98% (456/46 330) of women positive for HPV16/18 at baseline, including 0.32% (89/28 003) of women with HPV16/18 and negative cytology. Women with HPV types not 16/18 and negative or low grade cytology at both baseline and 12 months were at low risk of serious disease (3.4% CIN grade 3 or worse; 0.02% cancer; n=20 019) but estimated to account for 62.0% of referrals for this screening algorithm. CONCLUSIONS Colposcopy referral thresholds need to consider underlying cancer risk; on this basis, women with HPV16/18 in the first round of HPV screening were found to be at higher risk regardless of cytology result, even in a previously well screened population. Women with HPV types not 16/18 and negative or low grade cytology showed a low risk of serious abnormalities but constitute most referrals and could be managed safely with two rounds of repeat HPV testing rather than one. HPV16/18 driven referrals were low in HPV vaccinated cohorts.
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Affiliation(s)
- Megan A Smith
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - Maddison Sherrah
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - Farhana Sultana
- National Cancer Screening Register, Telstra Health, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Philip E Castle
- Division of Cancer Prevention, and Senior Investigator, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, NIH, Rockville, MD, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Dorota Gertig
- National Cancer Screening Register, Telstra Health, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - C David Wrede
- Oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - Marion Saville
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC, Australia
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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32
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Alsner J, Overgaard J, Tramm T, Lindegaard JC. Hypoxic gene expression is a prognostic factor for disease free survival in a cohort of locally advanced squamous cell cancer of the uterine cervix. Acta Oncol 2022; 61:172-178. [PMID: 34586924 DOI: 10.1080/0284186x.2021.1979249] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tumour hypoxia in locally advanced squamous cervical cancer (LACC) has been shown to be of substantial prognostic importance. The aims of the present study were therefore to investigate if hypoxia could be identified by a newly validated hypoxic gene expression classifier and used as a prognostic factor for disease free survival (DFS). MATERIAL AND METHODS Paraffin embedded biopsies were obtained from 190 patients with LACC with squamous cell carcinoma treated 2005-2016 with chemo-radiation and image guided adaptive brachytherapy. Analysis of hypoxia was successful in 183 patients (96%). Hypoxic classification of tumours into 'more' or 'less' hypoxic was based on 15 genes using the same method as in a prospective head and neck cancer trial (NCT02661152). HPV was genotyped using INNO-LiPA. Local tumour invasion was evaluated by the T-score. Primary endpoint was DFS analysed by Kaplan-Meier and Cox regression. Events were death of any cause, persistent disease, or recurrence. RESULTS The FIGO2009 stage distribution was IB-IIA 9%, IIB 64%, and III-IVA 27%, and mean T-score was 7.2. Pathological nodes were present in 53%. Median observation time was 5.2 years. Local control rate at 5 years was 96%, and pelvic (loco-regional) control 91%. Overall, 36% of the tumours were classified as 'more' hypoxic. The frequency of 'more' hypoxic tumours increased with local tumour intrusion (30% for T-score 0-9 vs. 55% for T-score ≥10, p = 0.004). Hypoxia was associated with decreased DFS in univariate, HR 1.71 (1.04-2.82), and multivariate analysis, HR 1.75 (1.04-2.92), and the effect was particularly observed among tumours with a T-score ≥10. HPV 16/18 was not associated with improved DFS in neither in univariate nor in multivariate analysis. CONCLUSION Hypoxic gene expression is a prominent prognostic factor for DFS in LACC with SCC histology and should be considered for treatment stratification in clinical trials.
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Affiliation(s)
- Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
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33
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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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34
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Celegato M, Messa L, Bertagnin C, Mercorelli B, Loregian A. Targeted Disruption of E6/p53 Binding Exerts Broad Activity and Synergism with Paclitaxel and Topotecan against HPV-Transformed Cancer Cells. Cancers (Basel) 2021; 14:cancers14010193. [PMID: 35008354 PMCID: PMC8750593 DOI: 10.3390/cancers14010193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The identification of new specific anti-human papillomavirus (HPV) drugs is highly needed, as HPV-induced cancers still represent a significant medical issue. The aim of this study was to analyze in more detail the therapeutic potential of a compound, Cpd12, that acts by blocking the binding between HPV E6 oncoprotein and cellular tumor suppressor p53. We demonstrated that by blocking such an interaction, driven by highly conserved residues among oncogenic HPVs, Cpd12 exhibits broad activity against cervical cancer cell lines infected by different HPV genotypes and HPV-positive head-and-neck cancer cells. Interestingly, Cpd12 also showed the ability to inhibit cancer cell migration and to increase the activity of chemotherapeutic drugs such as taxanes and topoisomerase inhibitors. These findings improve the knowledge about the in vitro efficacy of Cpd12, paving the way to preclinical studies to develop new therapeutic strategies against HPV-induced tumors. Abstract High-risk human papillomaviruses (HR-HPV) are the etiological agents of almost all cervical cancer cases and a high percentage of head-and-neck malignancies. Although HPV vaccination can reduce cancer incidence, its coverage significantly differs among countries, and, therefore, in the next decades HPV-related tumors will not likely be eradicated worldwide. Thus, the need of specific treatments persists, since no anti-HPV drug is yet available. We recently discovered a small molecule (Cpd12) able to inhibit the E6-mediated degradation of p53 through the disruption of E6/p53 binding in HPV16- and HPV18-positive cervical cancer cells. By employing several biochemical and cellular assays, here we show that Cpd12 is also active against cervical cancer cells transformed by other HR-HPV strains, such as HPV68 and HPV45, and against a HPV16-transformed head-and-neck cancer cell line, suggesting the possibility to employ Cpd12 as a targeted drug against a broad range of HPV-induced cancers. In these cancer cell lines, the antitumoral mechanism of action of Cpd12 involves p53-dependent cell cycle arrest, a senescent response, and inhibition of cancer cell migration. Finally, we show that Cpd12 can strongly synergize with taxanes and topoisomerase inhibitors, encouraging the evaluation of Cpd12 in preclinical studies for the targeted treatment of HPV-related carcinomas.
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Affiliation(s)
- Marta Celegato
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.C.); (L.M.); (C.B.); (B.M.)
| | - Lorenzo Messa
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.C.); (L.M.); (C.B.); (B.M.)
| | - Chiara Bertagnin
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.C.); (L.M.); (C.B.); (B.M.)
| | - Beatrice Mercorelli
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.C.); (L.M.); (C.B.); (B.M.)
| | - Arianna Loregian
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (M.C.); (L.M.); (C.B.); (B.M.)
- Clinical Microbiology and Virology Unit, Padua University Hospital, 35121 Padua, Italy
- Correspondence: ; Tel.: +39-0498272363
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35
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Staras SAS, Huo T, Rothbard SM, Hall JM, Cho HD, Guo Y, Richardson E, Salloum RG, Thompson LA, Silver NL, Shenkman EA. Human Papillomavirus Vaccination and Human Papillomavirus-Associated Cancer Rates Within Florida Counties. Am J Prev Med 2021; 61:812-820. [PMID: 34384654 DOI: 10.1016/j.amepre.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To direct interventions, the Florida counties with the greatest risk of current and future human papillomavirus‒associated cancers were identified by estimating county-level (1) percentages of adolescents aged 13-17 years who initiated (≥1 dose) and were up to date (2-3 doses) for the human papillomavirus vaccine and (2) human papillomavirus‒associated cancer incidence rates. METHODS Records were obtained for human papillomavirus vaccinations from the Florida immunization registry (2006-2019), incident cancer cases from the Florida registry (2013-2017), and annual population counts from the Florida Department of Health (2006-2019). In 2020, annual county-level human papillomavirus vaccine initiation, human papillomavirus vaccine up-to-date, and age-adjusted human papillomavirus‒associated cancer incidence rates were estimated. RESULTS Among adolescents aged 13-17 years, average 2018-2019 county-specific human papillomavirus vaccine initiation ranged from 38% to 100% for females and from 34% to 96% for males. Up-to-date estimates ranged from 20% to 72% for females and from 24% to 77% for males. The majority (78%) of counties with initiation and up-to-date estimates within the lowest tercile were located in Northern Florida. County-specific 2013-2017 annualized, adjusted human papillomavirus‒associated cancer incidence rates ranged from 0 to 29.8 per 100,000 among females and from 5.4 to 24.1 per 100,000 among males. Counties within the highest tercile for human papillomavirus‒associated cancers were primarily (90% for females and 77% for males) located in Northern Florida. CONCLUSIONS Human papillomavirus‒associated cancer risk varies widely across Florida counties, with particularly high risk within Northern Florida. Targeting interventions toward counties with low vaccination and high cancer rates may reduce human papillomavirus‒associated cancers.
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Affiliation(s)
- Stephanie A S Staras
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; UF Institute for Child Health Policy, University of Florida, Gainesville, Florida.
| | - Tianyao Huo
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Sarah M Rothbard
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Jaclyn M Hall
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; UF Institute for Child Health Policy, University of Florida, Gainesville, Florida
| | - Hee D Cho
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Yi Guo
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Eric Richardson
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Ramzi G Salloum
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; UF Institute for Child Health Policy, University of Florida, Gainesville, Florida
| | - Lindsay A Thompson
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; UF Institute for Child Health Policy, University of Florida, Gainesville, Florida; UF Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Natalie L Silver
- UF Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida
| | - Elizabeth A Shenkman
- UF Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida; UF Institute for Child Health Policy, University of Florida, Gainesville, Florida
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36
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Bebyn MG, Śledzińska P, Wojtysiak J, Jóźwicki W, Mierzwa T, Dziedzic J, Kowalewski J, Anna Lewandowska M. HPV RNA and DNA testing in Polish women screened for cervical cancer - A single oncological center study. Eur J Obstet Gynecol Reprod Biol 2021; 268:129-134. [PMID: 34915392 DOI: 10.1016/j.ejogrb.2021.11.427] [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: 08/27/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the incidence of HPV infection, and the frequency of the various genotypes, using mRNA and DNA testing; to assess their relationship with the cervical lesions and women's age in the Polish patients. STUDY DESIGN A group of 1840 women, most of whom had abnormal cytology, from the Franciszek Łukaszczyk Oncology Centre in Bydgoszcz, Poland were screened for presence of at least one of 13 high risk HPV. Following that, 545 HPV DNA positive women were tested for HPV infection using HPV mRNA with the Nucleic Acid Sequence-Based Amplification Assay (NASBA) method. RESULTS In our study group, 70.1% had DNA HPV positive results. Only 4% of the women had normal cytology. Among 545 HPV DNA positive patients, 36.3% had HPV mRNA positive tests. Moreover, 48% of the HPV mRNA positive patients were infected with HPV 16, followed by 18 (12.6%), 31 (10.1%), 33 (8.6%%), 45 (4.5%), and 16.2% of HPV mRNA positive women were infected with more than one HPV genotype. Furthermore, we found that in women under 30, HPV DNA positivity was higher than HPV mRNA positivity, supporting the hypothesis that younger women's infections are mostly temporary. CONCLUSIONS The differences in HPV prevalence and genotype distribution observed in our study may have an impact on the efficacy of HPV vaccinations for cervical cancer and the development of screening programs, which should be examined further in future studies.
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Affiliation(s)
- Marek G Bebyn
- The F. Lukaszczyk Oncology Center, Molecular Oncology and Genetics Department, Innovative Medical Forum, 85-796 Bydgoszcz, Poland; Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Paulina Śledzińska
- The F. Lukaszczyk Oncology Center, Molecular Oncology and Genetics Department, Innovative Medical Forum, 85-796 Bydgoszcz, Poland; Department of Thoracic Surgery and Tumors, Ludwik Rydygier Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, Torun, Poland
| | - Joanna Wojtysiak
- The F. Lukaszczyk Oncology Center, Molecular Oncology and Genetics Department, Innovative Medical Forum, 85-796 Bydgoszcz, Poland
| | - Wojciech Jóźwicki
- Department of Tumor Pathology and Pathomorphology, Franciszek Lukaszczyk Oncology Center, Ludwik Rydygier Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, Torun, Poland
| | - Tomasz Mierzwa
- Prevention and Health Promotion's Department, Franciszek Lukaszczyk Oncology Center, Bydgoszcz
| | - Józef Dziedzic
- Prevention and Health Promotion's Department, Franciszek Lukaszczyk Oncology Center, Bydgoszcz
| | - Janusz Kowalewski
- Department of Thoracic Surgery and Tumors, Ludwik Rydygier Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, Torun, Poland
| | - Marzena Anna Lewandowska
- The F. Lukaszczyk Oncology Center, Molecular Oncology and Genetics Department, Innovative Medical Forum, 85-796 Bydgoszcz, Poland; Department of Thoracic Surgery and Tumors, Ludwik Rydygier Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, Torun, Poland.
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37
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Halle MK, Munk AC, Engesæter B, Akbari S, Frafjord A, Hoivik EA, Forsse D, Fasmer KE, Woie K, Haldorsen IS, Bertelsen BI, Janssen EAM, Gudslaugsson E, Krakstad C, Øvestad IT. A Gene Signature Identifying CIN3 Regression and Cervical Cancer Survival. Cancers (Basel) 2021; 13:cancers13225737. [PMID: 34830895 PMCID: PMC8616457 DOI: 10.3390/cancers13225737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/10/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to establish a gene signature that may predict CIN3 regression and that may aid in selecting patients who may safely refrain from conization. Oncomine mRNA data including 398 immune-related genes from 21 lesions with confirmed regression and 28 with persistent CIN3 were compared. L1000 mRNA data from a cervical cancer cohort was available for validation (n = 239). Transcriptomic analyses identified TDO2 (p = 0.004), CCL5 (p < 0.001), CCL3 (p = 0.04), CD38 (p = 0.02), and PRF1 (p = 0.005) as upregulated, and LCK downregulated (p = 0.01) in CIN3 regression as compared to persistent CIN3 lesions. From these, a gene signature predicting CIN3 regression with a sensitivity of 91% (AUC = 0.85) was established. Transcriptomic analyses revealed proliferation as significantly linked to persistent CIN3. Within the cancer cohort, high regression signature score associated with immune activation by Gene Set enrichment Analyses (GSEA) and immune cell infiltration by histopathological evaluation (p < 0.001). Low signature score was associated with poor survival (p = 0.007) and large tumors (p = 0.01). In conclusion, the proposed six-gene signature predicts CIN regression and favorable cervical cancer prognosis and points to common drivers in precursors and cervical cancer lesions.
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Affiliation(s)
- Mari K. Halle
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5053 Bergen, Norway; (E.A.H.); (D.F.); (C.K.)
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway;
- Correspondence: ; Tel.: +47-55970723
| | - Ane Cecilie Munk
- Department of Obstetrics and Gynaecology, Sørlandet Hospital Kristiansand, 4604 Kristiansand, Norway;
| | - Birgit Engesæter
- Section for Cervical Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway;
| | - Saleha Akbari
- Department of Pathology, Stavanger University Hospital, 4068 Stavanger, Norway; (S.A.); (A.F.); (E.A.M.J.); (E.G.); (I.T.Ø.)
| | - Astri Frafjord
- Department of Pathology, Stavanger University Hospital, 4068 Stavanger, Norway; (S.A.); (A.F.); (E.A.M.J.); (E.G.); (I.T.Ø.)
| | - Erling A. Hoivik
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5053 Bergen, Norway; (E.A.H.); (D.F.); (C.K.)
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway;
| | - David Forsse
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5053 Bergen, Norway; (E.A.H.); (D.F.); (C.K.)
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway;
| | - Kristine E. Fasmer
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; (K.E.F.); (I.S.H.)
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Kathrine Woie
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway;
| | - Ingfrid S. Haldorsen
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; (K.E.F.); (I.S.H.)
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Bjørn I. Bertelsen
- Department of Pathology, Haukeland University Hospital, 5021 Bergen, Norway;
| | - Emiel A. M. Janssen
- Department of Pathology, Stavanger University Hospital, 4068 Stavanger, Norway; (S.A.); (A.F.); (E.A.M.J.); (E.G.); (I.T.Ø.)
- Department of Chemistry, Bioscience and Environmental Technology, University of Stavanger, 4036 Stavanger, Norway
| | - Einar Gudslaugsson
- Department of Pathology, Stavanger University Hospital, 4068 Stavanger, Norway; (S.A.); (A.F.); (E.A.M.J.); (E.G.); (I.T.Ø.)
| | - Camilla Krakstad
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5053 Bergen, Norway; (E.A.H.); (D.F.); (C.K.)
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway;
| | - Irene T. Øvestad
- Department of Pathology, Stavanger University Hospital, 4068 Stavanger, Norway; (S.A.); (A.F.); (E.A.M.J.); (E.G.); (I.T.Ø.)
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The use of biomarkers and HPV genotyping to improve diagnostic accuracy in women with a transformation zone type 3. Br J Cancer 2021; 126:91-99. [PMID: 34716397 DOI: 10.1038/s41416-021-01539-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/21/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Twenty percent of women referred to colposcopy have a type 3 transformation zone-where colposcopic assessment for high-grade dysplasia (CIN2+) is not possible. This study examines the effectiveness of HPV biomarkers and genotyping in combination with techniques that sample an endocervical TZ. METHODS A prospective diagnostic accuracy study. Women booked for large-loop excision (LLETZ) with squamous dyskaryosis, high-risk HPV and a TZ3 were recruited. Immediately prior to LLETZ samples were collected for p16/Ki-67 dual-stained cytology, HPV genotyping and H&E, p16- and Ki-67-stained endocervical curettings. RESULTS In women with low-grade screening (n = 64), 35.9% had CIN2+; dual-stained cytology had the greatest effect on the PPV of routine screening (76.1% vs 35.9%) and perfectly predicted the absence of CIN2+. In women with a high-grade screening result (n = 37); 75.6% had CIN2+ and dual-stained curettings improved the PPV (96.5 vs 75.6%). CONCLUSIONS With high-grade screening and a TZ3, LLETZ appears safest as three quarters have CIN2+ . Women with low-grade screening and a TZ3 have a twofold increased risk of CIN2+ when compared to women where the TZ is visible. The use of dual-stained cytology may help identify those women who can be safely offered surveillance and those who require treatment.
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Hanley SJB, Fujita H, Aoyama-Kikawa S, Kasamo M, Torigoe T, Matsuno Y, Noriaki S. Evaluation of partial genotyping with HPV16/18 for triage of HPV positive, cytology negative women in the COMPACT study. J Gynecol Oncol 2021; 32:e86. [PMID: 34708593 PMCID: PMC8550923 DOI: 10.3802/jgo.2021.32.e86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/15/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objective While cytology-based screening programs have significantly reduced mortality and morbidity from cervical cancer, the global consensus is that primary human papillomavirus (HPV) testing increases detection of high-grade cervical intraepithelial neoplasia (CIN) and invasive cancer. However, the optimal triage strategy for HPV+ women to avoid over-referral to colposcopy may be setting specific. We compared absolute and relative risk (RR) of >CIN2/3 within 12 months of a negative cytologic result in women HPV16/18+ compared to those with a 12-other high-risk HPV (hrHPV) genotype to identify women at greatest risk of high-grade disease and permit less aggressive management of women with other hrHPV infections. Methods Participants were 14,160 women aged 25–69 years with negative cytology participating in the COMparison of HPV genotyping And Cytology Triage (COMPACT) study. Women who were HPV16/18+ were referred to colposcopy. Those with a 12-other hrHPV type underwent repeat cytology after 6 months and those with >abnormal squamous cells of undetermined significance went to colposcopy. Results Absolute risk of >CIN2 in HPV16/18+ women was 19.5% (95% CI=12.4%–29.4%). In women 25–29 years and HPV16+ it was 40.0% (95% CI=11.8%–76.9%). Absolute risk of >CIN3 in women HPV16/18+ was 11.0% (95% CI=5.9%–19.6%). For women 30–39 years and HPV16+ it was 23.1% (95% CI=5.0%–53.8%). Overall risk of >CIN2, >CIN3 in women with a 12-other hrHPV HPV type was 5.6% (95% CI=3.1%–10.0%) and 3.4% (95% CI=1.6%–7.2%) respectively. RR of >CIN2, >CIN3 in HPV16/18+ vs. 12-other hrHPV was 3.5 (95% CI=1.7–7.3) and 3.3 (95% CI=1.2–8.8), respectively. Conclusion Primary HPV screening with HPV16/18 partial genotyping is a promising strategy to identify women at current/future risk of >CIN2 in Japan without over-referral to colposcopy. Trial Registration UMIN Clinical Trials Registry Identifier: UMIN000013203
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Affiliation(s)
- Sharon J B Hanley
- Department of Obstetrics and Gynecology, Hokkaido University Faculty of Medicine, Sapporo, Japan.,Hokkaido Center for Environmental and Health Sciences, Sapporo, Japan.
| | | | | | | | | | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Sakuragi Noriaki
- Department of Obstetrics and Gynecology, Hokkaido University Faculty of Medicine, Sapporo, Japan.,Women's Healthcare Center, Otaru General Hospital, Otaru, Japan
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Gargano JW, You M, Potter R, Alverson G, Swanson R, Saraiya M, Markowitz LE, Copeland G. An Evaluation of Dose-Related HPV Vaccine Effectiveness Using Central Registries in Michigan. Cancer Epidemiol Biomarkers Prev 2021; 31:183-191. [PMID: 34663615 DOI: 10.1158/1055-9965.epi-21-0625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/02/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccine effectiveness (VE) evaluations provide important information for vaccination programs. We established a linkage between statewide central registries in Michigan to estimate HPV VE against in situ and invasive cervical lesions (CIN3+). METHODS We linked females in Michigan's immunization and cancer registries using birth records to establish a cohort of 773,193 women with known vaccination history, of whom 3,838 were diagnosed with CIN3+. Residential address histories from a stratified random sample were used to establish a subcohort of 1,374 women without CIN3+ and 2,900 with CIN3+ among continuous Michigan residents. VE and 95% confidence intervals (CI) were estimated using cohort and case-cohort methods for up-to-date (UTD) vaccination and incomplete vaccination with 1 and 2 doses, and stratified by age at vaccination. RESULTS Both analytic approaches demonstrated lower CIN3+ risk with UTD and non-UTD vaccination vs. no vaccination. The cohort analysis yielded VE estimates of 66% (95% CI, 60%-71%) for UTD, 33% (95% CI, 18%-46%) for 2 doses-not UTD, and 40% (95% CI, 27%-50%) for 1 dose. The case-cohort analysis yielded VE estimates of 72% (95% CI, 64%-79%) for UTD, 39% (95% CI, 10%-58%) for 2 doses-not UTD, and 48% (95% CI, 25%-63%) for 1 dose. VE was higher for vaccination at age <20 than ≥20 years. CONCLUSIONS The statewide registry linkage found significant VE against CIN3+ with incomplete HPV vaccination, and an even higher VE with UTD vaccination. IMPACT Future VE evaluations by number of doses for women vaccinated at younger ages may further clarify dose-related effectiveness.
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Affiliation(s)
- Julia W Gargano
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Mei You
- Michigan Department of Health and Human Services, Lansing, Michigan
| | | | | | - Robert Swanson
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Glenn Copeland
- Michigan Department of Health and Human Services, Lansing, Michigan
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Ruipérez Pacheco E, Ramírez Mena M, Coronado Martín P. Estudio del aclaramiento de la infección por el VPH de alto riesgo después de una conización. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Comparison of DNA and RNA sequencing of total nucleic acids from human cervix for metagenomics. Sci Rep 2021; 11:18852. [PMID: 34552145 PMCID: PMC8458301 DOI: 10.1038/s41598-021-98452-4] [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: 11/05/2020] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
Although metagenomics and metatranscriptomics are commonly used to identify bacteria and viruses in human samples, few studies directly compare these strategies. We wished to compare DNA and RNA sequencing of bacterial and viral metagenomes and metatranscriptomes in the human cervix. Total nucleic acids from six human cervical samples were subjected to DNA and RNA sequencing. The effect of DNase-treatment before reverse transcription to cDNA were also analyzed. Similarities and differences in the metagenomic findings with the three different sequencing approaches were evaluated. A higher proportion of human sequences were detected by DNA sequencing (93%) compared to RNA sequencing without (76%) and with prior DNase-treatment (11%). On the contrary, bacterial sequences increased 17 and 91 times. However, the number of detected bacterial genera were less by RNA sequencing, suggesting that only a few contribute to most of the bacterial transcripts. The viral sequences were less by RNA sequencing, still twice as many virus genera were detected, including some RNA viruses that were missed by DNA sequencing. Metatranscriptomics of total cDNA provided improved detection of mainly transcribed bacteria and viruses in cervical swabs as well as detection of RNA viruses, compared to metagenomics.
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Garay OU, Maritano Furcada J, Ayerbe F, Pena Requejo Rave RA, Tatti SA. Cost-Effectiveness and Budget Impact Analysis of Primary Screening With Human Papillomavirus Test With Genotyping in Argentina. Value Health Reg Issues 2021; 26:160-168. [PMID: 34530292 DOI: 10.1016/j.vhri.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Cervical cancer (ICC) is the fourth leading cause of mortality in women in Argentina and primary screening with conventional cytology (Papanicolaou smear) is the most widely used strategy despite its limitations. Strategies based on human papillomavirus (HPV) testing have the potential to improve detection and reduce mortality. The objective of this study is to evaluate the cost-effectiveness and budgetary impact of a strategy based on HPV testing with genotyping. METHODS We used a decision model to compare the ICC screening strategies. The population consisted of 30- to 65-year-old females suitable for screening in Argentina. Inputs comprised epidemiologic, diagnostic performance, and costs data. The clinical impact was represented by the number of ICC detected and ICC-related mortality. Incremental cost-effectiveness ratio, estimated in terms of Argentinean pesos per life-year gained, and the budgetary impact were calculated at 5, 10, and 20 years. Univariate and probabilistic sensitivity analyses were performed. RESULTS Primary screening with HPV testing would prevent 1853 ICC deaths and reduce mortality by 13% at year 10 compared with Papanicolaou smear. With an incremental cost-effectiveness ratio of AR$329 042 in the base case, it would be cost-effective for a cost-effectiveness threshold of 1 gross domestic product per capita. It would imply an additional expense in the first 5 years and probably savings in the subsequent ones. Sensitivity analyses confirm the robustness of the findings. CONCLUSIONS The primary screening strategy based on HPV testing with genotyping compared with conventional cytology is most likely a cost-effective strategy in Argentina.
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Baumann A, Henriques J, Selmani Z, Meurisse A, Lepiller Q, Vernerey D, Valmary-Degano S, Paget-Bailly S, Riethmuller D, Ramanah R, Mougin C, Prétet JL. HPV16 Load Is a Potential Biomarker to Predict Risk of High-Grade Cervical Lesions in High-Risk HPV-Infected Women: A Large Longitudinal French Hospital-Based Cohort Study. Cancers (Basel) 2021; 13:cancers13164149. [PMID: 34439304 PMCID: PMC8394477 DOI: 10.3390/cancers13164149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary This study aimed at assessing HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 885 women positive for hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 135 developed a high-grade lesion during the follow-up. Considering an HPV16 viral load cut-off set at 3.2 log10 GE/103 cells a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97 p ≤ 0.0001) has been identified. Moreover, a composite score based on HPV16 load, cytology and hrHPV detection allowed for CIN2+ risk stratification. To conclude, HPV16 load is a relevant biomarker to identify women at high risk for developing precancerous lesions of the cervix. Abstract High-risk HPV (hrHPV) testing has been implemented as a primary screening tool for cervical cancer in numerous countries. However, there is still a need for relevant triage strategies to manage hrHPV positive women to avoid excessive referral to colposcopy. The objective of this study was to assess, in women infected by hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 2102 women positive for hrHPV, 885 had no lesion or mild cytological abnormalities at baseline and had at least one follow-up (FU) visit. HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 15% developed a high-grade lesion during the FU. An HPV16 viral load cut-off set at 3.2 log10GE/103 cells permitted to identify a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97; p ≤ 0.0001). No specific HPV18 viral load threshold could have been defined in regard to the present study. In multivariate analysis, HPV16 load (absence/log10GE/103 cells < 3.2 vs. ≥3.2), RLU/PC 239 (1–100 pg/mL vs. >100 pg/mL) and cytology (normal vs abnormal) were independently associated with a significant increased risk of high-grade lesion development and were used to construct the prognostic score. In conclusion, HPV16 load is a relevant biomarker to identify women at high risk for developing cervical precancerous lesions.
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Affiliation(s)
- Antoine Baumann
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- Pathology Department, CHU de Besançon, 25000 Besançon, France;
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Zohair Selmani
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Aurélia Meurisse
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Quentin Lepiller
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Séverine Valmary-Degano
- Pathology Department, CHU de Besançon, 25000 Besançon, France;
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Sophie Paget-Bailly
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Didier Riethmuller
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
- Gynecology Department, CHU de Besançon, 25000 Besançon, France;
| | - Rajeev Ramanah
- Gynecology Department, CHU de Besançon, 25000 Besançon, France;
| | - Christiane Mougin
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jean-Luc Prétet
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
- Correspondence: ; Tel.: +33-(03)-70-63-20-49
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Hernández-Aguado JJ, de La Fuente-Valero J, Ramírez Mena M, Ortega-Medina L, Vidart Aragón JA, Galán JC. Comparative pilot study about HPV test with partial genotyping in primary screening versus other strategies for cervical cancer population screening, CRYGEN 16/18 study. Enferm Infecc Microbiol Clin 2021; 41:S0213-005X(21)00231-7. [PMID: 34404547 DOI: 10.1016/j.eimc.2021.07.010] [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: 04/07/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The early detection of cervical cancer requires the implementation of molecular screening programs for human papillomavirus (HPV). However, there are discrepancies in the optimization of screening protocols. The performance of 10 primary screening strategies based on molecular, cytological or combined techniques is now evaluated. MATERIAL AND METHODS A blind, prospective, and interventional study was designed in 1977 35-year-old women. The molecular determination was carried out by the Cobas 4800 HPV platform. Cytological analysis was performed on the same samples without knowledge of the result of the molecular assay. All women in whom HPV-16/HPV-18 was detected or presented cytological alteration together with detection of other high-risk genotypes (HPVhr) were referred to colposcopy. RESULTS The molecular assay detected the presence of HPVhr genotypes in 12.5% of the women, while only 8.1% of the cytologies were pathological. Among the patients referred to colposcopy, in 19.5% high-grade lesions were observed, being HPV-16 present in 65.3% of them. In six of these high-grade lesions (associated with HPV-16 in all cases), cytology was reported as normal. The follow-up one year later, of women with normal cytology and HPVhr detection a HSIL/CIN2+ lesion was detected (associated to HPV-33). In the comparative study with other strategies, the protocol called CRYGEN 16/18 yielded the best balance of sensitivity and specificity with the least referral to colposcopy. CONCLUSIONS Performing molecular detection of HPVhr with partial first-line genotyping of at least HPV-16, with direct referral to colposcopy, increases the detection rate of HSIL/CIN2+ lesions.
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Affiliation(s)
| | | | - Mar Ramírez Mena
- Servicio de Ginecología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Luis Ortega-Medina
- Servicio de Anatomía Patológica, Hospital Universitario Clínico San Carlos, Madrid, España
| | | | - Juan Carlos Galán
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, España; CIBER Epidemiología Salud Pública (CIBERESP), Madrid, España.
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Wang Y, Cai YB, James W, Zhou JL, Rezhake R, Zhang Q. Human papillomavirus distribution and cervical cancer epidemiological characteristics in rural population of Xinjiang, China. Chin Med J (Engl) 2021; 134:1838-1844. [PMID: 34267066 PMCID: PMC8367023 DOI: 10.1097/cm9.0000000000001441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical cancer remains a major public health issue for the Uyghur women and other women living mainly in rural areas of Xinjiang. This study aims to investigate the distribution of human papillomavirus (HPV) infection and cervical cancer in rural areas of Xinjiang, China. METHODS Cervical cancer screening was performed on rural women aged 35 to 64 years from Xinjiang, China in 2017 through gynecological examination, vaginal discharge smear microscopy, cytology, and HPV testing. If necessary, colposcopy and biopsy were performed on women with suspicious or abnormal screening results. RESULTS Of the 216,754 women screened, 15,518 received HPV testing. The HPV-positive rate was 6.75% (1047/15,518). Compared with the age 35-44 years group, the odds ratios (ORs) of HPV positivity in the age 45-54 years and 55-64 years groups were 1.18 (95% confidence interval [CI]: 1.02-1.37) and 1.84 (95% CI: 1.53-2.21), respectively. Compared with women with primary or lower education level, the ORs for HPV infection rates of women with high school and college education or above were 1.37 (95% CI: 1.09-1.72) and 1.62 (95% CI: 1.23-2.12), respectively. Uyghur women were less likely to have HPV infection than Han women, with an OR (95% CI) of 0.78 (0.61-0.99). The most prevalent HPV types among Xinjiang women were HPV 16 (24.00%), HPV 33 (12.70%), and HPV 52 (11.80%). The detection rate of cervical intraepithelial neoplasia (CIN)2+ was 0.14% and the early diagnosis rate of cervical cancer was 85.91%. The detection rates of vaginitis and cervicitis were 19.28% and 21.32%, respectively. CONCLUSIONS The HPV infection rate in Xinjiang is low, but the detection rate of cervical cancer and precancerous lesions is higher than the national average level. Cervical cancer is a prominent public health problem in Xinjiang, especially in southern Xinjiang.
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Affiliation(s)
- Yan Wang
- Affiliated Tumor Hospital of Xinjiang Medical University, Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang 830011, China
| | - Ying-Bin Cai
- Department of Gastroenterology, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - William James
- Biological Sciences Collegiate Division, University of Chicago, Chicago, IL 60637, USA
| | - Jian-Lin Zhou
- Health and Family Planning Commission of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830011, China
| | - Remila Rezhake
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qian Zhang
- Affiliated Tumor Hospital of Xinjiang Medical University, Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang 830011, China
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Jang D, Ratnam S, Smieja M, Speicher DJ, Arias M, Clavio A, Costescu D, Elit L, Huang S, Herrero-Garcia E, Joseph AM, Jiang H, Needle R, Chernesky M. Comparison of Alinity m HPV and cobas HPV assays on cervical specimens in diverse storage media. Tumour Virus Res 2021; 12:200224. [PMID: 34242835 PMCID: PMC8319351 DOI: 10.1016/j.tvr.2021.200224] [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: 12/10/2020] [Revised: 06/01/2021] [Accepted: 06/23/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the concordance of high-risk HPV (HR-HPV) testing with the Alinity assay on cervical samples collected with diverse collection/storage protocols (ThinPrep, SurePath, Cervicollect) and to assess inter-assay concordance of HR-HPV testing of cervical cell specimens with Alinity m HR HPV assay (Alinity) vs cobas® 4800 HPV assay (cobas). Methods Specimens were obtained from 560 women attending a Women's Health clinic. Two specimens were obtained from each woman with combinations of two of the three collection devices and aliquots were tested by the two assays. Results Alinity showed an agreement of 93.9%, Kappa = 0.89 (263/280) between ThinPrep and SurePath specimens; 97.5%, Kappa = 0.95 (347/356) and 92.9%, Kappa = 0.85 (104/112) between ThinPrep and SurePath aliquots taken before or after cytology processing, respectively. Cervi-Collect specimens showed an agreement of 94.6%, Kappa = 0.89 (265/280) with ThinPrep specimens. Compared to cobas, Alinity showed agreements of 94.3%, Kappa = 0.88 (395/419) and 91.8%, Kappa = 0.82 (257/280) between ThinPrep and SurePath specimens, respectively. Alinity and cobas detected genotypes 16/18 and other high-risk HPV types at similar rates and showed similar correlations with cytology grades. Conclusions Compared to cobas, Alinity performed equally well for detecting HPV in cervical specimens obtained with ThinPrep and SurePath. The Cervi-Collect device compared well to the other collection methods. Alinity is a reliable assay for simultaneous detection of HPV-16/18 and other high-risk genotypes in cervical specimens. Alinity m HR HPV assay demonstrated very good agreement with ThinPrep and SurePath pre- and post-cytology cervical specimens. Alinity m HR HPV had very good agreement with ThinPrep and Cervi-Collect specimens. Alinity m HR HPV and cobas 4800 HPV had very good agreement and identified HPV-16/18 and other HR types.
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Affiliation(s)
- Dan Jang
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Sam Ratnam
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada; Memorial University, Faculty of Medicine, St. John's, Newfoundland, Canada; McGill University, Montreal, Quebec, Canada
| | - Marek Smieja
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - David J Speicher
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Manuel Arias
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Avery Clavio
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Dustin Costescu
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Laurie Elit
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Shihai Huang
- Abbott Molecular Inc., 1300, E Touhy Ave, Des Plaines, IL, USA
| | | | - Ajith M Joseph
- Abbott Molecular Inc., 1300, E Touhy Ave, Des Plaines, IL, USA
| | - Hao Jiang
- Abbott Molecular Inc., 1300, E Touhy Ave, Des Plaines, IL, USA
| | - Robert Needle
- Eastern Health, Public Health and Microbiology Laboratory, St. John's, Newfoundland, Canada
| | - Max Chernesky
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada.
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Salvadó A, Miralpeix E, Solé-Sedeno JM, Kanjou N, Lloveras B, Duran X, Mancebo G. Predictor factors for conservative management of cervical intraepithelial neoplasia grade 2: Cytology and HPV genotyping. Gynecol Oncol 2021; 162:569-574. [PMID: 34226019 DOI: 10.1016/j.ygyno.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the role of HPV genotyping and previous cytology result to predict the evolution of CIN2 histological lesions managed conservatively. METHODS A prospective observational study was conducted at Hospital del Mar in Barcelona from January 2012 to May 2017. Women with new diagnosis of CIN2 were invited to undergo conservative management for 24 months. Complete regression, partial regression, persistence and progression to CIN3 were defined as final outcomes. Univariate and multivariate analyses combining HPV genotyping and cytology were used to establish progression predictors of CIN2. RESULTS A total of 300 patients were included in the study, and 291 patients completed the 24-months follow-up. Of them, 214 patients (73.5%) showed regression; 43 (14.8%) persistence to CIN2, and 34 (11.7%) progression to CIN3. In multivariable analysis, HPV-16 infection (odds ratio [OR] 1.97, [95% confidence interval {CI} 1.13-3.43]) and previous HSIL cytology (OR 3.46, [95% CI 1.99-6.02]) significantly increased the risk of persistence or progression (CIN2+) of CIN2 lesions. In contrast, all HPV-negative lesions regressed (p < 0.001). CONCLUSIONS The regression rate of CIN2 lesions supports conservative management in selected patients regardless of their age. Patients with a CIN2 biopsy and negative HPV test had a high rate of regression and should be offered follow-up without excisional treatment. In contrast, patients with HPV-16 and HSIL cytology had an increased risk of CIN2+, their treatment should be individualized and excisional treatment should be considered. The age may not be considered a criterion to decide the best management. New markers may help in the future to select the best management of CIN2.
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Affiliation(s)
- Ariadna Salvadó
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ester Miralpeix
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M Solé-Sedeno
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nadwa Kanjou
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Belen Lloveras
- Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Duran
- Department of Epidemiology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Riibe MØ, Sørbye SW, Simonsen GS, Sundsfjord A, Ekgren J, Maltau JM. Risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) among women with HPV-test in 1990-1992, a 30-year follow-up study. Infect Agent Cancer 2021; 16:46. [PMID: 34158090 PMCID: PMC8220730 DOI: 10.1186/s13027-021-00386-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background/objective Having a 30-year follow-up of a cohort of women tested for HPV is a unique opportunity to further study long-term risk of CIN3+. The study objective was to compare HPV status at baseline with the risk of CIN3+ in the follow-up period of 30 years. Methods All women (n = 642) referred to the HPV outpatient clinic at the University Hospital of North Norway (UNN) in 1990–1992, with an HPV test at baseline, were included in a prospective cohort. HPV-testing was performed by two different HPV-DNA tests, and genotypes 6, 11, 16, 18, 31 and 33 were identified. High-risk (HR) HPV genotypes (16, 18, 31 and 33) were classified as HPV positive, whereas low-risk (LR) genotypes (6 and 11) in addition to absent HPV were classified as HPV negative. A single cohort in which women were classified for their HPV status underwent follow-up prospectively to the last time-point of observation of 30 years. Results During follow-up, 148 (148/642) cases of CIN3+ were detected, of whom 70.3% (104/148) were HPV positive and 29.7% (44/148) were HPV negative at baseline. The proportions of women who developed CIN3+ following a positive and a negative test were 46.6% (104/223) and 10.5% (44/419), respectively. Most cases of CIN3+ were seen shortly after the baseline HPV test, with 112 cases of CIN3+ diagnosed within the first year. In total, 48.6% (72/148) with HPV 16 and 57.6% (19/33) with HPV 33 developed CIN3+. Within the first year, CIN3+ was detected in 37.8% (56/148) with HPV 16, and 51.5% (17/33) with HPV 33. The long-term risk of CIN3+ was significantly lower than the short-term risk, and mainly associated with HPV 16. Overall, eight cases of cervical cancer were detected. Five were HPV positive, harboured HPV 16 at baseline and developed cervical cancer after 3, 4, 5, 11 and 24 years of follow-up. Conclusion and consequences HPV status at baseline is predictive for the subsequent risk of developing CIN3+. Women with a positive HPV test in 1990–1992 had a significantly higher risk of CIN3+ during 30 years of follow-up than those with a negative test. HPV 16 was associated with the greatest long-term risk of cervical cancer. All patients with a positive HPV test at baseline should be followed up until negative. Trial registration ISRCTN, ISRCTN10836802. Registered 14 December 2020 - Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00386-z.
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Affiliation(s)
| | | | - Gunnar Skov Simonsen
- Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Arnfinn Sundsfjord
- Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Josef Ekgren
- Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway
| | - Jan Martin Maltau
- Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway
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Magkana M, Mentzelopoulou P, Magkana E, Pampanos A, Daskalakis G, Domali E, Rodolakis A, Pappa K. The p16/ki-67 assay is a safe, effective and rapid approach to triage women with mild cervical lesions. PLoS One 2021; 16:e0253045. [PMID: 34115809 PMCID: PMC8195406 DOI: 10.1371/journal.pone.0253045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/27/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic accuracy and efficiency of p16/ki-67 dual stain in the identification of CIN2+ lesions, in Greek women with ASCUS or LSIL cytology. METHODS A total of 200 women, 20 to 60 years old, were enrolled in the study. All samples were cytologically evaluated and performed for p16/ki-67 and high-risk HPV (HR-HPV) test. All patients were referred to colposcopy for biopsy and histological evaluation. Three cervical cancer (CC) screening strategies were designed and the total direct medical costs of the procedures during our clinical trial were evaluated, from a healthcare perspective. RESULTS HPV 16 as expected was the most common HR-HPV type followed by HPV 31 and HPV 51. The risk for CIN2+ was significantly higher in HPV 16/18 positive cases. p16/ki-67 demonstrated a high sensitivity for CIN2+ identification in both ASCUS and LSIL groups (90.4% and 95%, respectively). HR-HPV test with sensitivity 52.3% and 65.5%, as well as colposcopy with sensitivity 14.3% and 36% respectively in ASCUS and LSIL group, showed inferior results compared to p16/ki-67. The specificity of p16/ki-67 for ASCUS and LSIL was 97.2% and 95.2% respectively, inferior only to colposcopy: 100% and 100%, lacking however statistical significance. HR-HPV test instead, presented the lowest specificity: 76.4% and 71.4% respectively in comparison to the other two methods. From a healthcare perspective, the costs and benefits of the tests implementation for the annual screening and triaging, in three CC screening strategies, were also calculated and discussed. CONCLUSIONS The results of the study indicate that p16/ki-67 is a safe and rapid assay that could be used to detect CIN2+ among women with mild cervical lesions, presenting both high sensitivity and specificity and could minimize the psychological and economic burden of HPV screening.
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Affiliation(s)
- Maria Magkana
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Cytology, "Alexandra" General Hospital, Athens, Greece
- * E-mail:
| | | | - Ekaterini Magkana
- Department of Cytology, "Alexandra" General Hospital, Athens, Greece
| | - Andreas Pampanos
- Department of Genetics, "Alexandra" General Hospital, Athens, Greece
| | - Georgios Daskalakis
- 1 Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ekaterini Domali
- 1 Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Rodolakis
- 1 Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Pappa
- 1 Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Cell and Gene Therapy Laboratory, Centre of Basic Research II, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
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