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Goillot V, Paté M, Delaitre A, Akladios C, Baldauf JJ, Lecointre L. [Use of HPV virologic test for atypical glandular cells in Alsace between 2014 and 2016]. ACTA ACUST UNITED AC 2019; 47:802-807. [PMID: 31336187 DOI: 10.1016/j.gofs.2019.07.005] [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: 05/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The new recommendations by the National Institute of Cancer (January 2017) recommend the use of a complementary human papillomavirus (HPV) virologic test during the diagnosis of atypical glandular cells in pap smear. The aim of this study was the performance analysis of the HPV virologic test for the detection of significant histological cervical abnormalities (CIN2 or more) in case of atypical glandular cells before the new recommendations were published. METHODS We performed a descriptive and retrospective cohort study in Alsace between January 2014 and December 2016. We have included, from the EVE-association database, the patients with atypical glandular cells in pap smear. RESULTS In total, 1074 patients had a pap smear with atypical glandular cells ; 0.18% of total pap smears. This study included 152 patients who had a HPV test. We observed 6 cases of CIN2 (3.9%) and 12 cases of CIN3 (7.9%). No in situ adenocarcinoma nor invasive carcinoma were detected. The sensitivity of the HPV test was 88.9% (95% CI: [0.65; 0.99]), the specificity was 65.9% (95% CI: [0.55; 0.76]), the positive predictive value was 34% (95% CI: [0.21; 0.49]) and the negative predictive value was 96.8% (95% CI: [0.89; 0.99]). CONCLUSION The detection of HPV in atypical glandular cells seems to be powerful with an excellent negative predictive value but, because of moderate sensitivity and due to the risk of histologic lesion progression, the current recommendations should to be applied with care.
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Affiliation(s)
- V Goillot
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - M Paté
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France.
| | - A Delaitre
- Département de médecine générale, 4, rue Kirschleger, 67058 Strasbourg cedex, France
| | - C Akladios
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - J-J Baldauf
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - L Lecointre
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
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Goyal A, Street J, Alperstein SA, Siddiqui MT. HPV test result monitoring of different Bethesda categories in gynaecologic cytology: A valuable quality assurance measure. Diagn Cytopathol 2018; 46:914-918. [PMID: 30353695 DOI: 10.1002/dc.23989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/13/2018] [Accepted: 05/30/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND High-risk human papillomavirus (HPV) test ordering has evolved since the 2006 ASCCP guidelines. In light of the availability of the HPV test results for most women ≥30 y, regardless of the Pap test diagnosis; we examined their value in assessing the overall performance of cytopathologists (CPs). METHODS Data were derived for six CPs for Pap test interpretations over 4 y. HPV positivity rates for atypical squamous cells of undetermined significance (ASC-US) and for patients ≥30 y for negative for intraepithelial lesion or malignancy (NILM) and squamous intraepithelial lesion (SIL) (inclusive of low grade SIL (LSIL), high grade SIL (HSIL), and carcinoma) categories were retrieved for individual CPs. ASC/SIL ratios were analysed overall and separately for patient groups <30 y and ≥30 y. Pearson correlation coefficient was calculated to assess correlation between HPV positivity rates for ASC-US, NILM and SIL, and ASC/SIL ratios. RESULTS The overall ASC-US HPV positivity rate was 41%-49% for patients <30 y, 32% for patients ≥30 y. Stratifying by patient age group, ASC-US HPV positivity rate, and ASC/SIL ratio showed a negative correlation. Excluding an outlier, the NILM HPV positivity rate and ASC/SIL ratio showed a strong negative correlation. CONCLUSION Our study shows that ASC-US HPV positivity rate is dependent on the age of the population that is tested. Monitoring of the HPV positivity rates for NILM and SIL categories can serve as an additional objective measure to assess the performance of CPs. Based on the patient population, the laboratory can establish an initial baseline for these rates and use it to adjust interpretive thresholds in ensuring the diagnostic sensitivity of the test and the quality of the interpretation.
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Affiliation(s)
- Abha Goyal
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
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Aleksioska-Papestiev I, Chibisheva V, Micevska M, Dimitrov G. Prevalence of Specific Types of Human Papiloma Virus in Cervical Intraepithelial Lesions and Cervical Cancer in Macedonian Women. ACTA ACUST UNITED AC 2018; 72:26-30. [PMID: 29416214 PMCID: PMC5789568 DOI: 10.5455/medarh.2018.72.26-30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction Cervical cancer is a malignancy originating in the transformation zone of the cervix, most commonly in the squamous cells. It is the fourth most common cancer in women worldwide, and the third most common cause of female cancer death. Genital human papilloma viruses (HPV) are sexually transmitted and approximately 630 milion people worldwide are infected. More than 200 genotypes, subtypes and variants have been reported, 13-15 being oncogenic type, which could be responsible for cervical intraepithelial lesions (CIN) or cancer. Aim Aim of this study was to evaluate the prevalence of this infection and to identify specific types of human papiloma virus in cervical intraepithelial lesions and cervical cancer in Macedonian women. Material and methods The study was conducted at the University Clinic for Obstetrics and Gynecology, Skopje, Macedonia, in a period of four years. The study was performed on a cohort of 1895, 18 - 73 year old patients who during primary examination had already abnormal PAP smear test. Cervical cells were collected in the lithotomy gynecological position of the patient, using endocervical cytobrush and cotton-tipped swab, and both were placed in sterile test tube with phosphate buffered saline. Samples were stored at temperature of 2 - 8 °C and Human Pappiloma Virus (HPV) genotyping was analyzed within 7 days by multiple Polymerase Chain Reaction (PCR) methods. Results The mean age of enrolled women was 40,8 years±10.36 SD(minimum of 18 and maximum 73 years. Among the patients, the presence of HPV by using PCR was detected in 40,68 % (769 patients) and was highly associated with cervical abnormalities. The prevalence of HPV was highest (82,1%) in women aged 20-years or less and it decreased with age and was lowest (19,9%) among patients older than 50 years. The prevalence of oncogenic types of the virus was higher if the cytologic diagnosis is CIN 3/Carcinoma in situ (CIS). In these patients detection of high risk HPV was in 79,1% females with CIN 3 and 97,5 % in females with CIS. The lowest prevalence was detected in patients with atypical squamous cells of undetermined significance (ASCUS) (23,9%) and CIN 1-25 (6%). Results of HPV typing show that genotypes were found either single or multiple in both single and multiple infections. We have seen that HPV 16, 18 and 31 were the most common types detected among the patients from Macedonia. HPV 16 was present even in 52,1 % of women with CIS and in 41,2% in women with CIN 3. HPV type 31 ranked second in patients wit CIN1, CIN2, CIN3 but HPV 18 ranked second in patients with CIS with (12,8%). Surprisingly, patients with mixed infection had more low grade intraepithelial squamous lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL) then CIS. Conclusion Among Macedonian women, HPV 16, 31 and 18 were HPV types strongly associated with intraepithelial cervical lesions and cervical cancers. The prevalence of high risk HPV was highest in youngest women, but the risk was highest among patients with invasive cervical cancer (ICC). Surprisingly, patients with mixed infection had more LSIL and HSIL then CIS.
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Affiliation(s)
| | - Vesna Chibisheva
- University Clinic for Obstetrics and Gynecology, Skopje, Macedonia
| | - Megi Micevska
- University Clinic for Obstetrics and Gynecology, Skopje, Macedonia
| | - Goran Dimitrov
- University Clinic for Obstetrics and Gynecology, Skopje, Macedonia
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Adenis A, Dufit V, Douine M, Najioullah F, Molinie V, Catherine D, Kilié O, Thomas N, Deshayes JL, Brousse P, Amor HB, Pignoux R, Carles G, Grenier C, Lacoste V, Cesaire R, Nacher M. The singular epidemiology of HPV infection among French Guianese women with normal cytology. BMC Public Health 2017; 17:279. [PMID: 28340612 PMCID: PMC5366144 DOI: 10.1186/s12889-017-4181-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/09/2017] [Indexed: 11/25/2022] Open
Abstract
Background In French Guiana, cervical cancer is the second most frequent cancer in females. The objective of the present study was to describe the prevalence of HPV infections in women with normal cervical cytology living in the remote villages of French Guiana. Methods Before the study, the study team communicated in the remote villages on the importance of screening. All women from the target population were offered to participate. They signed informed consent during inclusion and then had a concomitant HPV-test and cervical smear. Only women with normal cytology and a good quality smear were analyzed. The detection of HPV-DNA was performed using the GREINER-BIO-ONE kit. Results Overall, 27.2% of women with normal cervical cytology had a positive HPV-test. There was a U-shaped evolution of prevalence with women over 50 years having the highest HPV prevalence, followed by the 20 to 29 years group. The most prevalent HPV genotypes were HPV 53(3.52%), 68(3.33%), 52(2.59%), 31(2.22%) and 16 (1.85%). The proportion of HPV 16 among HPV-infected women was 6.8%. Conclusions HPV prevalence in cytologically normal women was very high. The most prevalent genotypes were very different from what is usually described in the world, and notably in South America.
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Affiliation(s)
- Antoine Adenis
- Centre d'Investigation Clinique Antilles-Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Rue des flamboyants, 97300, Cayenne, French Guiana
| | - Valentin Dufit
- Centre d'Investigation Clinique Antilles-Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Rue des flamboyants, 97300, Cayenne, French Guiana
| | - Maylis Douine
- Centre d'Investigation Clinique Antilles-Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Rue des flamboyants, 97300, Cayenne, French Guiana
| | - Fatiha Najioullah
- Laboratoire de Virologie, CHU de la Martinique, Fort de France, Martinique
| | - Vincent Molinie
- Laboratoire d'anatomopathologie, CHU de la Martinique, Fort de France, Martinique
| | - Dominique Catherine
- Laboratoire d'anatomopathologie, CHU de la Martinique, Fort de France, Martinique
| | - Odile Kilié
- Laboratoire de Virologie, CHU de la Martinique, Fort de France, Martinique
| | - Nadia Thomas
- Service de Gynecologie Obstétrique, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Jean Luc Deshayes
- AGDOC Association de Dépistage Organisé des Cancers de Guyane, Cayenne, French Guiana
| | - Paul Brousse
- Département des Centres délocalisés de prévention et de soins, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Hatem Ben Amor
- Département des Centres délocalisés de prévention et de soins, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Remy Pignoux
- Département des Centres délocalisés de prévention et de soins, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Gabriel Carles
- Service de Gynecologie Obstétrique, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, Cayenne, French Guiana
| | - Claire Grenier
- Département des Centres délocalisés de prévention et de soins, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Vincent Lacoste
- Laboratoire des interactions virus Hôtes, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Raymond Cesaire
- Laboratoire de Virologie, CHU de la Martinique, Fort de France, Martinique
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles-Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Rue des flamboyants, 97300, Cayenne, French Guiana.
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[Human papillomavirus infection and its correlates with clinically relevant gynecological and obstetric conditions: A cross-sectional study]. Med Clin (Barc) 2016; 147:101-8. [PMID: 27297704 DOI: 10.1016/j.medcli.2016.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJETIVE To analyze the prevalence of human papillomavirus (HPV) infection and the possible epidemiological association with conditions of clinical relevance in women. MATERIAL AND METHODS A cross-sectional study from Mexico City was conducted from January 2012 to December 2014. HPV molecular detection was performed on cervical samples. Data were analyzed with appropriated statistic tests. RESULTS A total of 1,604 females (median 47, interquartile range 38-54) were analyzed. Global prevalence of infection for any HPV is 9.91% (95% CI 8.6-11.3). An association between infection with 16-HPV and number of abortions (NA) (OR=1.427; 95% CI 1.091-1.866), by univariate regression model (UVRM) was estimated. Moreover, menarche (OR=1.566; 95% CI 1.079-2.272), NA (OR=1.570; 95% CI 1.106-2.227) and number of pregnancies (NP) (OR=0.461; 95% CI 0.260-0.818) have a direct and inverse association with infection by genotype 18 of HPV, respectively. Also, infection with HR-HPV genotypes has an inverse association with NP (OR=0.791; 95% CI 0.707-0.884) by normal labor (OR=0.867; 95% CI 0.767-0.979) and NA (OR=0.715; 95% CI 0.534-0.959) (UVRM), and a direct association with number of sexual partners (OR=1.082; 95% CI 1.015-1.154). Onset of sexual activity has an inverse association with infection by genotype 16- (UVRM: OR=0.814; 95% CI 0.715-0.926; multinomial regression model (MNRM): OR=0.803; 95% CI 0.702-0.918) and HR-HPV (UVRM: OR=0.933; 95% CI 0.889-0.980, and MNRM: OR=0.912; 95% CI 0.867-0.959), all P values were lower than .03. CONCLUSIONS Prevalence of HPV cervical infection is different according to age and it is associated with several medical conditions of clinical relevance in women.
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Attributing oncogenic human papillomavirus genotypes to high-grade cervical neoplasia: which type causes the lesion? Am J Surg Pathol 2015; 39:496-504. [PMID: 25353286 DOI: 10.1097/pas.0000000000000342] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human papillomavirus (HPV) is found in most women with high-grade cervical intraepithelial neoplasia (CIN) 2/3 in cervical cytology and biopsies. Multiple high-risk HPV (hrHPV) genotypes are present in 15% to 50% of cytology samples. We have shown by laser-capture microscopy (LCM)-polymerase chain reaction (PCR) that each lesion is associated with a single hrHPV type. Attribution of hrHPV types to CIN2/3 is important to understand the oncogenic role of different types and the limitations of cytologic typing. We studied hrHPV genotypes in 257 women with histologic CIN2/3 referred on the basis of abnormal cytology. HPV typing was done on cytology and CIN2/3 biopsies. If the whole-tissue section of the biopsy was positive for multiple hrHPV types, LCM-PCR was performed. We found 181 (70%) single and 71 (28%) multiple hrHPV infections in cytology, with 5 (2%) cases HPV-positive only on whole-tissue section PCR. Of cases with multiple cytologic hrHPV infections, 47/71 (66%) showed a single type in CIN2/3 lesions. In total, in 232 of 257 (90%) women with CIN2/3, a single hrHPV type caused CIN2/3. One was nonattributable on the LCM level. The remaining 24 women had 2 or more contiguous or separated lesions, each associated with a single hrHPV infection. The probability of HPV16 being present in CIN2/3, if detected in cytology, was 0.96 (95% confidence interval=0.90-0.98). LCM-PCR confirms that only 9% of histologic CIN2/3 is associated with multiple hrHPV types, much less than cytology would indicate, and each lesion was associated with a single hrHPV infection.
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Kuperman L, Krumholz BA. The Triage of Women with ASCUS Cytology Using Human Papillomavirus DNA Testing. J Low Genit Tract Dis 2015; 4:1-6. [PMID: 25950782 DOI: 10.1046/j.1526-0976.2000.41001.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Our goal was to determine whether human papillomavirus (HPV) DNA testing is a valuable tool in triage of patients with cytology demonstrating atypical squamous cells of undetermined significance (ASCUS). METHODS Our study included a total of 355 women who were referred for evaluation of a Papanicolaou smear with ASCUS diagnosed during routine screening. At the first visit, all patients had colposcopic examinations and HPV DNA testing by Hybrid Capture assay. Patients were evaluated every 4 to 6 months. Follow-up included repeat cytology and colposcopy at each visit; biopsy was performed if indicated. Followup continued for up to 2 years. RESULTS Sensitivity, specificity, and positive and negative predictive values of HPV DNA testing in detecting cervical intraepithelial neoplasia grade 2 (CIN2) or CIN3 were 85%, 77%, 12%, and 99%, respectively. The prevalence of oncogenic HPV types was higher in patients younger than age 35 (35% versus 25%) in whom ASCUS-favor dysplasia/ASCUS-not otherwise specified was diagnosed. The presence of oncogenic HPV types equated with a 12.4% risk of biopsy-proven CIN2 and CIN3. The rate of CIN2 and CIN3 was 0.4% in those who tested negative (95% confidence interval, 0-2.1%). CONCLUSIONS HPV DNA testing appears to be a valuable tool for triage of women with ASCUS smears. Its high negative predictive value provides needed reassurance for follow-up with only periodic cytology.
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Affiliation(s)
- L Kuperman
- Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY
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Abstract
OBJECTIVE This study aimed to determine if there are differences in the histological findings of excisional biopsies between younger women (aged ≤25 years) and older women who undergo large loop excision of the transformation zone or cone biopsy for a biopsy-proven high-grade squamous intraepithelial lesion (HSIL). MATERIALS AND METHODS A retrospective cohort analysis of women referred to a tertiary hospital colposcopy clinic with a colposcopically directed biopsy of HSIL (cervical intraepithelial neoplasia 2 [CIN 2] or CIN 3) during the period of 2008 to 2011 was performed.The histological excisional biopsy specimens for younger women (aged ≤25 years) were compared with those of older women (aged >25 years.) Bivariate analysis comparing demographic characteristics and outcomes across the 2 study groups was initially undertaken to identify potential confounders for inclusion in the multivariate analysis. RESULTS Of 348 women who had a satisfactory colposcopic assessment and reported no previous treatment for cervical intraepithelial neoplasia, 87 were 25 years or younger, and 261 women were older than 25 years. After excisional biopsy of the cervix, the histological specimen for younger women was more likely to be reported as CIN 1 or no dysplasia (16.3% vs 8.2%). When adjusted for confounders (parity, smoking, previous sexual infection, and referring Pap smear), age less than 25 years remained an independent predictor of having a histological excisional biopsy specimen reported as CIN 1 or no dysplasia (adjusted odds ratio = 2.35; 95% confidence interval = 1.0-5.49). CONCLUSIONS Younger women with biopsy-proven HSIL (CIN 2/3), have a higher likelihood that the histological specimen after an excisional biopsy of the cervix will be reported as CIN 1 or no dysplasia.
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Deftereos G, Kiviat NB. Detection and Clinical Management of Cervical Pathology in the Era of HPV. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0081-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prevalence, distribution, and viral burden of all 15 high-risk human papillomavirus types in adenosquamous carcinoma of the uterine cervix: a multiplex real-time polymerase chain reaction–based study. Hum Pathol 2014; 45:303-9. [DOI: 10.1016/j.humpath.2013.07.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/03/2013] [Accepted: 07/10/2013] [Indexed: 11/21/2022]
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Hung JH, Teng YN, Wang LHC, Su IJ, Wang CCC, Huang W, Lee KH, Lu KY, Wang LH. Induction of Bcl-2 expression by hepatitis B virus pre-S2 mutant large surface protein resistance to 5-fluorouracil treatment in Huh-7 cells. PLoS One 2011; 6:e28977. [PMID: 22216150 PMCID: PMC3245229 DOI: 10.1371/journal.pone.0028977] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/18/2011] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide with poor prognosis due to resistance to conventional chemotherapy and limited efficacy of radiotherapy. Our previous studies have indicated that expression of Hepatitis B virus pre-S2 large mutant surface antigen (HBV pre-S2Δ) is associated with a significant risk of developing HCC. However, the relationship between HBV pre-S2Δ protein and the resistance of chemotherapeutic drug treatment is still unclear. METHODOLOGY/PRINCIPAL FINDINGS Here, we show that the expression of HBV pre-S2Δ mutant surface protein in Huh-7 cell significantly promoted cell growth and colony formation. Furthermore, HBV pre-S2Δ protein increased both mRNA (2.7±0.5-fold vs. vehicle, p=0.05) and protein (3.2±0.3-fold vs. vehicle, p=0.01) levels of Bcl-2 in Huh-7 cells. HBV pre-S2Δ protein also enhances Bcl-2 family, Bcl-xL and Mcl-1, expression in Huh-7 cells. Meanwhile, induction of NF-κB p65, ERK, and Akt phosphorylation, and GRP78 expression, an unfolded protein response chaperone, were observed in HBV pre-S2Δ and HBV pre-S-expressing cells. Induction of Bcl-2 expression by HBV pre-S2Δ protein resulted in resistance to 5-fluorouracil treatment in colony formation, caspase-3 assay, and cell apoptosis, and can enhance cell death by co-incubation with Bcl-2 inhibitor. Similarly, transgenic mice showed higher expression of Bcl-2 in liver tissue expressing HBV pre-S2Δ large surface protein in vivo. CONCLUSION/SIGNIFICANCE Our result demonstrates that HBV pre-S2Δ increased Bcl-2 expression which plays an important role in resistance to 5-fluorouracil-caused cell death. Therefore, these data provide an important chemotherapeutic strategy in HBV pre-S2Δ-associated tumor.
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Affiliation(s)
- Jui-Hsiang Hung
- Department of Biotechnology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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[HPV-Hr detection by home self sampling in women not compliant with pap test for cervical cancer screening. Results of a pilot programme in Bouches-du-Rhône]. Bull Cancer 2011; 98:723-31. [PMID: 21700548 DOI: 10.1684/bdc.2011.1388] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The non-participation to cervical screening is the major determinant in the risk of mortality due to cervical cancer. In France, around 40% of women do not participate to regular screening. The cultural or economic barriers for performing screening by Pap test are numerous; one of the most frequent is the refusal of gynaecological examination. A persistent HPV(HR) infection is a necessary factor for developing cervical cancer. The HPV(HR) testing has a high sensibility to detect high grade cervical intra-epithelial neoplasia (CIN 2-3) and a satisfactory specificity after 30-35 years old. The principal objective of this study was to compare the participation rates in women 35-69 years old who did not perform a Pap test after a first individual invitation, either when an HPV(HR) auto-test was offered to be performed at home or a second invitation to Pap test was sent. We also evaluated the quality of the two tests, the positive results obtained by age groups and the following histological type of lesions diagnosed in the women with positive results. The study included 9,334 women, 35-69 years old, who did not realized a Pap-test during the 2 previous years and who did not respond at a first individual invitation. These non-responders were randomized into two groups: one group (n=4,934) received a second individual invitation and the other (n=4,400) an offer of receiving and performing an HPV auto-test at home. In women 35-69 years the participation to the second invitation to Pap test was significantly lower (7.2%) than the participation to auto-test (26.4%) with P<0.001. The quality of the two tests was satisfactory; the auto-test was not altered by the postage to laboratory (non interpretable rate=1.4% [CI at 95%=0.65%; 2.15%]. From the 311 Pap tests done, 5.5% (17) were classified "abnormal" (nine ASCUS, one high grade and seven low grades). The follow up of 13 women out of 17 confirmed the diagnosis for 1 case of CIN2 and 2 cases of CIN3, 4 women are lost of follow up after 6 months. From the 939 HPV(HR) tests done, 6.2% (58) were positive. Such positivity rate was not influenced by age. Out of the 58 positive HPV(HR) cases, 27 only were of the 16 genotype (46.5% [CI 95%=33.7%; 59.3%]). This law rate is a consequence of an inversion of the ratio HPV 16 versus other types in women 60 years old and over. In this group, the follow-up of 36 women diagnosed five cases of CIN1, one of CIN2 and four of CIN3; 22 patients are lost of follow up at 6 months. Globally, in the studied population, an individual recall for pap test allowed to diagnose and treat 3 high grade lesions (7‰) and the dispatching of an auto test allowed the diagnosis and treatment of five high grade lesions (1,4‰), this difference is significant (P=0.02; OR=0.25 [0.05; 0.97]). The HPV(HR) auto-test seems to be better accepted than the Pap test in the 35-69 years old women previously non-responders to individual invitation, and the quality of the test is satisfactory. Such a test can be proposed to the 35-69 years old non-participant to Pap test to increase the coverage for cervical screening, if the rates of diagnostic examinations performed in case of an HPV(HR) positive is sufficiently high.
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Syrjänen K, Shabalova I, Naud P, Kozachenko V, Derchain S, Zakharchenko S, Roteli-Martins C, Nerovjna R, Longatto-Filho A, Kljukina L, Tatti S, Branovskaja M, Hammes LS, Branca M, Grunjberga V, Eržen M, Juschenko A, Costa S, Sarian L, Podistov J, Syrjäen S, Syrjänen K, Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J, Podistov J, Chemeris G, Sozaeva L, Lipova E, Tsidaeva I, Ivanchenko O, Pshepurko A, Zakharenko S, Nerovjna R, Kljukina L, Erokhina O, Branovskaja M, Nikitina M, Grunjberga V, Grunjberg A, Juschenko A, Santopietro R, Cintorino M, Tosi P, Syrjänen K, Naud P, Derchain S, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Eržen M, Hammes LS, Matos J, Gontijo R, Sarian L, Braganća J, Arlindo FC, Maeda MYS, Lörincz A, Dores GB, Costa S, Syrjänen S. Risk estimates for persistent high-risk human papillomavirus infections as surrogate endpoints of progressive cervical disease critically depend on reference category: analysis of the combined prospective cohort of the New Independent States of the Former Soviet Union and Latin American Screening Studies. Int J STD AIDS 2011; 22:315-23. [DOI: 10.1258/ijsa.2009.009365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary To make feasible future clinical trials with new-generation human papillomavirus (HPV) vaccines, novel virological surrogate endpoints of progressive disease have been proposed, including high-risk HPV (HR-HPV) persistence for six months (6M+) or 12 months (12M+). The risk estimates (relative risks [RRs]) of these ‘virological endpoints’ are influenced by several variables, not yet validated adequately. We compared the impact of three referent groups: (i) HPV-negative, (ii) HPV-transient, (iii) HPV-mixed outcome on the risk estimates for 6M+ or 12M+ HR-HPV persistence as predictors of progressive disease. Generalized estimating equation models were used to estimate the strength of 6M+ and 12M+ HR-HPV persistence with disease progression to squamous intraepithelial lesions (SILs), cervical intraepithelial neoplasia (CIN) grade 1 +, CIN2+, CIN/SIL endpoints, comparing three optional reference categories (i)-(iii) in a prospective sub-cohort of 1865 women from the combined New Independent States of the Former Soviet Union (NIS) and Latin American Screening (LAMS) studies cohort ( n = 15,301). The RRs of these viral endpoints as predictors of progressive disease are affected by the length of viral persistence (6M+ or 12M+) and the surrogate endpoint (SIL, CIN1, CIN2, CIN/SIL). Most dramatic is the effect of the referent group used in risk estimates, with the HPV-negative referent group giving the highest and most consistent RRs for both 6M+ and 12M+ viral persistence, irrespective of which surrogate is used. In addition to deciding on whether to use 6M+ or 12M+ persistence criteria, and cytological, histological or combined surrogate endpoints, one should adopt the HPV-negative referent group as the gold standard in all future studies using viral persistence as the surrogate endpoint of progressive disease.
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Affiliation(s)
- K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - I Shabalova
- Russian Academy of Post-Graduate Medical Education. Moscow, Russia
| | - P Naud
- Hospital de Clinicas de Porto Alegre, and Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul. Porto Alegre
| | - V Kozachenko
- Russian Academy of Post-Graduate Medical Education. Moscow, Russia
| | - S Derchain
- Universidade Estadual de Campinas, Campinas, Brazil
| | - S Zakharchenko
- Novgorod Municipal Dermato-venereological Dispensary, Department of Gynaecology, Novgorod, Russia
| | | | - R Nerovjna
- Novgorod Female Consultative Outpatient Hospital. Department of Gynaecology, Novgorod, Russia
| | - A Longatto-Filho
- lnstituto Adolfo Lutz, Sao Paulo, Brazil and Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - L Kljukina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - S Tatti
- First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina
| | - M Branovskaja
- Minsk State Medical Institute. Department of Gynaecology and Obstetrics, Minsk, Belarus
| | - L S Hammes
- Hospital de Clinicas de Porto Alegre, and Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul. Porto Alegre
| | - M Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | - V Grunjberga
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - M Eržen
- SIZE Diagnostic Center, Ljubljana, Slovenia
| | - A Juschenko
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - S Costa
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - L Sarian
- Universidade Estadual de Campinas, Campinas, Brazil
| | - J Podistov
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - S Syrjäen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Turku, Finland
| | - K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, and MediCity Research Laboratory, University of Turku, Finland
| | - I Shabalova
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - N Petrovichev
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - V Kozachenko
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - T Zakharova
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - J Pajanidi
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - J Podistov
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - G Chemeris
- NN Blokhin Cancer Research Centre of Russian Academy of Medical Sciences (RAMS), Moscow, Russia
| | - L Sozaeva
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - E Lipova
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - I Tsidaeva
- Russian Academy of Post-Graduate Medical Education, Moscow, Russia
| | - O Ivanchenko
- Novgorod Clinical Regional Hospital, Centralised Cytology Laboratory, Novgorod, Russia
| | - A Pshepurko
- Novgorod Clinical Regional Hospital, Centralised Cytology Laboratory, Novgorod, Russia
| | - S Zakharenko
- Novgorod Municipal Dermato-venereological Dispensary, Department of Gynaecology, Novgorod, Russia
| | - R Nerovjna
- Novgorod Female Consultative Outpatient Hospital, Department of Gynaecology, Novgorod, Russia
| | - L Kljukina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - O Erokhina
- Research Institute of Oncology and Medical Radiology, Republican Centre of Clinical Cytology, Minsk, Belarus
| | - M Branovskaja
- Minsk State Medical Institute, Department of Gynaecology and Obstetrics, Minsk, Belarus
| | - M Nikitina
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - V Grunjberga
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - A Grunjberg
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - A Juschenko
- Latvian Cancer Centre, Department of Gynaecology, and Laboratory of Cytology, Riga, Latvia
| | - R Santopietro
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - M Cintorino
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - P Tosi
- Department of Human Pathology and Oncology, University of Siena, Italy
| | - K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - P Naud
- Hospital de Clinicas de Porto Alegre, Brazil
| | - S Derchain
- Universidade Estadual de Campinas, Campinas, Brazil
| | | | - A Longatto-Filho
- Instituto Adolfo Lutz, Sao Paulo, Brazil and (ALF) Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - S Tatti
- First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina
| | - M Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | - M Eržen
- SIZE Diagnostic Center, Ljubljana, Slovenia
| | - LS Hammes
- Hospital de Clinicas de Porto Alegre, Brazil
| | - J Matos
- Hospital de Clinicas de Porto Alegre, Brazil
| | - R Gontijo
- Universidade Estadual de Campinas, Campinas, Brazil
| | - L Sarian
- Universidade Estadual de Campinas, Campinas, Brazil
| | - J Braganća
- Universidade Estadual de Campinas, Campinas, Brazil
| | - FC Arlindo
- Hospital Leonor M de Barros, Sao Paulo, Brazil
| | - MYS Maeda
- Instituto Adolfo Lutz, Sao Paulo, Brazil and (ALF) Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | | | - GB Dores
- Di gene Brazil, Sao Paulo, Brazil
| | - S Costa
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Finland
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Green VA, Munshi SU, Marakalala MJ, Mourão MM. Molecular mechanisms of viral infection and propagation: An overview of the second Advanced Summer School in Africa. IUBMB Life 2010; 62:573-83. [PMID: 20681023 PMCID: PMC7165971 DOI: 10.1002/iub.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Victoria A Green
- Antiviral Gene Therapy Research Unit, Department of Molecular Medicine & Haematology,University of the Witwatersrand, 7 York Road, Johannesburg, South Africa.
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Tamalet C, Richet H, Carcopino X, Henry M, Leretraite L, Heid P, Leandri FX, Sancho-Garnier H, Piana L. Testing for human papillomavirus and measurement of viral load of HPV 16 and 18 in self-collected vaginal swabs of women who do not undergo cervical cytological screening in Southern France. J Med Virol 2010; 82:1431-7. [DOI: 10.1002/jmv.21835] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Syrjänen K, Shabalova I, Naud P, Kozachenko V, Derchain S, Zakharchenko S, Roteli-Martins C, Nerovjna R, Longatto-Filho A, Kljukina L, Tatti S, Branovskaja M, Hammes LS, Branca M, Grunjberga V, Erzen M, Sarian LO, Juschenko A, Costa S, Podistov J, Syrjänen S. Persistent high-risk human papillomavirus infections and other end-point markers of progressive cervical disease among women prospectively followed up in the New Independent States of the Former Soviet Union and the Latin American Screening study cohorts. Int J Gynecol Cancer 2009; 19:934-42. [PMID: 19574788 DOI: 10.1111/igc.0b013e3181a834fe] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND New end points are needed in future human papillomavirus (HPV) vaccine efficacy studies that accurately predict disease progression. OBJECTIVES Potential intermediate end points were analyzed in the combined New Independent States of the Former Soviet Union (NIS) and the Latin American Screening (LAMS) study cohorts. STUDY DESIGN AND METHODS Data files of 2 international screening trials, the NIS (n = 3187) and the LAMS (n = 12,114) study cohorts, were combined, and a subcohort of 1865 (n = 854 and n = 1011 for the NIS and the LAMS, respectively) women prospectively followed up for 19.7 (median, 22.2) months was analyzed for different intermediate end-point markers of disease progression to squamous intraepithelial lesion (SIL), cervical intraepithelial neoplasia grade 1 and higher (CIN1+), and CIN grade 2 and higher (CIN2+) as terminal events. RESULTS : Altogether, 131 (7.0%), 90 (4.8%), and 39 (2.1%) cases progressed to SIL, CIN1+, and CIN2+, respectively, progression times being equal in the NIS (11.9, 16.8, and 19.6 months) and LAMS (13.6, 14.1, and 15.4 months) cohorts (P = 0.931, P = 0.335, and P = 0.535). The 2 most powerful end-point markers of disease progression to CIN2+ were high-grade squamous intraepithelial lesions based on Papanicolaou test results at 6-month (odds ratio [OR] = 47.1; 95% confidence interval [CI], 17.3-128.7) and 12-month (OR = 21.5; 95% CI, 5.1-90.8) follow-up visits, with longitudinal positive and negative predictive values of 42.1% and 98.0% (6 months) and 33.3% and 97.7% (12 months). Of the virological end points, more than 6 months of persistent high-risk HPV (HR-HPV) was the most powerful predictor of progression to CIN1+ (OR = 18.6; 95% CI, 2.5-136.5), with longitudinal positive and negative predictive values of 10.3% and 99.4%, respectively. No additional benefit was obtained using more than 12 months of persistent HR-HPV end point. CONCLUSIONS High-grade squamous intraepithelial lesion based on a Papanicolaou test results at 6- or 12-month follow-up visits was the most powerful end point, either considering cytological end points alone or in comparison to any of the virological end points. Of the virological end points, more than 6-month HR-HPV persistence criteria give the most powerful estimate of a progressive disease.
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Affiliation(s)
- Kari Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland.
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18
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Rosa MID, Medeiros LR, Rosa DD, Bozzeti MC, Silva FR, Silva BR. [Human papillomavirus and cervical neoplasia]. CAD SAUDE PUBLICA 2009; 25:953-64. [PMID: 19488480 DOI: 10.1590/s0102-311x2009000500002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 11/26/2008] [Indexed: 12/11/2022] Open
Abstract
Human papillomavirus (HPV) has been established as an important etiological factor for the development of cervical cancer. This DNA virus primarily infects the epithelium and can induce benign and malignant lesions of the mucous membranes and skin. Some HPVs are considered high risk due to their role in malignant progression of cervical tumors. Genital HPV infections are common and usually transient among young sexually active women. Only a small fraction of infected women develop cervical cancer, implying the involvement of environmental and genetic cofactors in cervical carcinogenesis. Classification, virology, pathology, natural history, epidemiological features of genital HPV infection, and future prospects for cervical cancer prevention with HPV vaccines will be reviewed here.
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Affiliation(s)
- Maria Inês da Rosa
- Curso de Medicina, Universidade do Extremo Sul Catarinense, Criciúma, Brasil.
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19
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Human papillomavirus infection in Honduran women with normal cytology. Cancer Causes Control 2009; 20:1663-70. [PMID: 19685147 PMCID: PMC2767515 DOI: 10.1007/s10552-009-9414-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Accepted: 07/29/2009] [Indexed: 11/16/2022]
Abstract
Objective This study was aimed at estimating type-specific HPV prevalence and its cofactors among Honduran women with normal cytology in order to provide valuable information to health policymakers about the epidemiology of this important sexually transmitted infection. Methods A total of 591 women with normal cytology from Tegucigalpa, Honduras were interviewed and tested for HPV using the SPF10 LiPA25. A structured epidemiological questionnaire was administered to each woman. Results The overall HPV prevalence was 51%. Twenty-three types of HPV were detected; HPV 16, 51, 31, 18, and 11 were the most common. The highest prevalence of cancer associated HPV types (15.0%) was found in the women less than 35 years. Besides the association with age, the main independent predictors of HPV infection were the lifetime number of sexual partners and having a low socioeconomic status and less than 5 previous Pap smears. Conclusions In the population studied, there was a broad diversity of HPV infections, with high-risk types being the most common types detected. The establishment of a well-characterized population with regard to the community prevalence of type-specific HPV infection will provide a valuable baseline for monitoring population effectiveness of an HPV vaccine.
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20
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Smith JS, Melendy A, Rana RK, Pimenta JM. Age-specific prevalence of infection with human papillomavirus in females: a global review. J Adolesc Health 2008; 43:S5-25, S25.e1-41. [PMID: 18809145 DOI: 10.1016/j.jadohealth.2008.07.009] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 06/27/2008] [Accepted: 07/03/2008] [Indexed: 01/08/2023]
Abstract
PURPOSE Global data on age-specific prevalence of human papillomavirus (HPV) infection overall, and for high-risk HPV types 16 and 18, are essential for the future implementation of HPV prophylactic vaccines for cervical cancer prevention. METHODS A systematic review of peer-reviewed publications was conducted to summarize worldwide data on genital HPV-DNA prevalence in women. Studies with clear descriptions of polymerase chain reaction or hybrid capture detection assays were included. RESULTS A total of 346,160 women were included in 375 studies. Of 134 studies with age-stratified HPV prevalence data (116 low sexual risk populations, 18 high sexual risk populations), over 50% were from Europe and the Middle East (38%) and North America (19%), with smaller proportions from Asia and Australia (21%), Central and South America (11%), and Africa (10%). Across all geographical regions, data on HPV prevalence were generally limited to women over 18 years of age. Consistently across studies, HPV infection prevalence decreased with increasing age from a peak prevalence in younger women (< or =25 years of age). In middle-aged women (35-50 years), maximum HPV prevalence differed across geographical regions: Africa (approximately 20%), Asia/Australia (approximately 15%), Central and South America (approximately 20%), North America (approximately 20%), Southern Europe/Middle East (approximately 15%), and Northern Europe (approximately 15%). Inconsistent trends in HPV prevalence by age were noted in older women, with a decrease or plateau of HPV prevalence in older ages in most studies, whereas others showed an increase of HPV prevalence in older ages. Similar trends of HPV 16 and/or 18 prevalence by age were noted among 12 populations with available data. DISCUSSION Genital HPV infection in women is predominantly acquired in adolescence, and peak prevalence in middle-aged women appears to differ across geographical regions. Worldwide variations in HPV prevalence across age appear to largely reflect differences in sexual behavior across geographical regions. Further studies of HPV prevalence in adolescents are needed for all geographic regions.
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Affiliation(s)
- Jennifer S Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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21
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Comparison of GP5+/6+-PCR and SPF10-line blot assays for detection of high-risk human papillomavirus in samples from women with normal cytology results who develop grade 3 cervical intraepithelial neoplasia. J Clin Microbiol 2008; 46:3215-21. [PMID: 18685007 DOI: 10.1128/jcm.00476-08] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Using a case control approach, we performed a two-way comparison study between GP5+/6+-PCR and HPV SPF(10)-Line Blot 25 (SPF(10)) assays for detection of 14 types of high-risk human papillomavirus (hrHPV) in samples from women with normal cytology results who had or developed grade 3 cervical intraepithelial neoplasia (CIN 3). Samples were pooled from two cohorts, i.e., women participating in population-based screening and women attending a gynecological outpatient clinic. Cases (n = 45) were women with histologically confirmed CIN 3 diagnosed within a median follow-up time of 2.7 (range, 0.2 to 7.9) years. Control samples were from women (n = 264) who had developed CIN 1 lesions at maximum (median follow-up at 5.8 [range, 0 to 10] years). Identical numbers of cases tested positive for 1 or more of the 14 hrHPV types by both systems (40/45; McNemar; P = 1.0). Conversely, SPF(10) scored significantly more controls as hrHPV positive than did GP5+/6+-PCR (95/264 versus 29/264; McNemar; P < 0.001). Consequently, women with normal cytology results and an hrHPV GP5+/6+-PCR-positive test exhibited a risk of CIN 3 that was 4.5 times higher (odds ratio [OR], 65; 95% confidence interval [95%CI], 24 to 178) than that seen for women with an hrHPV-positive SPF(10) test (OR, 14; 95%CI, 5 to 38)). Similar results were obtained after analysis of both cohorts separately. Discrepancy analysis by viral load assessment for the most common discordant hrHPV types (HPV16, -18, and -52) showed that samples which were SPF(10) positive only for these types had viral loads significantly lower than those for samples that were positive by both assays (analysis of variance; P < or = 0.006). Our data indicate that GP5+/6+-PCR has a better clinical performance than SPF(10) for women who are diagnosed with CIN 3 after prior normal cytology results. The extra positivity scored by SPF(10) mainly involved infections characterized by low viral loads that do not result in CIN 3.
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Heideman DAM, Snijders PJF, Berkhof J, Verheijen RHM, Helmerhorst TJM, Meijer CJLM. Vaccination against HPV: indications for women and the impact on the cervical screening programme. BJOG 2008; 115:938-46. [DOI: 10.1111/j.1471-0528.2008.01779.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Michael KM, Waterboer T, Sehr P, Rother A, Reidel U, Boeing H, Bravo IG, Schlehofer J, Gärtner BC, Pawlita M. Seroprevalence of 34 human papillomavirus types in the German general population. PLoS Pathog 2008; 4:e1000091. [PMID: 18566657 PMCID: PMC2408730 DOI: 10.1371/journal.ppat.1000091] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 05/16/2008] [Indexed: 11/23/2022] Open
Abstract
The natural history of infections with many human papillomavirus (HPV) types is poorly understood. Here, we describe for the first time the age- and sex-dependent antibody prevalence for 29 cutaneous and five mucosal HPV types from 15 species within five phylogenetic genera (alpha, beta, gamma, mu, nu) in a general population. Sera from 1,797 German adults and children (758 males and 1,039 females) between 1 and 82 years (median 37 years) were analysed for antibodies to the major capsid protein L1 by Luminex-based multiplex serology. The first substantial HPV antibody reactions observed already in children and young adults are those to cutaneous types of the genera nu (HPV 41) and mu (HPV 1, 63). The antibody prevalence to mucosal high-risk types, most prominently HPV 16, was elevated after puberty in women but not in men and peaked between 25 and 34 years. Antibodies to beta and gamma papillomaviruses (PV) were rare in children and increased homogeneously with age, with prevalence peaks at 40 and 60 years in women and 50 and 70 years in men. Antibodies to cutaneous alpha PV showed a heterogeneous age distribution. In summary, these data suggest three major seroprevalence patterns for HPV of phylogenetically distinct genera: antibodies to mu and nu skin PV appear early in life, those to mucosal alpha PV in women after puberty, and antibodies to beta as well as to gamma skin PV accumulate later in life.
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Affiliation(s)
- Kristina M Michael
- Infection and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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24
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Kulasingam SL, Benard S, Barnabas RV, Largeron N, Myers ER. Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A cost-effectiveness analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2008; 6:4. [PMID: 18279515 PMCID: PMC2290741 DOI: 10.1186/1478-7547-6-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 02/15/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assessed the cost-effectiveness of adding a quadrivalent (6/11/16/18) human papillomavirus (HPV) vaccine to the current screening programme in the UK compared to screening alone. METHODS A Markov model of the natural history of HPV infection incorporating screening and vaccination was developed. A vaccine that prevents 98% of HPV 6, 11, 16 and 18-associated disease, with a lifetime duration and 85% coverage, in conjunction with current screening was considered. RESULTS Vaccination with screening, compared to screening alone, was associated with an incremental cost-effectiveness ratio of pound21,059 per quality adjusted life year (QALY) and pound34,687 per life year saved (LYS). More than 400 cases of cervical cancer, 6700 cases of cervical intraepithelial neoplasia and 4750 cases of genital warts could be avoided per 100,000 vaccinated girls. Results were sensitive to assumptions about the need for a booster, the duration of vaccine efficacy and discount rate. CONCLUSION These analyses suggest that adding a quadrivalent HPV vaccine to current screening in the UK could be a cost-effective method for further reducing the burden of cervical cancer.
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Affiliation(s)
| | | | - Ruanne V Barnabas
- Cancer Epidemiology Unit, University of Oxford, Oxford, OX3 7LF, UK
- HIV Vaccines Trials Network, Fred Hutchinson Research Center, Seattle, WA, USA
| | | | - Evan R Myers
- Dept. of Obstetrics and Gynecology, Duke University, Durham, NC 27705, USA
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25
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Tworek JA, Jones BA, Raab S, Clary KM, Walsh MK. The value of monitoring human papillomavirus DNA results for Papanicolaou tests diagnosed as atypical squamous cells of undetermined significance: a College of American Pathologists Q-Probes study of 68 institutions. Arch Pathol Lab Med 2007; 131:1525-31. [PMID: 17922588 DOI: 10.5858/2007-131-1525-tvomhp] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Papanicolaou (Pap) tests are often diagnosed as atypical squamous cells of undetermined significance (ASC-US). Human papillomavirus (HPV) DNA testing has been proposed as a quality metric for this diagnosis. OBJECTIVE To measure the frequency of HPV positivity in Pap tests diagnosed as ASC-US and to examine laboratory variables that are associated with institutional deviation from the mean percent of HPV positivity. DESIGN As part of a College of American Pathologist Q-Probes program, 68 participating laboratories retrospectively identified approximately 50 consecutive ASC-US Pap tests that had HPV testing results. RESULTS The mean percentage of HPV positivity for ASC-US was 43.74% among institutions surveyed, but it had a broad distribution, with an SD of 17.77%. Associations were found for lower difference of the institutional mean from the surveyed interinstitutional mean percentage of positive HPV with (1) higher numbers of Pap tests in the past year that had HPV testing, (2) in-house HPV testing, and (3) teaching hospitals. All 3 factors correlated with a larger volume of Pap tests per institution. An association was found between patient age and the probability of a positive HPV result, indicating a dependence upon prevalence of HPV. CONCLUSIONS Larger volumes of Pap tests may offer an opportunity to gain greater comfort in interpreting Pap tests. While there is significant variability in interinstitutional HPV-positive rates in ASC-US Pap tests, monitoring the HPV-positive rate in ASC-US Pap tests is a valuable broad measure of quality. Performance beyond 2 SDs of the mean should prompt reassessment of diagnostic criteria used in the evaluation of Pap tests and/or investigation of the prevalence of HPV positivity in the population from which the Pap tests are obtained.
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Affiliation(s)
- Joseph A Tworek
- Department of Pathology, St Joseph Mercy Hospital, 5301 E Huron River Dr, PO Box 995, Ann Arbor, MI 48106-0995, USA.
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Sapy T, Poka R, Szarka K, Konya J, Huga S, Hernadi Z. Age-specific prevalence of high-risk human papillomavirus infection in a Hungarian female population with positive cytology. Eur J Obstet Gynecol Reprod Biol 2007; 138:194-8. [PMID: 17714853 DOI: 10.1016/j.ejogrb.2007.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Revised: 06/25/2007] [Accepted: 07/03/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Patients with positive screening results and persistence of high-risk human papillomavirus (HPV) infection represent the population at the highest risk for developing cervical cancer. To describe the epidemiology in this high-risk population, data were collected and analysed at the referral centre for patients with positive cytology. STUDY DESIGN Between January 1997 and December 2002 the authors performed 3480 virus identifications using the Digene Hybrid Capture system in a female population with positive cytology at cervical cancer screening. Age-specific prevalence data were evaluated and compared between the age groups by running the chi(2) and Pearson chi(2) tests. Subgroup analysis was performed to estimate monthly clearance rates among eligible women with positive HR-HPV results. RESULTS Low-risk (LR), high-risk (HR) and double infections were detected in 91 cases (2.6%), 1072 cases (30.8%) and 59 cases (1.7%), respectively. A significantly higher incidence of high-, rather than low-risk HPV infections was found in all age groups (p<0.001). Also, in this high-risk population with positive screening a significant decrease was detected in the prevalence of both high- and low-risk infections beyond 35 years of age (p<0.001). However, the decline in the HR-HPV types occurred later than in the case of LR infections, and HR-HPV was of remarkable frequency in the older age groups, which might represent both incidental and prevalent cases. Subgroup analysis for estimating monthly clearance rates revealed no significant differences between the various age groups and between women with various cytology results. CONCLUSIONS In a population with positive cytology the prevalence of HPV drops with age while the relative frequency of high-risk HPV infection remains at the same level as that of the youngest age group.
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Affiliation(s)
- Tamas Sapy
- Department of Gynecological Oncology, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary.
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Monsonego J. [Prevention of cervical cancer (II): prophylactic HPV vaccination, current knowledge, practical procedures and new issues]. Presse Med 2007; 36:640-66. [PMID: 17350792 DOI: 10.1016/j.lpm.2007.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 02/04/2007] [Indexed: 11/20/2022] Open
Abstract
Despite the considerable success of early screening for prevention of cervical cancer, Pap smears have not fulfilled the hopes that it would lead to a large-scale reduction of this cancer's incidence. Screening appears to be useful for a tiny portion of the world population, although a relatively large portion must put up with its limitations and disadvantages. Human papilloma viruses (HPV) 16 and 18 are responsible for two thirds of all cervical cancers worldwide. The condylomata (condyloma acuminatum), or genital warts, induced by HPV 6 and 11 are frequent among the young and difficult to manage. The extent and burden of HPV infection are considerable, as is the psychological and emotional impact of the diseases associated with it. Because cancer of the cervix is the final consequence of chronic HPV infection, it can be prevented by vaccination. A prophylactic vaccine to protect against the precancerous and cancerous lesions associated with HPV should save lives, reduce expensive diagnostic and therapeutic interventions, and have substantial individual and collective benefits. Clinical trials of anti-HPV vaccines for the prevention of cervical cancer and condyloma have shown remarkable results and an efficacy unequaled in the history of vaccination against infectious diseases. Vaccine efficacy has been shown only in young girls never exposed to the virus and only for the lesions associated with the specific viral types in the vaccine. Preliminary data indicate that the vaccination is effective in women who have previously eliminated naturally the virus. It has no therapeutic effects on existing lesions or in healthy virus carriers. Practical questions remain to be resolved. If the vaccination is left to individual initiative and vaccination coverage is insufficient, there will be no perceptible reduction in the frequency of cervical cancer. Vaccination policies will not be identical in poor countries, where the disease represents one of the leading causes of mortality among women, and in the rich countries, where screening programs have considerably reduced the frequency of this cancer. Current planning calls for the introduction of systematic vaccination of young girls aged 9-15 years, with progressive "catch-up" vaccination of the cohorts of young women aged 16-26 years. Nonetheless mathematical models and immunogenicity results indicate a possible benefit for individual vaccination of adults. This approach must still be assessed in the clinical trials underway. Because the vaccine does not protect against all types of HPV associated with cervical cancer, screening must be continued according to the conditions currently set. Vaccination and screening, which are complementary and synergistic, now constitute the new standards for prevention of this disease.
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Rijkaart DC, Bontekoe TR, Korporaal H, Boon ME. Alternating high-risk human papillomavirus infection: consequences of progression to cervical intraepithelial neoplasia. Cancer 2007; 108:475-9. [PMID: 17063498 DOI: 10.1002/cncr.22305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nearly every Dutch woman will be exposed to genital human papillomavirus (HPV) at least once during her lifetime, and most likely several times. In the current study, the authors investigated the prevalence of high-risk-HPV (HR-HPV) infection and the likelihood of progression to cervical intraepithelial neoplasia (CIN). METHODS In this study, the course of HR-HPV infection in 703 women was observed. From a database of 720,016 negative cytology smears, the authors selected 703 women based on the availability of at least 2 HR-HPV polymerase chain reaction tests. The authors database stores not only the HPV data but also all other cytologic and histologic data, allowing the detection of women who progressed from negative cytology to CIN within a period of 10 years. RESULTS Of the 703 selected women, 159 were found to have alternating HR-HPV infection (change from a negative HR-HPV test to a positive test or vice versa), 40 had a persistently positive HR-HPV test, and 504 women had a persistently negative HR-HPV test. The percentage of alternating HPV infection declined over time from 37% to 7%. Of the women age older than 40 years, 17% had an alternating HR-HPV infection, 2 of whom developed CIN. These findings led the authors to conclude that all the women in the current study with an increased risk of developing type 2 or 3 CIN were identified using 2 HPV tests. Women age older than 40 years still have a significant risk of acquiring a HR-HPV. CONCLUSIONS In light of the current study findings, the authors believe it is worth considering the inclusion of women age 40 years and older who have negative cytology for HPV testing as part of the Dutch national screening program.
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Kulmala SMA, Shabalova IP, Petrovitchev N, Syrjänen KJ, Gyllensten UB, Syrjänen SM. Prevalence of the most common high-risk HPV genotypes among women in three new independent states of the former Soviet Union. J Med Virol 2007; 79:771-81. [PMID: 17457909 DOI: 10.1002/jmv.20839] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Type distribution of HPV has been studied in different geographic regions, but the data are scanty from the new independent states of the former Soviet Union. Here the HPV prevalence and distribution of the most frequent high-risk HPV types among 3,187 women at different risk for HPV and cervical intraepithelial neoplasia in Russia, Belarus, and Latvia is reported. HPV detection, type distribution and viral load analysis in DNA samples from cervical scrapes were done with real-time PCR-based assay detecting HPV types 16, 18, 31, 33, 35, 39, 45, 52, and 58. The overall HPV prevalence was 31.2%, HPV16 was the most prevalent type followed by HPV31 and HPV33 group. The overall HPV prevalences in Russia, Belarus and Latvia were 33.4%, 27.5%, and 26.2%. The type distributions were similar in these countries, except for Latvia where HPV39 was the third prevalent genotype. HPV prevalence was highest (40.8%) among women from sexually transmitted disease clinic, followed by 30.9% among gynecological outpatients and 27.2% in screening patients. HPV detection increased with cytological abnormality (P = 0.0001) and lesion grade in the biopsy (P = 0.0001), from 27% to 72% in normal samples to cancer, and from 64% to 77% in cervical intraepithelial neoplasia 1 to cancer. The normalized viral loads varied greatly between and among different HPV-types. The mean log HPV33 group copies/cell increased from negative for intraepithelial lesions to cancer (P = 0.049). Distribution of the most common high-risk HPV-types seems to be similar in these countries as reported in other major geographical regions.
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Affiliation(s)
- Satu-Maria A Kulmala
- Department of Oral Pathology, Institute of Dentistry, MediCity Research Laboratory, University of Turku, Turku, Finland
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Abstract
Worldwide, cervical cancer is diagnosed annually in more than 500,000 women and accounts for 270,000 deaths, making it the second leading cause of cancer in women. In Europe, where many countries have set up screening program, cervical cancer ranks third among cancers in women. In France, cervical cancer is diagnosed in 3400-4500 women each year and kills 1000-1600. Since its introduction, Pap smear screening has transformed cervical cancer from a fatal disease into a rare condition. Despite the considerable success of this cytologic screening, Pap smears have not, as was first hoped, reduced incidence on a large scale. The principal reasons are related to the difficulties in ensuring optimum coverage of the population to be screened and in maximizing women's adherence: the success of screening depends on strict compliance with the calendar from 25 to 65 years of age. In 1/3 of cases, invasive cancers are found in women who undergo regular screening, because Pap smears are insufficiently sensitive. In 5% of cases, cancers are observed in women who were inappropriately managed after an abnormal Pap smear finding. The contribution of the HPV test to primary screening opens up promising perspectives of optimum protection. The test's sensitivity for high-grade lesions exceeds 95% and its negative predictive value exceeds 99%. The HPV test is the only test available for which a negative result provides instantaneous assurance that there is no risk of cervical cancer. The Pap smear alone, with its sensitivity of less than 70%, cannot provide this certainty. European and American guidelines recommend screening strategies based on a combined test using the Pap smear and HPV test after the age of 30 years. The impending availability of prophylactic HPV vaccines, which are expected to provide 70% protection against cervical cancer, will not affect the practice of screening, which must continue.
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Abstract
A variety of cytological changes suggestive of genital tract infection may be noted during microscopy of a Papanicolaou-stained cervical smear. The dilemma faced by cytopathologists is whether or not to report suspicious changes to the clinician responsible for the woman's care. This review examines the effectiveness of Papanicolaou-smear microscopy in the diagnosis of the more common sexually transmitted infections, and aims to encourage debate on the reporting of suggestive cytological changes.
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Affiliation(s)
- A McMillan
- Department of Genitourinary Medicine, Edinburgh Royal Infirmary, NHS Lothian, University Hospitals Division, Edinburgh, UK.
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Monteiro DLM, Trajano AJB, da Silva KS, Russomano FB. Pre-invasive cervical disease and uterine cervical cancer in Brazilian adolescents: prevalence and related factors. CAD SAUDE PUBLICA 2006; 22:2539-48. [PMID: 17096030 DOI: 10.1590/s0102-311x2006001200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 12/11/2005] [Indexed: 11/21/2022] Open
Abstract
The objective was to describe the prevalence and factors associated with uterine cervical cancer (CA) and high-grade squamous intraepithelial lesions (HSIL) in adolescents. A cross-sectional study was carried out with 702 sexually active adolescents treated at a general hospital in Rio de Janeiro, Brazil, from 1993 to 2002. Screening was performed by cytopathology and colposcopy and confirmation by biopsy. Exposure variables were socio-demographic characteristics and those related to reproductive health, habits, and sexual behavior. Adjusted odds ratios were estimated using multivariate logistic regression analysis. Based on histopathology, the prevalence of HSIL/CA was 3% (95%CI: 1.8-4.6). There was one case of invasive cancer. With each additional pregnancy, the odds of HSIL/CA increased by 2.2 (95%CI: 1.1-4.4). Age was also associated with this outcome, doubling the odds of acquiring this degree of disease with each year of age (OR = 2.0; 95%CI: 1.2-3.4). The prevalence of lesions suggests the importance of including sexually active adolescent females in cervical cancer screening programs aimed at early detection and treatment of these lesions.
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Abstract
Vaccines for preventing human papillomavirus (HPV) infection are far along in clinical development and testing, and hold great promise for reducing HPV infections and HPV-associated disease. HPV is the most common sexually transmitted infection in the United States, affecting an estimated 75% of the U.S. population. HPV infection is highly prevalent in sexually active adolescents and young adults. Sexual activity is the most important risk factor for infection, with 64% to 82% of sexually active adolescent girls testing positive for HPV. Clinical manifestations of HPV infection include genital warts, cervical intraepithelial neoplasia (CIN), and invasive cervical cancer, all of which cause significant morbidity and, in the case of cervical cancer, mortality. The majority of HPV-associated disease is caused by 4 HPV types: HPV 6 and 11 are responsible for low-grade genital lesions and more than 90% of genital warts, and HPV 16 and 18 both account for approximately 70% of all high-grade CIN or dysplasia and invasive cervical cancer. Although current screening methods have proven effective in reducing cervical cancer incidence and associated mortality, more than 10,000 women are diagnosed annually and 4000 U.S. women die from the disease each year.
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Affiliation(s)
- Dorothy Wiley
- School of Nursing, University of California-Los Angeles, Los Angeles, CA, USA
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Shroyer KR, Homer P, Heinz D, Singh M. Validation of a novel immunocytochemical assay for topoisomerase II-α and minichromosome maintenance protein 2 expression in cervical cytology. Cancer 2006; 108:324-30. [PMID: 16937378 DOI: 10.1002/cncr.22171] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cervical cytopathology has limited specificity for the detection of underlying clinically significant lesions in cases with low-grade cytologic abnormalities. The current study evaluated the performance of a novel immunocytochemical test (ProEx C) for topoisomerase II alpha (TOP2A) and minichromosome maintenance protein 2 (MCM2) in normal versus high-grade squamous intraepithelial lesion (HSIL) and positive control (SiHa) pooled cytology preparations and in a pilot series of prospectively collected patient specimens. METHODS TOP2a and MCM2 were detected as markers of aberrant S-phase induction in SurePath cervical cytology specimens by an indirect polymer-based immunoperoxidase method (ProEx C, TriPath Oncology, Burlington, NC). Slides were scored based on specimen adequacy, the presence of nuclear stain in epithelial cells, and the association of nuclear staining with cytologic atypia (>/=atypical squamous cell of undetermined significance [ASC-US] or atypical glandular cells [AGC]). RESULTS Intense nuclear staining was detected in cytologically abnormal cells but not in most normal squamous and glandular cells. Slides were scored positive in pooled samples in 1 of 40 (2.5%) cases that were negative for intraepithelial neoplasia or malignancy (NIL), in 40 of 40 (100%) SiHa-spiked NIL, and in 40 of 40 (100%) HSILs. There was 100% concordance in test classification of 20 slides between 2 pathologists. Subsequent evaluation of prospectively collected patient specimens was positive for ProEx C in none of 10 NIL (0%), 2 of 10 ASC-US (20%), 5 of 10 low-grade SIL (LSIL) (50%), and in 10 of 10 (100%) HSILs. CONCLUSIONS The ProEx C test showed almost no variability with regard to scoring and staining reproducibility and was consistently positive in HSIL. Further studies are indicated to evaluate the potential role of ProEx C as a diagnostic adjunct for the triage of ASC-US/LSIL.
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Affiliation(s)
- Kenneth R Shroyer
- Department of Pathology, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, USA.
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Jeronimo J, Schiffman M. Colposcopy at a crossroads. Am J Obstet Gynecol 2006; 195:349-53. [PMID: 16677597 DOI: 10.1016/j.ajog.2006.01.091] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 01/12/2006] [Accepted: 01/20/2006] [Indexed: 11/28/2022]
Abstract
New cervical cancer prevention strategies are arising from rapidly improving insight into human papillomavirus (HPV) natural history and cervical carcinogenesis, challenging the conventional roles of cytology and colposcopically directed biopsy as the reference standards of screening and diagnosis, respectively. HPV testing has high sensitivity but mediocre specificity and positive predictive value, making the role of colposcopy for the accurate identification of patients requiring treatment even more important. We believe that deficiencies of the colposcopically guided biopsy must be addressed, in particular, the inaccuracy of biopsy placement leading to low sensitivity for detection of CIN3. This opinion outlines our concerns and summarizes new data, suggesting possible steps that may lead to improvement in colposcopic accuracy.
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Affiliation(s)
- Jose Jeronimo
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Resources, Bethesda, MD, USA
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Zoundi-Ouango O, Morcel K, Classe JM, Burtin F, Audrain O, Levêque J. Lésions cervicales utérines pendant la grossesse : diagnostic et prise en charge. ACTA ACUST UNITED AC 2006; 35:227-36. [PMID: 16645555 DOI: 10.1016/s0368-2315(06)78306-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To define a practical attitude for the management of pregnant women with cervical intraepithelial neoplasia (CIN) and cervical cancer. MATERIALS AND METHODS Review of the literature indexed in Medline. RESULTS The prevalence of the HPV infections is unchanged among pregnant women with infection by low risk viruses. The viral load increases at the time of the pregnancy, and decreases in the post-partum period. Cervical cytology is easily to perform with reliable results: among the 5% of pathological cervical smears, low grade lesions predominate. The high grade smears require colposcopic exploration, usefully completed by directed biopsies to rule out invasive lesions. Surveillance of high grade CIN is required during pregnancy with post-partum control; most regress. In France during the year 2000, 189 cancers of the uterine cervix were detected during 774.782 pregnancies. Clinical diagnosis is delayed by the non specific clinical signs and the histological aspects of the lesions which are identical with those observed in young woman. The intrinsic outcome of cancer is not modified by pregnancy, and the cesarean section is often preferred (vaginal delivery likely facilitates vascular dissemination). For fetal reasons, a therapeutic delay can be proposed for small sized lesions with a favourable histological subtype and no progression after 20 weeks of gestation. CONCLUSION Pregnancy offers the opportunity to perform cervical smears in women not regularly followed. A conservative attitude with a revaluation in postpartum can be proposed in the event of diagnosis of CIN during pregnancy. Pregnancy has little influence on invasive cervical cancers. Management decisions must be made on a case-by-case basis.
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Affiliation(s)
- O Zoundi-Ouango
- Département d'Obstétrique Gynécologie et Médecine de la Reproduction, CHU de Rennes, Hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes Cedex 2
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Monsonego J, Pintos J, Semaille C, Beumont M, Dachez R, Zerat L, Bianchi A, Franco E. Human papillomavirus testing improves the accuracy of colposcopy in detection of cervical intraepithelial neoplasia. Int J Gynecol Cancer 2006; 16:591-8. [PMID: 16681731 DOI: 10.1111/j.1525-1438.2006.00361.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To assess the performance of human papillomavirus (HPV) testing and colposcopy in detection of cervical pathology. A series of 389 women referred for colposcopy due to an abnormal Pap smear had cervical swabs analyzed for oncogenic (high-risk [HR]) HPV types using Hybrid Capture II (HC2) assay. Loop electrical excision procedure cone biopsy (88%) or colposcopic biopsy (11%) was used as the gold standard. Of the atypical squamous cells of undetermined significance (ASCUS) smears, 48% were positive for HR HPV, as compared to 76.3% of low-grade squamous intraepithelial lesions (LSIL) smears. HR HPV was detected in 66.7% and 90% of patients with cervical intraepithelial neoplasia (CIN) 1 and CIN2 (or higher), respectively. The sensitivity of the Pap smear using an ASCUS threshold in detecting high-grade CIN was 94.5% (95% confidence intervals (CI): 91-97%) and that of colposcopy 98.5% (95% CI: 95-99%). The respective specificities were 30% (95% CI: 17-28%) and 35.6% (CI: 29-42%). HC2 test had comparable sensitivity, 90% (95% CI: 85-93%), but higher specificity, 54.3% (95% CI: 47-61%). Combining HC2 test with Pap increased specificity, 66.7% and 41.3% for ASCUS and LSIL cutoff, respectively. The minor-abnormality threshold together with HC2 increased specificity of colposcopy with no changes in sensitivity. High viral load (>100 relative light unit/positive control) was associated with significant disease. HPV DNA testing improves the accuracy of colposcopy in the detection of high-grade CIN in women with ASCUS or LSIL smears.
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Monsonégo J. Prévention du cancer du col utérin : enjeux et perspectives de la vaccination antipapillomavirus. ACTA ACUST UNITED AC 2006; 34:189-201. [PMID: 16529969 DOI: 10.1016/j.gyobfe.2006.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 01/20/2006] [Indexed: 10/24/2022]
Abstract
Cervical cancer remains a critical public health problem that is second only to breast cancer in overall disease burden for women throughout the world. In spite of the success of cervical cancer screening, Pap cytology screening is yet to be effectively implemented or has failed to reduce cervical cancer rates to an appreciable extent. Screening appears to benefit only a small fraction of women although a much larger percentage endures the inconvenience of the Pap test in order to avoid cervical cancer. The establishment of Human Papillomavirus (HPV) infection as the necessary cause of cervical precancers and cancers provides a tremendous opportunity for cervical cancer prevention through vaccination. HPV 16 and 18 which cause 70% of cervical cancers worldwide. Thus a prophylactic vaccine to prevent HPV related precancerous lesions and cancers would save lives, reduce the need for costly medical procedures and provide both women and communities throughout the world with substantial benefits. Based on the induction of neutralizing antibodies by non infectious Virus Like Particles (VLP) of L1 capside protein, prophylactic HPV vaccines have consistently induced high titter of neutralizing antibodies with minimal side effects and induce more than 90% protection from persistent HPV 16-18 infection and HPV 16 and 18 associated high-grade Cervical Intraepithelial Neoplasia (CIN) in proof of concept efficacy trials. HPV 16-18 vaccination will prevent HPV16-18 incident infection, and subsequently decrease in 90% the frequency of abnormal Pap attributable to these types and in about 50% overall abnormal Pap. HPV vaccination will reduce the number of women who require colposcopy, biopsy and cervical treatment for precancerous cervical lesions. The level of protection from death due to cervical cancer could exceed 95%. Three large phases prophylactic HPV VLP trials are now in progress and will form the basis for licensing of candidate vaccines in 2006. HPV vaccination targeting young female adolescents, aged 11 to 16 years, with a catch-up of those aged 17-25 years, would be a strategy to be addressed. Cervical cancer screening strategies, that will be cost-effective for the proper surveillance of women protected by HPV vaccination, are under analysis.
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Affiliation(s)
- J Monsonégo
- Institut A.-Fournier, 174, rue de Courcelles, 75017 Paris, France.
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39
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Affiliation(s)
- Carol Dallred
- Department of Nursing Professional Development and Education, University of Texas M.D. Anderson Cancer Center, Houston, USA.
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Seo SS, Song YS, Kim JW, Park NH, Kang SB, Lee HP. Good correlation of HPV DNA test between self-collected vaginal and clinician-collected cervical samples by the oligonucleotide microarray. Gynecol Oncol 2006; 102:67-73. [PMID: 16375952 DOI: 10.1016/j.ygyno.2005.11.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2005] [Revised: 11/16/2005] [Accepted: 11/16/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy of self-collected vaginal samples for high-risk HPV detection by the HPV oligonucleotide microarray method (HPVDNAChip). METHODS One hundred and eighteen patients with abnormal Pap smears were included. Self-collected vaginal and clinician-collected cervical samples for HPV testing were obtained. The result of the HPV DNA test was compared with the histopathological diagnosis or colposcopic finding. RESULTS Of the 118 patients, 42 (35.6%) had >or= cervical intraepithelial neoplasia (CIN) III lesions. Using the HPVDNAChip, high-risk types of HPV were detected in 38 of these 42 patients (90.5%) with the self-collected vaginal samples and in 37 of 42 (88.1%) with the clinician-collected cervical samples. The agreement of HPVDNAchip results between self- and clinician-collected samples was very good (kappa = 0.81) with a 93.2% concordance rate. Multiple HPV infections were found in 17 of 88 (19.3%) HPV-positive clinician-collected cervical samples. The rate of multiple HPV infection tended to decrease as the degree of pathologic classification increased. CONCLUSION Using the HPVDNAchip to assay for HPV infection, results from self-collected vaginal samples were compatible with those from clinician-collected cervical samples.
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Affiliation(s)
- Sang-Soo Seo
- Center for Uterine Cancer, National Cancer Center, 809 Madu1-dong, Goyang-si, Gyeonggi-do 411-351, Korea
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Vinokurova S, Wentzensen N, Einenkel J, Klaes R, Ziegert C, Melsheimer P, Sartor H, Horn LC, Höckel M, von Knebel Doeberitz M. Clonal history of papillomavirus-induced dysplasia in the female lower genital tract. J Natl Cancer Inst 2005; 97:1816-21. [PMID: 16368943 DOI: 10.1093/jnci/dji428] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dysplastic lesions of the vagina or the vulva often occur in women who have a previous history of cervical dysplasia. Most lesions in the female lower genital tract are induced by infections with high-risk oncogenic human papillomaviruses (HR-HPVs), including HPV16 and HPV18. HR-HPV genomes frequently integrate into host cell chromosomes at random sites. We analyzed viral integration sites in multiple metachronous lesions of the lower genital tract from women previously treated for HR-HPV-positive cervical dysplasia or cancer to determine whether the metachronous lesions emerged from a single common preexisting dysplastic cell clone or as consequence of independent HR-HPV infection events in the female lower genital tract. METHODS From among 1500 patients with anogenital lesions, seven patients with high-grade vaginal or vulvar lesions and with a previous history of cervical disease (five with prior high-grade cervical dysplasia and two with a history of cervical cancer) were included in this study. Integration sites of HPV16 or HPV18 in vaginal or vulvar lesions were mapped by an adaptor ligation polymerase chain reaction (PCR) method. The sequence information was used to design an integrate-specific PCR assay that was applied to DNA extracted from archival paraffin-embedded material derived from biopsy samples of cervical lesions. RESULTS Identical HPV DNA integration loci were found in vaginal or vulvar and cervical samples of all lesions available for four of the five patients with a prior history of high-grade cervical dysplasia and for both patients with a history of cervical cancer. CONCLUSIONS These data indicate that high-grade dysplastic lesions in the female lower genital tract may emerge primarily as monoclonal lesions from a transformed cell population derived from the uterine cervix.
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Affiliation(s)
- Svetlana Vinokurova
- Department of Molecular Pathology/Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
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Baay MFD, Tjalma WAA, Lambrechts HAJ, Pattyn GGO, Lardon F, Weyler J, Van Royen P, Van Marck EAE, Vermorken JB. Combined Pap and HPV testing in primary screening for cervical abnormalities: Should HPV detection be delayed until age 35? Eur J Cancer 2005; 41:2704-8. [PMID: 16242316 DOI: 10.1016/j.ejca.2005.04.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 03/29/2005] [Accepted: 04/12/2005] [Indexed: 11/16/2022]
Abstract
In 2003, the United States Food and Drug Administration has approved the Hybrid Capture 2 assay for use with a Pap test to adjunctively screen women of 30 years and older for the presence of high-risk human papillomavirus (HR-HPV) infection. Although the predictive power of a negative test is strong, the number of false-positives may still be high. We investigated HPV prevalence in relation to age in a group of 2293 women, aged between 20 and 50, with normal cytology. Overall HR-HPV prevalence was 6.9% (95%CI=5.9-8.0%). Regression analysis using 5-year intervals showed that the HR-HPV prevalence did not significantly decline up to age 34, whereas it declined significantly after age 35. This would suggest that postponing HPV detection in primary screening from age 30 to 35 would result in a decrease of almost 50% of the number of women with normal cytology and a transient HPV infection. However, larger scale studies are required to confirm this finding.
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Affiliation(s)
- Marc F D Baay
- Department of Medical Oncology, University of Antwerp (CDE, T3), Universiteitsplein 1, 2610 Wilrijk, Belgium.
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43
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Egawa K, Honda Y. Simultaneous Human Papillomavirus 6 (HPV 6) -Positive Condyloma Acuminatum, HPV 3l-Positive Bowen's Disease, and Non HPV-Associated Extramammary Paget's Disease Coexisting Within an Area Presenting Clinically as Condyloma Acuminatum. Am J Dermatopathol 2005; 27:439-42. [PMID: 16148417 DOI: 10.1097/01.dad.0000157463.57087.6a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An 83-year-old Japanese man presented with multiple verrucous papules clustering on a plaque located on the frontal aspect of the scrotum. Histologically, there were three distinct epithelial changes compatible with condyloma acuminatum, Bowen's disease, and extramammary Paget's disease (EMPD). By in situ hybridization, the zone of condyloma acuminatum was positive for HPV 6 and well demarcated from HPV 31-positive Bowen's disease. EMPD was negative for targeted HPV 6/11/16/18/31/33 probes. Immunohistochemically, Paget's cells expressing cytokeratin 7 were distributed as scattered single cells or clusters mainly in the lower part of the HPV 6/31-positive epithelium. To the best of our knowledge, this is the first reported case of the occurrence of condyloma acuminatum, Bowen's disease, and EMPD within the same lesion.
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Affiliation(s)
- Kiyofumi Egawa
- Department of Dermatology, Kumamoto University School of Medicine, Kumamoto, Japan.
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44
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Bollmann M, Bánkfalvi A, Trosic A, Speich N, Schmittt C, Bollmann R. Can we detect cervical human papillomavirus (HPV) infection by cytomorphology alone? Diagnostic value of non-classic cytological signs of HPV effect in minimally abnormal Pap tests. Cytopathology 2005; 16:13-21. [PMID: 15859310 DOI: 10.1111/j.1365-2303.2004.00179.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Our aim was to assess the validity of non-classical cytological signs in minimally abnormal cervical smears for the prediction of HPV infection. METHODS 164 ThinPrep monolayers were re-screened for mild nuclear changes, disorders of keratinisation, abortive koilocytes and 'measles cells', as well as degenerative changes. HPV DNA was detected by GP5+/6+ and MY09/MY11 consensus primer PCR assays. RESULTS Seventy six of 164 cases (46.3%) had HPV positivity by PCR. All cytomorphological features studied were significantly associated with the presence of HPV. Mild nuclear changes had 100% sensitivity and 100% negative predictive value for HPV infection. CONCLUSIONS Our results indicate that non-classic cytomorphological signs can improve the sensitivity of cytology for detecting HPV. Minimally abnormal Pap smears lacking mild nuclear changes (16%) in the present study--do not require further molecular HPV testing.
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Affiliation(s)
- M Bollmann
- Institute of Pathology Bonn-Duisdorf, Bonn, Germany
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45
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Scheurer ME, Tortolero-Luna G, Adler-Storthz K. Human papillomavirus infection: biology, epidemiology, and prevention. Int J Gynecol Cancer 2005; 15:727-46. [PMID: 16174218 DOI: 10.1111/j.1525-1438.2005.00246.x] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Over the past several decades, knowledge of the biology and epidemiology of human papillomavirus (HPV) infection has increased tremendously. However, there are still many unanswered questions concerning the interaction of the virus with its host. The virus has been identified as a necessary causal agent for cervical squamous neoplasia and has been linked to the development of neoplasia in several other mucosal sites. The viral oncogenes E6 and E7 are the major players in the virus' scheme to evade the immune system and use the host cell replication machinery to survive. Many risk factors for infection with HPV have been identified; however, the focus now centers on identifying risk factors for persistence of the infection as it is likely that transient infections play a very small role in the overall development of clinical disease. Prevention measures to date have centered around screening programs, mostly for cervical cancer, including the perfection of screening techniques and inclusion of molecular testing for HPV into screening regimens. The development of prophylactic and therapeutic vaccines has also increased as primary prevention measures appear to have the best hope for long-term effects on cancer incidence.
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Affiliation(s)
- M E Scheurer
- Department of Epidemiology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Maehama T. Epidemiological study in Okinawa, Japan, of human papillomavirus infection of the uterine cervix. Infect Dis Obstet Gynecol 2005; 13:77-80. [PMID: 16011997 PMCID: PMC1784562 DOI: 10.1080/10647440400028151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: To investigate the prevalence and type distribution of human papillomavirus (HPV) in women with normal cervical cytology and with cervical intraepithelial neoplasia I to III(CIN) or carcinoma of the cervix in Okinawa, Japan. METHODS: We investigated HPV DNA in 4,078 subjects with cytologically normal cervices, 279 subjects with CIN, and 383 subjects with cervical cancer in Okinawa Prefecture in Japan. The presence of HPV DNA was also compared among generations. HPV DNA was both detected and typed using polymerase chain reaction (PCR). RESULTS: The HPV positivity rate was 10.6% in the subjects who were normal on cervical cytodiagnosis. In each generation, the positivity rate was 20.4% in women aged 20-29 years and approximately 10% in the groups aged 30-89 years, with significant differences among generations. The HPV positivity rates in CIN and cervical cancer groups were 76.0% and 86.2%, respectively, with no significant difference between the groups. The positivity rate of HPV 16 decreased with age in both CIN and cervical cancer groups. CONCLUSION: Among non-cancer subjects, HPV infection rates were almost 20% in women aged 20-29 years and 10% in women aged 30-89 years. HPV16-positive CIN or carcinoma were more prevalent in the younger women, suggesting that HPV16-infected epithelial cells rapidly progress to cervical cancer.
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Affiliation(s)
- Toshiyuki Maehama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
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van Ham MAPC, Bakkers JMJE, Harbers GK, Quint WGV, Massuger LFAG, Melchers WJG. comparison of two commercial assays for detection of human papillomavirus (HPV) in cervical scrape specimens: validation of the Roche AMPLICOR HPV test as a means to screen for HPV genotypes associated with a higher risk of cervical disorders. J Clin Microbiol 2005; 43:2662-7. [PMID: 15956381 PMCID: PMC1151918 DOI: 10.1128/jcm.43.6.2662-2667.2005] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Certain high-risk (HR) human papillomavirus (HPV) types are a necessary cause for the development of cervical disorders. Women with persistent HR HPV infections have an increased risk of developing high-grade cervical lesions, compared with those who have no or low-risk HPV infections. Therefore, implementation of HPV detection into cervical screening programs might identify women at risk of cervical cancer. Several HPV detection methods with different sensitivities and specificities are available. Recently, a new PCR-based technique, the Roche AMPLICOR HPV Test, was developed. This test recognizes a group of 13 HR HPV types simultaneously. This study was undertaken to validate and compare HPV detection in 573 cervical scrape specimens by the AMPLICOR HPV Test and the INNO-LiPA HPV detection/genotyping assay (SPF10-LiPA system version 1). Human beta-globin was not detected in nine specimens, which were therefore excluded from the comparison. Eleven scrape specimens containing HPV type 53 or 66 were also excluded from the comparison because these (probably) HR HPV types cannot be detected by the AMPLICOR HPV Test. The results of HPV detection by the Roche AMPLICOR HPV Test were confirmed by INNO-LiPA HPV detection/genotyping assay in 539/553 cases, showing an absolute agreement of 97.5% with a Cohen's kappa of 0.9327, indicating almost complete similarity of the two tests. Like the INNO-LiPA HPV detection/genotyping assay, the AMPLICOR HPV Test was sensitive, specific, feasible, and easy to handle. The value of the Roche AMPLICOR HPV Test with a broad-spectrum HR HPV detection has to be determined in prospective clinical studies.
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Affiliation(s)
- Maaike A P C van Ham
- Department of Gynaecology, Nijmegen University Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
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Chin-Hong PV, Vittinghoff E, Cranston RD, Browne L, Buchbinder S, Colfax G, Da Costa M, Darragh T, Benet DJ, Judson F, Koblin B, Mayer KH, Palefsky JM. Age-related prevalence of anal cancer precursors in homosexual men: the EXPLORE study. J Natl Cancer Inst 2005; 97:896-905. [PMID: 15956651 DOI: 10.1093/jnci/dji163] [Citation(s) in RCA: 176] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infection with human papillomavirus (HPV) is causally linked to the development of anal and cervical cancer. In the United States, the incidence of anal cancer among men who have sex with men (MSM) is higher than the incidence of cervical cancer among women. Anal squamous intraepithelial lesions (ASILs) are anal cancer precursors comprising low-grade squamous intraepithelial lesions (LSILs) and high-grade squamous intraepithelial lesions (HSILs). The prevalence of cervical cancer precursor lesions peaks at around 30 years of age. The age-related prevalence of ASILs in HIV-negative MSM is unknown. METHODS We conducted a cross-sectional analysis of the prevalence and determinants of ASILs in 1262 HIV-negative MSM aged 18-89 years recruited from four U.S. cities. Anal cytology and behavioral data were obtained. Anal HPV infection status was assessed by polymerase chain reaction. Independent predictors of ASILs were identified using logistic regression. All statistical tests were two-sided. RESULTS The prevalences of LSILs and HSILs were 15% and 5%, respectively, and did not change with age. In a multivariable analysis, the risk of LSILs was associated with having more than five male receptive anal sex partners (P = .03), any use of poppers (alkyl nitrites) in the previous 6 months [odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.1 to 2.5; P = .03] or use of injection drugs two or more times per month during the previous 6 months [OR = 19, 95% CI = 1.3 to 277; P = .03], older age at first receptive anal intercourse (P = .004), and infection with a greater number of HPV types (P < .001 for linear trend). The risk of HSILs was associated with any anal HPV infection (OR = 3.2, 95% CI = 1.1 to 9.4; P = .039) and infection with an increasing number of HPV types (P < .001 for linear trend). CONCLUSIONS Sexually active HIV-negative MSM in all age groups have a high prevalence of ASILs, possibly reflecting their ongoing sexual exposure to HPV.
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Affiliation(s)
- Peter V Chin-Hong
- Department of Medicine, University of California-San Francisco, CA 94143-0654, USA.
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Arora R, Kumar A, Prusty BK, Kailash U, Batra S, Das BC. Prevalence of high-risk human papillomavirus (HR-HPV) types 16 and 18 in healthy women with cytologically negative Pap smear. Eur J Obstet Gynecol Reprod Biol 2005; 121:104-9. [PMID: 15950365 DOI: 10.1016/j.ejogrb.2004.11.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2004] [Revised: 11/17/2004] [Accepted: 11/25/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the prevalence of high-risk human papillomavirus (HR-HPV) types 16 and 18 in healthy women with negative Pap smears in identifying women with underlying cervical squamous intra-epithelial (SIL) lesions. METHODS A total of 3300 women who were attending the Gynecology OPD of Lok Nayak Hospital, one of the major government tertiary hospitals in New Delhi, were screened during a 1-year study period, and 2079 (63%) of them were found to have cytologically negative Pap smear with inflammation and the rest (37%) also had negative Pap report but without inflammation. Hundred and sixty of these sexually active women aged between 20 and 60 years were randomly selected, and were investigated by colposcopy and a guided biopsy was done wherever required. HPV types 16 and 18 DNA was detected in scraped cervical cells from all women using type-specific primers in polymerase chain reaction (PCR). RESULTS The high-risk HPV (type 16 and 18) prevalence by PCR was found to be 10% (16/160). Histopathological findings were obtained in 123 women, out of which 15 had LSIL and four had HSIL. High-risk HPV types 16/18 could be detected in nine out of these 19 (47.3%) squamous intra-epithelial lesions (p < 0.00008) which includes two out of the four women (50%) having HSIL, while only seven out of 104 (6.7%) of the subjects with normal (negative) Pap reports (p = 0.03) had infection of high-risk HPV. CONCLUSION The results indicate that about 10% of women who show a negative Pap smear, but have inflammation are positive for high-risk HPV types 16/18 and about 15% harbor squamous intra-epithelial lesions. It is suggested that high-risk HPV detection can be utilized as an adjunct to routine cytology screening programs to identify 'high risk' women who have concurrently negative Pap smears but may harbor oncogenic HPV infection and/or more likely to develop CIN lesions.
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Affiliation(s)
- Raksha Arora
- Department of Obstetrics and Gynecology, Lok Nayak Hospital, New Delhi, India
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50
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Honda Y, Egawa K. Extramammary Paget’s Disease Not Only Mimicking but Also Accompanying Condyloma acuminatum. Dermatology 2005; 210:315-8. [PMID: 15942218 DOI: 10.1159/000084756] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Accepted: 08/16/2004] [Indexed: 11/19/2022] Open
Abstract
Although its significance remains unknown, it has recently been reported that epidermal papillomatous hyperplasia could be frequently found in extramammary Paget's disease (EMPD). The simultaneous occurrence of EMPD and various human-papillomavirus (HPV)-associated neoplasms has also been reported. We report a case of a perianal EMPD with multiple verrucous papules on its surface. Histologically, the verrucous papules consisted of two distinct histological patterns; one showed numerous Paget's cells within the hyperplastic epidermis with papillomatosis, and the other showed the features compatible with condyloma acuminatum (CA). HPV-6 DNA was demonstrated in koilocytic keratinocytes of the CA by in situ hybridization. No positive signal was obtained for targeted HPV type 6/11/16/18/31/33 DNA in either the verrucous or plaque EMPD. Since the verrucous papules were localized on the plaque of EMPD, our case suggests that some undetermined EMPD-related factors may contribute to the development of epithelial hyperplasia, including HPV-associated neoplasms.
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Affiliation(s)
- Yumi Honda
- Department of Surgical Pathology, Kumamoto University School of Medicine, Kumamoto, Japan.
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