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Kafasi A, Kaparos G, Pitiriga VC, Spanakis N, Vlachos N, Thomakos N, Stournaras S, Tsakris A. Prevalence of HPV Genotypes among Greek Women in Association with Their Potential to Cause Precancerous Lesions. Microorganisms 2024; 12:1404. [PMID: 39065172 PMCID: PMC11278821 DOI: 10.3390/microorganisms12071404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The escalating global rates of precancerous lesions associated with human papillomavirus (HPV) types not targeted by current vaccines underscore the need to explore the prevalence of HPV types within the Greek female population and their involvement in precancerous lesion development. In the current study, we enrolled a cohort of 253 women aged 18 to 65 years, residing in Greece, who underwent routine screening in three tertiary care referral hospitals. Each participant completed a demographic questionnaire. An HPV DNA test was administered using the VisionArray® HPV kit (ZytoVision GmbH) to qualitatively detect and genotype 41 clinically relevant HPV genotypes. Of all 253 women examined, 114 (45.1%) tested positive for HPV DNA. The primary type detected was HPV51 (high-risk), present in 21 women (8.3% of the total), followed by HPV54 (low-risk) in 17 women (6.7%); HPV16 (high-risk) ranked third, identified in 14 women (5.5%). Among the HPV-positive women, 65 were positive for high-risk HPV types (57% of HPV-positive women) and were referred for colposcopy and cervical biopsy. These procedures identified 24 women with cervical intraepithelial neoplasia 1 (CIN1) lesions and 2 with cervical intraepithelial neoplasia 2 (CIN2) lesions. The most prevalent HPV type among women with CIN1 lesions was HPV16, found in nine (37.5%) women, while HPV51 ranked second, identified in six (25%) women. Both women with CIN2 lesions tested positive for HPV16, whereas one of them was also tested positive for HPV45. Our study is the first to report the prevalence of HPV51 among HPV-positive women in the Greek female population. This highlights the need for further research to fully understand the potential of HPV types not covered by current vaccines, such as HPV51, to cause high-grade lesions or cervical cancer.
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Affiliation(s)
- Athanasia Kafasi
- Deparment of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgios Kaparos
- Department of Microbiology, Areteion Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vassiliki C. Pitiriga
- Deparment of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Spanakis
- Deparment of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Vlachos
- 2nd Department of Obstetrics and Gynecology, Areteion Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Nikolaos Thomakos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Athanasios Tsakris
- Deparment of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Qi M, Naranjo AR, Duque AJ, Lorey TS, Schapiro JM, Suh-Burgmann BJ, Rummel M, Salipante SJ, Wentzensen N, Greene DN. Evaluation of Pre-Analytical Variables for Human Papillomavirus Primary Screening from Self-Collected Vaginal Swabs. J Mol Diagn 2024; 26:487-497. [PMID: 38494078 PMCID: PMC11238274 DOI: 10.1016/j.jmoldx.2024.02.006] [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: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Human papillomavirus (HPV) primary screening is an effective approach to assessing cervical cancer risk. Self-collected vaginal swabs can expand testing access, but the data defining analytical performance criteria necessary for adoption of self-collected specimens are limited, especially for those occurring outside the clinic, where the swab remains dry during transport. Here, we evaluated the performance of self-collected vaginal swabs for HPV detection using the Cobas 6800. There was insignificant variability between swabs self-collected by the same individual (n = 15 participants collecting 5 swabs per participant), measured by amplification of HPV and human β-globin control DNA. Comparison of self-collected vaginal swab and provider-collected cervical samples (n = 144 pairs) proved highly concordant for HPV detection (total agreement = 90.3%; positive percentage agreement = 84.2%). There was no relationship between the number of dry storage days and amplification of HPV (n = 68; range, 4 to 41 days). Exposure of self-collected dry swabs to extreme summer and winter temperatures did not affect testing outcomes. A second internal control (RNase P) demonstrated that lack of amplification for β-globin from self-collected specimens was consistent with poor, but not absent, cellularity. These data suggest that self-collected vaginal samples enable accurate clinical HPV testing, and that extended ambient dry storage or exposure to extreme temperatures does not influence HPV detection. Furthermore, lack of β-globin amplification in HPV-negative samples accurately identified participants who required recollection.
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Affiliation(s)
- Michelle Qi
- LetsGetChecked Laboratories, Monrovia, California
| | | | - Abigail J Duque
- The Permanente Medical Group, Northern California Kaiser Permanente Regional Reference Laboratory, Oakland, California
| | - Thomas S Lorey
- The Permanente Medical Group, Northern California Kaiser Permanente Regional Reference Laboratory, Oakland, California
| | - Jeffrey M Schapiro
- The Permanente Medical Group, Northern California Kaiser Permanente Regional Reference Laboratory, Oakland, California
| | | | | | - Stephen J Salipante
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Dina N Greene
- LetsGetChecked Laboratories, Monrovia, California; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington.
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Harper DM, Yu TM, Fendrick AM. Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results. O&G OPEN 2024; 1:e001. [PMID: 38533459 PMCID: PMC10964775 DOI: 10.1097/og9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To model the potential number of cancers prevented and life-years saved over a range of adherence rates to cervical cancer screening, surveillance follow-up, and follow-up colposcopy that may result from removing financial barriers to these essential clinical services. METHODS A previously validated decision-analytic Markov microsimulation model was used to evaluate the increase in adherence to screening, surveillance, and colposcopy after an abnormal cervical cancer screening result. For each incremental increase in adherence, we modeled the number of cervical cancer cases avoided, the stages at which the cancers were detected, the number of cervical cancer deaths avoided, and the number of life-years gained. RESULTS Compared with current adherence rates, the model estimated that an optimized scenario of perfect screening, surveillance, and colposcopy adherence per 100,000 women currently eligible for screening in the United States was 128 (95% CI, 66-199) fewer cervical cancers detected (23%), 62 (95% CI, 7-120) fewer cervical cancer deaths (20%), and 2,135 (95% CI, 1,363-3,057) more life-years saved. Sensitivity analysis revealed that any increase in adherence led to clinically meaningful health benefits. CONCLUSION The consequences of not attending routine screening or follow-up after an abnormal cervical cancer screening result are associated with preventable cervical cancer morbidity and premature mortality. Given the potential for the removal of consumer cost sharing to increase the use of necessary follow-up after abnormal screening results and to ultimately reduce cervical cancer morbidity and mortality, public and private payers should remove cost barriers to these essential services.
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Affiliation(s)
- Diane M Harper
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - Tiffany M Yu
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - A Mark Fendrick
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
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4
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Wheeler CM, Torrez-Martinez NE, Torres-Chavolla E, Parvu V, Andrews JC, Du R, Robertson M, Joste NE, Cuzick J. Comparing the performance of 2 human papillomavirus assays for a new use indication: a real-world evidence-based evaluation in the United States. Am J Obstet Gynecol 2024; 230:243.e1-243.e11. [PMID: 37806613 DOI: 10.1016/j.ajog.2023.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The US Food and Drug Administration supports innovations to facilitate new indications for high-risk human papillomavirus testing. This report describes the retrospective testing of stored specimens and analysis of existing data to efficiently and cost-effectively support a new indication for the Onclarity human papillomavirus assay (Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD). The performance of this index test was compared with that of a predicate test, the cobas human papillomavirus assay (Roche Diagnostics, Indianapolis, IN). Both human papillomavirus assays are based on real-time polymerase chain reaction platforms that detect the presence of 14 high-risk human papillomavirus genotypes. The predicate assay reports human papillomavirus types 16 and 18 as individual results and the other 12 human papillomavirus genotypes as 1 pooled result. The index assay reports 9 independent results (human papillomavirus types 16, 18, 31, 33/58, 35/39/68, 45, 51, 52, and 56/59/66). Both the index and predicate assays are approved by the Food and Drug Administration for cervical cancer screening, but at the time that this study was initiated, the index human papillomavirus assay was not approved for use with cervical specimens collected in PreservCyt (Hologic, Inc, San Diego, CA) liquid-based cytology media. OBJECTIVE The performance of the index human papillomavirus assay was compared with that of the predicate human papillomavirus assay for the detection of cervical intraepithelial neoplasia grades 2 or greater and 3 or greater (≥CIN2 or ≥CIN3) using PreservCyt liquid-based cytology specimens collected from women aged 21 to 65 years. In addition, the ability of the index test's extended genotyping to stratify ≥CIN2 and ≥CIN3 risks, using these specimens, was evaluated. STUDY DESIGN The New Mexico HPV Pap Registry was used to select an age- and cytology-stratified random sample of 19,879 women undergoing opportunistic cervical screening and follow-up in routine clinical practice across New Mexico. A subset (n = 4820) of PreservCyt specimens was selected from 19,879 women for paired testing by the index and predicate human papillomavirus assays within age and cytology strata and included women with or without cervical biopsy follow-up. Point estimate differences and ratios were calculated for cervical disease detection and positivity rates, respectively, with 95% confidence intervals to determine statistical significance. The cumulative risk of ≥CIN2 or ≥CIN3, with up to 5-year follow-up, was estimated for the index assay using Kaplan-Meier methods. RESULTS The 5-year cumulative ≥CIN3 detection rates were 5.6% for the index assay and 4.6% for the predicate assay (difference, 1.0%; 95% confidence interval, 0.5%-1.5%). The ≥CIN3 positivity rates within <1 year were 95.3% for the index assay and 94.5% for the predicate assay (ratio, 1.01; 95% confidence interval, 0.98-1.06). The ≥CIN3 cumulative positivity rates for the index and predicate assays were also similar at 5 years. Among cases of ≥CIN3, the positive agreement rates between the index and predicate assays for human papillomavirus types 16 and 18 were 100.0% (95% confidence interval, 95.0%-100.0%) and 90.9% (95% confidence interval, 62.3%-98.4%), respectively. Human papillomavirus type 16 carried the highest ≥CIN2 or ≥CIN3 risk, followed by human papillomavirus types 18/31/33/58/52/45 and human papillomavirus types 35/56/59/51/56/59/66. CONCLUSION The index and predicate human papillomavirus assays demonstrated equivalent performance, and extended human papillomavirus genotyping, using the index assay, provided effective ≥CIN2 and ≥CIN3 risk stratification, supporting a new indication for use of the index assay with PreservCyt.
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Affiliation(s)
- Cosette M Wheeler
- Center for HPV Prevention, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Norah E Torrez-Martinez
- Center for HPV Prevention, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Edith Torres-Chavolla
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD
| | - Valentin Parvu
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD
| | - Jeffrey C Andrews
- Becton, Dickinson and Company, BD Life Sciences - Integrated Diagnostic Solutions, Sparks, MD
| | - Ruofei Du
- Center for HPV Prevention, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Michael Robertson
- Center for HPV Prevention, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Nancy E Joste
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Jack Cuzick
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Possati-Resende JC, Fritsch TZ, Souza KCB. Risk Profile of High-grade Cervical Lesions and Cervical Cancer Considering the Combination of Cytology, HPV Genotype, and Age among Women Undergoing Colposcopy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e689-e698. [PMID: 38029771 PMCID: PMC10686761 DOI: 10.1055/s-0043-1772483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE The present study aims to establish a risk profile for high-grade cervical lesions and cervical cancer (CIN2 + ) in women undergoing colposcopy at the Hospital do Câncer de Barretos, through the analysis of Human Papillomavirus (HPV) infection, cervical cytology, and patient's age. METHODS Retrospective cross-sectional study based on a computerized database of women aged ≥ 18 years old who underwent colposcopy at the Prevention Department of the Hospital do Câncer de Barretos from 2017 to 2019. RESULTS A total of 3,411 women were included, 58.0% were positive for high-risk-HPV test, with a higher prevalence of CIN2+ for HPV16 (30.3%) and other HPV (45.0%). Cytological findings that suggest invasive cervical cancer (squamous cells or adenocarcinoma), regardless of the status of HPV test, showed 100% diagnosis of CIN2 + , while atypias that suggest high-grade lesions, HSIL and ASC-H, positive for HPV test, showed in 86 and 55.2%, respectively, diagnosis of CIN2 + . ASC-H cytological results among women aged > 40 years old and negative HPV were mainly associated with benign findings. We observed that ≤ CIN1 has a higher prevalence among older women with negative HPV, while for high-grade lesions there is an increase among young women HPV16- and/or 18-positive. In cancer diagnosis, we observed a predominance of HPV 16/18 regardless of the age group. CONCLUSION The highest risks of precursor lesions and cervical cancer were found among women with positive HPV 16/18 tests and severe cytological atypia in population screening tests. In addition, cytological findings of ASC-H HPV negative in women > 40 years old usually represent benign findings in histological investigation.
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Affiliation(s)
| | - Thais Zilles Fritsch
- Research and Education Institute, Hospital do Câncer de Barretos, Barretos, SP, Brazil.
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Dai Y, Chen T, Li X, Zhang C, Li T, Zhao Y, Wang Y, Chen S, Yu L, Jiang M, Wu Z, Yang J, Chen W. Evaluation of the clinical performance of p16/Ki-67 dual-staining cytology for cervical lesion detection in premenopausal and postmenopausal Chinese women. J Cancer Res Clin Oncol 2023; 149:10645-10658. [PMID: 37302113 DOI: 10.1007/s00432-023-04938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Studies on the clinical performance of p16/Ki-67 dual-staining in detecting cervical lesions by menopausal status were limited. METHODS 4364 eligible women were enrolled with valid p16/Ki-67, HR-HPV, and LBC test results, including 542 cancer and 217 CIN2/3 cases. The positivity rates of p16 and Ki-67 single staining and p16/ Ki-67 dual-staining were analyzed by different pathological grades and age groups. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV) of each test in different subgroups were calculated and compared. RESULTS P16/Ki-67 dual-staining positivity increased with histopathological severity in premenopausal and postmenopausal women (P < 0.05), while no increasing trends of individual expression of p16 single staining and Ki-67 single staining were observed in postmenopausal women. P16/Ki-67 showed higher SPE (88.09% vs. 81.91%, P < 0.001) and PPV (33.8% vs. 13.18%, P < 0.001) in detecting CIN2/3, and higher SEN (89.97% vs. 82.61%, P = 0.012) and SPE (83.22% vs. 79.89%, P = 0.011) in detecting cancer in premenopausal women than postmenopausal women. For triaging the HR-HPV+ population to identify CIN2/3, p16/Ki-67 performed comparably to LBC in the premenopausal women, and showed higher PPV (51.14% vs. 23.08%, P < 0.001) in premenopausal than postmenopausal women. For triaging ASC-US/LSIL population, p16/Ki-67 demonstrated higher SPE and lower colposcopy referral rate than HR-HPV in both premenopausal and postmenopausal women. CONCLUSIONS Expressions of p16/Ki-67 dual-staining between premenopausal and postmenopausal women are varied. P16/Ki-67 performs better in detecting cervical lesions in premenopausal women. For triaging, p16/Ki-67 is suitable for HR-HPV+ women, especially premenopausal women, to identify CIN2/3 and women with ASC-US/LSIL.
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Affiliation(s)
- Yu Dai
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tingting Chen
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, 518104, China
| | - Xinyue Li
- College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding, 071000, China
| | - Changning Zhang
- College of Life Sciences, Institute of Life Science and Green Development, Hebei University, Baoding, 071000, China
| | - Tingyuan Li
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yuqian Zhao
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yakun Wang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Simiao Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lulu Yu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Mingyue Jiang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zeni Wu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jinghong Yang
- Mianyang Maternity and Child Health Care Hospital, Mianyang, 621000, China.
| | - Wen Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Lamsisi M, Li G, Chauleur C, Ennaji MM, Bourlet T. The potential of urine for human papillomavirus-related cervical cancer prevention. Future Virol 2022. [DOI: 10.2217/fvl-2021-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cervical cancer is one of the most preventable cancers. The introduction of human papillomavirus (HPV) vaccines and the adaptation of regular screening programs are key actions that need to be generalized globally to achieve the goal of cervical cancer elimination. However, it is still challenging to achieve satisfactory coverage rate, and many women are reluctant to participate in gynecologic examination. In this article, we review the research on the application of HPV detection in urine samples for cervical cancer screening and vaccine monitoring, as well as discuss the technical challenges and new technological advancements in urine-based tests. HPV detection in urine is an excellent noninvasive alternative that is widely accepted by women, relatively affordable, and provides the potential to reach women without the necessity for clinical visits. Thus, it is an attractive tool for both cervical cancer screening and vaccine monitoring.
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Affiliation(s)
- Maryame Lamsisi
- Team of Virology, Oncology & Medical Biotechnologies, Laboratory of Virology, Microbiology, Quality, & Biotechnologies/ETB, Faculty of Science & Techniques Mohammedia, Hassan II University of Casablanca, 20650, Mohammedia, Morocco
| | - Guorong Li
- Department of Urology/Biology Pathology Lab, North Hospital, CHU Saint-Etienne, 42000, Saint Etienne, France
| | - Celine Chauleur
- Deparment of Gynecology & Obstetrics, North Hospital, CHU Saint-Etienne, 42000, Saint Etienne, France
| | - Moulay Mustapha Ennaji
- Team of Virology, Oncology & Medical Biotechnologies, Laboratory of Virology, Microbiology, Quality, & Biotechnologies/ETB, Faculty of Science & Techniques Mohammedia, Hassan II University of Casablanca, 20650, Mohammedia, Morocco
| | - Thomas Bourlet
- Department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42000, Saint Etienne, France
- Centre International de Recherche en Infectiologie, GIMAP Team 15, Inserm, U1111, CNRS, UMR5308, University of Saint-Etienne, University of Lyon, 42000, Saint Etienne, France
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Zervixkarzinomscreening in den USA: HPV, Zytologie und intraepitheliale Neoplasien. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1605-8058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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9
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Wright TC, Stoler MH, Ranger-Moore J, Fang Q, Volkir P, Safaeian M, Ridder R. Clinical validation of p16/Ki-67 dual-stained cytology triage of HPV-positive women: Results from the IMPACT trial. Int J Cancer 2021; 150:461-471. [PMID: 34536311 PMCID: PMC9293341 DOI: 10.1002/ijc.33812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 02/01/2023]
Abstract
Triage strategies are needed for primary human papillomavirus (HPV)‐based cervical cancer screening to identify women requiring colposcopy/biopsy. We assessed the performance of p16/Ki‐67 dual‐stained (DS) immunocytochemistry to triage HPV‐positive women and compared it to cytology, with or without HPV16/18 genotyping. A prospective observational screening study enrolled 35 263 women aged 25 to 65 years at 32 U.S. sites. Cervical samples had HPV and cytology testing, with colposcopy/biopsy for women with positive tests. Women without cervical intraepithelial neoplasia Grade 2 or worse (≥CIN2) at baseline (n = 3876) were retested after 1 year. In all, 4927 HPV‐positive women with valid DS results were included in this analysis. DS sensitivity for ≥CIN2 and ≥CIN3 at baseline was 91.2% (95% confidence interval [CI]: 86.8%‐94.2%) and 91.9% (95% CI: 86.1%‐95.4%), respectively, in HPV16/18‐positive women and 83.0% (95% CI: 78.4%‐86.8%) and 86.0% (95% CI: 77.5%‐91.6%) in women with 12 “other” genotypes. Using DS alone to triage HPV‐positive women showed significantly higher sensitivity and specificity than HPV16/18 genotyping with cytology triage of 12 “other” genotypes, and substantially higher sensitivity but lower specificity than using cytology alone. The risk of ≥CIN2 was significantly lower in HPV‐positive, DS‐negative women (3.6%; 95% CI: 2.9%‐4.4%), compared to triage‐negative women using HPV16/18 genotyping with cytology for 12 “other” genotypes (7.4%; 95% CI: 6.4%‐8.5%; P < .0001) or cytology alone (7.5%; 95% CI: 6.7%‐8.4%; P < .0001). DS showed better risk stratification than cytology‐based strategies and provided high reassurance against pre‐cancers both at baseline and at 1‐year follow‐up, irrespective of the HPV genotype. DS allows for the safe triage of primary screening HPV‐positive women.
What's new?
Primary screening for human papillomavirus (HPV) requires efficient triage of HPV‐positive women to colposcopy and biopsy. In this prospective observational trial in the United States, with 1‐year longitudinal follow‐up, the authors investigated the performance of p16/Ki‐67 dual‐stain cytology for the triage of women identified as HPV‐positive during primary screening. Compared to HPV16/18 genotyping combined with cytological triage of other HPV genotypes, dual‐stain cytology was significantly more sensitive for predicting risk of cervical intraepithelial neoplasia grade 2/3 or worse. The findings indicate that dual‐stain cytology is effective for triage of HPV‐positive women, either alone or when combined with partial HPV genotyping.
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Affiliation(s)
- Thomas C Wright
- Department of Pathology and Cell Biology, Columbia University, New York, New York, USA
| | - Mark H Stoler
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jim Ranger-Moore
- Ventana Medical Systems, Inc/Roche Tissue Diagnostics, Tucson, Arizona, USA
| | - Qijun Fang
- Roche Molecular Solutions, Inc, Pleasanton, California, USA
| | - Patrick Volkir
- Roche Molecular Solutions, Inc, Pleasanton, California, USA
| | | | - Ruediger Ridder
- Ventana Medical Systems, Inc/Roche Tissue Diagnostics, Tucson, Arizona, USA
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