Risks for cervical abnormalities in women with non-16/18 high-risk human papillomavirus infections in south Shanghai, China

Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy

Objective

The aim of this study was to investigate the significance of colposcopy in diagnosing cervical lesions when negative cervical cytology is combined with positive human papillomavirus (HPV).

Methods

Overall, 370 patients with cervical epithelial lesions who had negative cervical fluid-based cytology combined with positive HPV results were selected and analysed for severity of cervical lesions and HPV distribution.

Results

Among the patients with cervical lesions, 242 had a single HPV infection, and 128 cases had multiple infections. No significant difference was found between HPV single infection and multiple infections in both groups of patients with cervical lesions (P > 0.05). Furthermore, 137 had non-HPV 16 and 18, accounting for 37.30% of all the patients with cervical lesions. Among them, HPV 52, 58, and 33 infections were the most common at 38.69, 30.66 and 29.20%, respectively - significantly higher than other high-risk HPV types (P < 0.05).

Conclusion

High-risk HPV testing is crucial in patients with negative cervical fluid-based cytology combined with positive HPV results. Patients with HPV 16 and 18 and those with simple HPV 52, 58, and 33 infections should undergo timely colposcopy.

Triage performance of PAX1m/JAM3m in opportunistic cervical cancer screening of non‒16/18 human papillomavirus-positive women: a multicenter prospective study in China

OBJECTIVES

In this study, we aimed to validate the performance of the PAX1 and JAM3 methylation (PAX1m/JAM3m) test as a triage tool for detecting cervical intraepithelial neoplasia grade 3 or worse (CIN3 +) in non-16/18 high-risk human papillomavirus-positive patients (non-16/18 hrHPV +).

METHODS

The triage performance of liquid-based cytology (LBC) and the PAX1m/JAM3m test for detecting CIN3 + were compared.

RESULTS

In total, 1851 participants had cervical histological outcomes and were included in the analysis. The sensitivity/specificity of the LBC test results with atypical squamous cells of undetermined significance or worse (LBC ≥ ASCUS) and the PAX1m/JAM3m test were 90.1%/26.7% and 84.8%/88.5%, respectively. PAX1m/JAM3m( +) had the highest diagnostic AUC (0.866, 95% confidence interval (CI) 0.837-0.896) in the whole cohort. All cancers (n = 20) were detected by PAX1m/JAM3m(+). Compared with LBC ≥ ASCUS, PAX1m/JAM3m(+) reduced the number of patients who needed referral for colposcopy by 57.21% (74.66% vs. 17.45%). The odds ratios for detecting CIN3 + by LBC ≥ ASCUS and PAX1m/JAM3m(+) were 3.3 (95% CI 2.0-5.9) and 42.6 (27.1-69.6), respectively (p < 0.001). The combination of LBC ≥ ASCUS or PAX1m/JAM3m(+) slightly increased the diagnostic sensitivity (98.0%, 95% CI: 95.8-100%) and referral rate (77.09%) but reduced the diagnostic specificity (24.8%, 22.7-26.8%).

CONCLUSIONS

In non-16/18 hrHPV(+) women, PAX1m/JAM3m was superior to cytology for detecting CIN3 + . Compared with LBC ≥ ASCUS, PAX1m/JAM3m(+) reduced the number of significant referrals to colposcopy without compromising diagnostic sensitivity.

Pap Cytology and Human Papillomavirus (HPV) Genotypes in Western Romania: A Retrospective Analysis

Background and objective Vigorous proactive measures are needed to combat cervical cancer, linked to the human papillomavirus (HPV). HPV genotyping aids in identifying high-risk strains, enabling targeted screening and risk assessment. This informs treatment decisions, reducing cervical cancer cases. In light of this, we conducted a retrospective analysis of Pap cytology and HPV genotypes to assess western Romania's new screening program. Understanding HPV prevalence, genotype correlations, and risk factors will help refine risk stratification models and enhance public health strategies. Methodology This retrospective study analyzed Pap smears from 195 patients with a mean age of 40 years [standard deviation (SD): 12 years], with a peak of incidence between 25 and 30 years. The patient cohort, with equal representation from urban and rural areas, comprised sexually active women of reproductive age presenting to the Gynaecology Ambulatory of the Municipal Emergency Clinical Hospital Timișoara over two years. Patients not sexually active and those in menopause were excluded. HPV genotyping was done on 67 patients. Data were analyzed using JASP, employing descriptive statistics, frequency tables, contingency tables, chi-squared test, odds ratio, and Fisher's exact test. Results Among 195 patients undergoing Pap smear tests, the most prevalent finding was negative (77.95%), indicating no abnormal cells detected. A smaller proportion of patients exhibited low-grade squamous intraepithelial lesions (LSIL, 11.28%) or atypical squamous cells of undetermined significance (ASC-US, 8.72%) findings. High-grade lesions (HSIL, ASC-H) were rare. For cytology grading, Category II (CII) was the most prevalent (75.90%), followed by Category III (CIII, 24.10%). HPV genotyping was performed on a subset of patients (n=67). Among them, Type 16 was the most frequent (28.36%), followed by Other high-risk types (20.89%), Type 16 (28.35%), and Type 18 (13.43%). HPV testing was not performed for 65.64% of the patients. Overall, the study suggests that a significant majority of the patients had normal Pap smears. However, a small proportion did have abnormal findings, including HPV infection. These findings highlight the importance of Pap smear screening for early detection of cervical abnormalities. Conclusions Our study from western Romania highlights the importance of HPV testing and Pap cytology in cervical cancer prevention. HPV testing is a potent tool for identifying high-risk women, and when combined with Pap cytology, it provides a more comprehensive screening strategy. Our research also revealed a diverse HPV genotype distribution, suggesting the need for broader-spectrum vaccines like the nonavalent vaccine. Despite our study's limitations, our findings underscore the need for including HPV testing in national screening guidelines. Future research should focus on larger studies and the cost-effectiveness of broader-spectrum vaccines. Implementing policies based on these findings could lead to more effective cervical cancer prevention in western Romania.

Genetic variability analysis of human papillomavirus 58: Novel sublineage identification and persistent infection association

This study aims to characterize the genetic variability of HPV58, identify novel lineages and sublineages, and explore the association between persistent/multiple HPV58 infections and genetic variation. In this study, samples from 124 women with HPV58 infection in Eastern China were collected and 81 isolates of E6 and L1 full-length genes were successfully amplified from 55 samples. We evaluated the diversity of genetic variants and performed correlation analyses between genetic variability and pathology, vaccination, multiple infections, and persistent infections. Among the E6 and L1 gene sequences collected, the dominant prevailing sublineages were A1 (46.2%) and A2 (23.1%). In addition, we found two potential novel sublineages denoted as the A4 and A5 sublineage. A total of 50 nucleotide substitutions, including 28 synonymous substitutions and 22 nonsynonymous substitutions, were observed in the E6 and L1 genes. Among them, variants with A388C/K93N substitutions in the E6 gene correlated with persistent infection (≥1 and ≥2 years) (p < 0.005), and C307T/C66C was associated with persistent infection (≥2 years) (p < 0.005). Notably, two mutations above were detected in the isolate from the patient with breakthrough vaccine infection. Our study found two novel sublineages and sites of genetic variability in multiple and persistent infection variants. In addition, we identified two mutational sites associated with persistent infection. This study provides new insight into the clinical characteristics of HPV 58 genetic variations and offers new ideas for research on next-generation vaccines in Eastern China.

Extended human papillomavirus genotype distribution in cervical intraepithelial neoplasia and cancer: Analysis of 40 352 cases from a large academic gynecologic center in China

Our aim was to conduct a large epidemiologic analysis of the distribution of human papilloma virus (HPV) genotypes associated with cervical neoplasias and cancers at a major Chinese gynecologic center. The pathologic database was searched for cervical histopathologic diagnoses with prior HPV genotyping from liquid cervical cytology specimens obtained ≤6 months before biopsy. HPV testing was performed by using the Tellgenplex HPV27 or YanengBio HPV23 genotyping assays. A total of 40 352 cases meeting study criteria were identified. High risk human papillomavirus (hrHPV) was detected in 94.1% of squamous cancers compared to in only 83.3% of cervical adenocarcinomas. The prevalence of multiple HPV infections was highest in cervical intraepithelial neoplasia 1 (CIN1) (33.8%) and decreased with increasing severity of squamous lesions. The distribution of HPV genotypes was similar between CIN1 and histopathologic-negative cases. HPV16 was one of the three most common hrHPV genotypes before all histopathologic abnormalities, ranging from 72.0% for cervical cancers, 38.7% for CIN2/3/AIS, 13.1% for CIN1, and 9.1% for biopsy-negative cases. HPV16 and HPV18 accounted for over 87.2% of detected hrHPV genotypes for all glandular intraepithelial neoplastic lesions and cancers, whereas squamous lesions did not show this pattern. 80.3% of cervical cancers were associated with genotypes covered by HPV16/18 vaccines and 89.6% with genotypes covered by 9-valent vaccination.

Cervical cancer screening in high-altitude areas in China: A large cross-section study of 25,173 women in northern Tibet

Background

Cervical cancer has become a worldwide concern owing to its high incidence and mortality rates. To date, high-altitude areas of Tibet have not benefited from any large-scale cervical cancer screening programs. Therefore, we initiated a screening program to investigate the prevalence of human papilloma virus (HPV) and HPV genotype distribution to reveal cervical cancer and its precursor which lead to morbidity among women in the city of Nagqu in northern Tib3et.

Methods

A total of 25,173 women were recruited to undergo HPV genotype tests between June and December 2019. Women infected with HPV 16 and/or 18 underwent colposcopy and histological examination. Women with other high-risk HPV type (hr-HPV) underwent cytological tests to determine whether to conduct further colposcopy and histological examination for diagnosis. HPV prevalence was calculated in the total population and further stratified according to various parameters, such as age group, area location (altitude level), and single or mixed infection status. The HPV genotype distribution was also investigated accordingly. Cervical lesions revealed by further colposcopic findings were also analyzed; high-grade and malignant lesion morbidities were calculated in total and in each county. Most data were collected and analyzed using descriptive and consistency check statistical methods, and a risk factor investigation for HPV infection was performed using logistic regression models.

Results

The total HPV infection rate among women in Nagqu was 13.42%. Of the 25,173 women in the study, 999 (3.97%) were HPV 16/18 positive, 2,379 (9.45%) were other hr-HPV-positive, and 21,795 (86.58%) were HPV-negative. The five most common HPV genotypes, accounting for more than 60% of all HPV infections in Nagqu people, were HPV 16, 58, 31, 18, and 52. Tibetan women younger than 20 years and older than 60 years were the two age groups with the highest rates of HPV infection, 26.7% and 19.8%, respectively. Among the HPV-positive women, 2,656 (78.33%) were infected with a single strain and 732 (21.67%) were infected with multiple strains (more than two genotypes). HPV prevalence increased in high-altitude areas (positive rate highest in Nyima with an altitude of 5,000 m, 23.9%) and decreased in relatively low-altitude areas (positive rate lowest in Lhari with an altitude of 4,000 m, 6.6%). Multiple analyses showed that age, parity, age at first delivery, and altitude of residence were independent factors facilitating HPV infection in Tibetan women. High-grade and malignant cervical lesions revealed by histological findings were different among living locations, with the highest rates in Xainza, Baingoin, and Nyainrong, these being 2.019%, 1.820%, and 1.116%, respectively, among women in these areas.

Conclusion

Our survey provides an overall perspective on HPV genotype infection and cervical lesions in women in northern Tibet. The data not only provide useful information for the treatment of cervical lesions but also has great value in terms of the primary and secondary prevention measures that can be taken for women living in these regions.

Clinical Trial Registration

www.chictr.org.cn, indentifier ChiCTR2000035061.