1
|
Ozawa N, Kurokawa T, Hareyama H, Tanaka H, Satoh M, Metoki H, Suzuki M. Evaluation of the feasibility of human papillomavirus sponge-type self-sampling device at Japanese colposcopy clinics. J Obstet Gynaecol Res 2023; 49:701-708. [PMID: 36522145 PMCID: PMC10107887 DOI: 10.1111/jog.15496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022]
Abstract
AIM Self-sampling human papillomavirus (HPV) testing has been introduced for cervical cancer screening worldwide. In Japan, there are two types (brush and sponge) of HPV self-sampling devices. However, the recommended type for cervical cancer screening remains unclear. This study aimed to evaluate the feasibility of the HPV self-sampling device-sponge type (HSD-ST). Additionally, we aimed to examine the positive rate (sensitivity) for cervical intraepithelial neoplasia (CIN) 2 or worse using the HSD-ST. Finally, we aimed to perform a questionnaire survey regarding the usability of the HSD-ST. METHODS We included 165 women who underwent HPV testing at one of three gynecologic clinics. First, the women used the HSD-ST and completed a questionnaire regarding its usability. Subsequently, they underwent physician-sampling HPV testing and cytology. We examined the agreement rate of HPV positivity between self- and physician-sampling HPV testing. RESULTS The HPV-positive rates of self- and physician-collected samples were 59.4% and 62.4%, respectively, with an overall concordance rate of 88.5% and a calculated kappa coefficient of 0.76, indicating high concordance. Moreover, the positive (sensitivity) rates for CIN2 or worse were 81.4% and 89.8% in the self- and physician-collected samples, respectively. CONCLUSIONS Our findings demonstrated the feasibility and usability of the HSD-ST.
Collapse
Affiliation(s)
| | - Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Fukui, Japan
| | | | | | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Mitsuaki Suzuki
- Japan Association of Obstetricians and Gynecologists, Tokyo, Japan
| |
Collapse
|
2
|
Gutiérrez AL, Lindberg JH, Shevchenko G, Gustavsson I, Bergquist J, Gyllensten U, Enroth S. Identification of Candidate Protein Biomarkers for CIN2+ Lesions from Self-Sampled, Dried Cervico-Vaginal Fluid Using LC-MS/MS. Cancers (Basel) 2021; 13:cancers13112592. [PMID: 34070587 PMCID: PMC8198222 DOI: 10.3390/cancers13112592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Cervical cancer is the fourth most common cancer among women worldwide, and screening programs increase its detection rate and survivability. The molecular screening of the presence of human papilloma viruses (HPV) as alternatives to physical examinations offers cost-efficient solutions and can be performed on self-collected samples. A persistent infection with HPV is necessary (but not sufficient) to develop cancer, and additional biomarkers are needed to increase the precision. Here, we have analysed protein biomarkers found in self-collected dried cervico–vaginal fluid (CVF) from both controls and women with cervical cancer pre-stages. Our conclusion is that protein biomarkers can be robustly detected from dried CVF and that these can aid in the detection of cervical cancer pre-stages. Abstract Molecular screening programs for cervical cancer detect the presence of human papilloma virus (HPV) in cell material or vaginal fluids. Persistent infection with high-risk HPV is a necessary pre-requisite, but the majority of infections do not lead to pathological states. Additional biomarkers are needed to increase the specificity of the molecular tests. Here, we have investigated the possibility of detecting protein biomarkers using mass spectrometry from dried self-sampled cervico–vaginal fluid deposited on FTA cards. We found significant intra-individual correlations (p < 2.2 × 10−16), although heterogenous protein profiles were obtained between individuals. Out of 3699 proteins found in total, 169 were detected in at least 95% of the samples. Using a discovery/replication design, 18 proteins were found to be significant in the discovery cohort, with higher values in those cases compared to controls. All of these were found to also have higher levels among the cases in the replication cohort, with one protein (DEAD-Box Helicase) remaining statistically significant. Finally, a predictive 7-protein multivariate model was developed with a sensitivity and specificity of 0.90 and 0.55, respectively. Our results demonstrate that robust measurements of protein biomarkers can be obtained from self-sampled dried CVF and that these could be used to predict cervical cancer pre-stages.
Collapse
Affiliation(s)
- Ariadna Lara Gutiérrez
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
| | - Julia Hedlund Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
| | - Ganna Shevchenko
- Analytical Chemistry, Department of Chemistry-Biomedical Center, Uppsala University, SE-75237 Uppsala, Sweden; (G.S.); (J.B.)
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
| | - Jonas Bergquist
- Analytical Chemistry, Department of Chemistry-Biomedical Center, Uppsala University, SE-75237 Uppsala, Sweden; (G.S.); (J.B.)
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
- Correspondence: ; Tel.: +46-(0)-18-471-0000
| |
Collapse
|
3
|
Pedrão PG, de Carvalho AC, Possati-Resende JC, de Paula Cury F, Campanella NC, de Oliveira CM, Tavares Guerreiro Fregnani JH. DNA Recovery Using Ethanol-Based Liquid Medium from FTA Card-Stored Samples for HPV Detection. Acta Cytol 2021; 65:264-271. [PMID: 33951624 DOI: 10.1159/000515913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/09/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Alternative methods of dry storage and transportation may be a viable alternative to the use of liquid storage medium for cervical samples, especially for screening programs in places with few resources. OBJECTIVE The objective of this study is to verify the viability and efficacy of human papillomavirus DNA (HPV-DNA) detection in cervical cell samples collected and stored on a Flinders Technology Associates (FTA) card (Whatman Indicating FTA® Elute Micro Card) and subsequently recovered in ethanol-based liquid medium and to compare the results to those obtained using samples stored directly in ethanol-based liquid medium. STUDY DESIGN Thirty-four women submitted to ETZ (excision of the transformation zone of the cervix) were included in this study. Before ETZ, 2 samples of exfoliated cervical cells were collected from each woman by a doctor and stored in ethanol-based liquid medium and on an FTA card. DNA recovery from FTA samples was performed using ethanol-based liquid medium. Detection of HPV-DNA in the samples was performed using the Cobas® 4800 HPV Test Platform. RESULTS AND CONCLUSIONS The HPV-DNA detection positivity rates were 70.6% for the samples collected directly in liquid medium and 64.7% for the samples stored on the FTA card, with high detection accuracy in the DNA samples recovered from the FTA card (area under the curve = 0.958; 95% confidence interval = 0.890-1.000). The concordance between the results obtained using the 2 storage media was 94.1% (Kappa = 0.866). These preliminary results suggest that collection of cervical material on an FTA card may be an alternative to storage in liquid medium since the liquid medium has some limitations. In addition, DNA recovery from the card using ethanol-based liquid medium streamlines the workflow in the laboratory and reduces the cost associated with reagents, thereby facilitating access to the HPV test in places with few resources and potentially improving cervical cancer screening.
Collapse
Affiliation(s)
- Priscila Grecca Pedrão
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | | | | | - Nathália C Campanella
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristina Mendes de Oliveira
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- DASA Laboratories, São Paulo, Brazil
| | | |
Collapse
|
4
|
Taku O, Mbulawa ZZA, Phohlo K, Garcia-Jardon M, Businge CB, Williamson AL. Distribution of Human Papillomavirus (HPV) Genotypes in HIV-Negative and HIV-Positive Women with Cervical Intraepithelial Lesions in the Eastern Cape Province, South Africa. Viruses 2021; 13:v13020280. [PMID: 33670231 PMCID: PMC7916956 DOI: 10.3390/v13020280] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 12/14/2022] Open
Abstract
South African women have a high rate of cervical cancer cases, but there are limited data on human papillomavirus (HPV) genotypes in cervical intraepithelial neoplasia (CIN) in the Eastern Cape province, South Africa. A total of 193 cervical specimens with confirmed CIN from women aged 18 years or older, recruited from a referral hospital, were tested for HPV infection. The cervical specimens, smeared onto FTA cards, were screened for 36 HPV types using an HPV direct flow kit. HPV prevalence was 93.5% (43/46) in CIN2 and 96.6% (142/147) in CIN3. HIV-positive women had a significantly higher HPV prevalence than HIV-negative women (98.0% vs. 89.1%, p = 0.012). The prevalence of multiple types was significantly higher in HIV-positive than HIV-negative women (p = 0.034). The frequently detected genotypes were HPV35 (23.9%), HPV58 (23.9%), HPV45 (19.6%), and HPV16 (17.3%) in CIN2 cases, while in CIN3, HPV35 (22.5%), HPV16 (21.8%), HPV33 (15.6%), and HPV58 (14.3%) were the most common identified HPV types, independent of HIV status. The prevalence of HPV types targeted by the nonavalent HPV vaccine was 60.9% and 68.7% among women with CIN2 and CIN3, respectively, indicating that vaccination would have an impact both in HIV-negative and HIV-positive South African women, although it will not provide full protection in preventing HPV infection and cervical cancer lesions.
Collapse
Affiliation(s)
- Ongeziwe Taku
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (O.T.); (Z.Z.A.M.); (K.P.)
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Zizipho Z. A. Mbulawa
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (O.T.); (Z.Z.A.M.); (K.P.)
- SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town 7925, South Africa
- Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha 5100, South Africa
- National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha 5100, South Africa
| | - Keletso Phohlo
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (O.T.); (Z.Z.A.M.); (K.P.)
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Mirta Garcia-Jardon
- Department of Pathology, Walter Sisulu University and National Health Laboratory Service, Mthatha 5100, South Africa;
| | - Charles B. Businge
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Mthatha 5100, South Africa;
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
| | - Anna-Lise Williamson
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (O.T.); (Z.Z.A.M.); (K.P.)
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
- SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town 7925, South Africa
- Correspondence: ; Tel.: +21-4066124
| |
Collapse
|
5
|
Du H, Duan X, Liu Y, Shi B, Zhang W, Wang C, Qu X, Bao J, Li J, Zhao C, Jiang J, Liu J, Wu K, Xiao A, Duan L, Huang X, Bian S, Zhang L, Luo H, Wei L, Belinson JL, Wu R. An evaluation of solid versus liquid transport media for high-risk HPV detection and cervical cancer screening on self-collected specimens. Infect Agent Cancer 2020; 15:72. [PMID: 33292341 PMCID: PMC7706049 DOI: 10.1186/s13027-020-00333-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/28/2020] [Indexed: 01/30/2023] Open
Abstract
Background The solid transport media is a small size card that allows fast, easy DNA extraction from a variety of biological samples. In 2016 we developed a solid media transport card; for that pilot study to control the self-collection we used a pseudo-self-collection technique. The current study expands this prior work using true self-collections and only the POI card, and aims to evaluate the solid media transport card to detect HR-HPV in self-samples compared to liquid transport media. Methods Ten thousand eight hundred eighty-five women between the ages of 30–59 with no screening for 3 years were enrolled. The self-collected sample was first applied to a new solid media transport card (Labeled as SC) then the brush placed in 6 ml ThinPrep liquid (Labeled as SL). Then a physician collected a direct endocervical specimen into ThinPrep liquid (Labeled as DL). Samples were tested with Cobas 4800 and the SeqHPV NGS assay for HR-HPV. Patients positive on any test were recalled for colposcopy and biopsy. Results Ten thousand three hundred thirty-nine participants had complete data. The mean age was 43.9 years. CIN 2+ rates were 1.4% (142/10339). The agreement in HPV detection between the two different self-sample collection media was also good (Cobas HPV kappa = 0.86; SeqHPV kappa = 0.98). Tested with Cobas, the sensitivity of Cobas-SL and Cobas-SC for CIN 2+ was95.07 and 94.37%; and for CIN3+ was 96.30, 96.30% respectively. The specificity of Cobas-SC, and Cobas-SL for CIN2+ was 88.74 and 87.35%; for CIN3 was 88.04and 86.65% respectively. Tested with SeqHPV, the sensitivity for CIN2+ of Seq-SC and Seq-SL was 95.77 and 96.48%; for CIN3+, both the SC and SL specimens had a sensitivity of 100%. The specificity for CIN2+ of Seq-SC and Seq-SL was 89.54 and 89.53%; for CIN3+ was 88.84,88.82% respectively. For both HR-HPV assays, the sensitivities were similar for the two self-sample media (SC vs SL, p = 1.00). Conclusions The solid transport card for collecting vaginal self-samples as accurate as liquid transport media assayed by two different PCR based HR-HPV tests. The solid transport media is a suitable medium for collecting and storing vaginal self-samples. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-020-00333-4.
Collapse
Affiliation(s)
- Hui Du
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Xianzhi Duan
- Capital Medical University Beijing Tongren Hospital, Beijing, PR China
| | - Yan Liu
- Fudan University Huashan Hospital North, Shanghai, PR China
| | - Bin Shi
- The second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wei Zhang
- Wuhan University Zhongnan Hospital, Wuhan, PR China
| | - Chun Wang
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Xinfen Qu
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Juncui Bao
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Jingran Li
- Peking University People's Hospital, Beijing, PR China
| | - Chao Zhao
- Peking University People's Hospital, Beijing, PR China
| | - Jing Jiang
- The second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Juan Liu
- Fudan University Huashan Hospital North, Shanghai, PR China
| | - Kejia Wu
- Wuhan University Zhongnan Hospital, Wuhan, PR China
| | - Aimin Xiao
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Lvfang Duan
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Xia Huang
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Shuhuang Bian
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Lijie Zhang
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Hongxue Luo
- Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Lihui Wei
- Peking University People's Hospital, Beijing, PR China.
| | - Jerome L Belinson
- Preventive Oncology International Inc, and the Cleveland Clinic, Cleveland, OH, USA.
| | - Ruifang Wu
- Peking University Shenzhen Hospital, Shenzhen, PR China.
| | | |
Collapse
|
6
|
Taku O, Meiring TL, Gustavsson I, Phohlo K, Garcia-Jardon M, Mbulawa ZZA, Businge CB, Gyllensten U, Williamson AL. Acceptability of self- collection for human papillomavirus detection in the Eastern Cape, South Africa. PLoS One 2020; 15:e0241781. [PMID: 33170891 PMCID: PMC7654756 DOI: 10.1371/journal.pone.0241781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) testing on vaginal self-collected and cervical clinician-collected specimens shows comparable performance. Self-sampling on FTA cards is suitable for women residing in rural settings or not attending regular screening and increases participation rate in the cervical cancer screening programme. We aimed to investigate and compare high-risk (HR)-HPV prevalence in clinician-collected and self-collected genital specimens as well as two different HPV tests on the clinician collected samples. A total of 737 women were recruited from two sites, a community health clinic (n = 413) and a referral clinic (n = 324) in the Eastern Cape Province. Cervical clinician-collected (FTA cards and Digene transport medium) and vaginal self-collected specimens were tested for HR-HPV using the hpVIR assay (FTA cards) and Hybrid Capture-2 (Digene transport medium). There was no significant difference in HR-HPV positivity between clinician-collected and self-collected specimens among women from the community-based clinic (26.4% vs 27.9%, p = 0.601) or the referral clinic (83.6% vs 79.9%, p = 0.222). HPV16, HPV35, and HPV33/52/58 group were the most frequently detected genotypes at both study sites. Self-sampling for HPV testing received a high positive response of acceptance (77.2% in the community-based clinic and 83.0% in referral clinic). The overall agreement between hpVIR assay and HC-2 was 87.7% (k = 0.754). The study found good agreement between clinician-collected and self-collected genital specimens. Self-collection can have a positive impact on a cervical screening program in South Africa by increasing coverage of women in rural areas, in particular those unable to visit the clinics and women attending clinics where cytology-based programs are not functioning effectively.
Collapse
Affiliation(s)
- Ongeziwe Taku
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Tracy L. Meiring
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Keletso Phohlo
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Mirta Garcia-Jardon
- Department of Pathology at Walter Sisulu University and National Health Laboratory Service, Mthatha, South Africa
| | - Zizipho Z. A. Mbulawa
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- Department of Laboratory Medicine and Pathology, National Health Laboratory Service Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, Eastern Cape, South Africa
- Medical Virology, National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - Charles B. Businge
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Mthatha, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Anna-Lise Williamson
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- * E-mail:
| |
Collapse
|
7
|
Molina MA, Carosi Diatricch L, Castany Quintana M, Melchers WJ, Andralojc KM. Cervical cancer risk profiling: molecular biomarkers predicting the outcome of hrHPV infection. Expert Rev Mol Diagn 2020; 20:1099-1120. [PMID: 33044104 DOI: 10.1080/14737159.2020.1835472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cervical cancer affects half a million women worldwide annually. Given the association between high-risk human papillomavirus (hrHPV) infection and carcinogenesis, hrHPV DNA testing became an essential diagnostic tool. However, hrHPV alone does not cause the disease, and, most importantly, many cervical lesions regress to normal in a year because of the host immune system. Hence, the low specificity of hrHPV DNA tests and their inability to predict the outcome of infections have triggered a further search for biomarkers. AREAS COVERED We evaluated the latest viral and cellular biomarkers validated for clinical use as primary screening or triage for cervical cancer and assessed their promise for prevention as well as potential use in the future. The literature search focused on effective biomarkers for different stages of the disease, aiming to determine their significance in predicting the outcome of hrHPV infections. EXPERT OPINION Biomarkers such as p16/Ki-67, hrHPV genotyping, hrHPV transcriptional status, and methylation patterns have demonstrated promising results. Their eventual implementation in the screening programs may support the prompt diagnosis of hrHPV infection and its progression to cancer. These biomarkers will help in making clinical management decisions on time, thus, saving the lives of hrHPV-infected women, particularly in developing countries.
Collapse
Affiliation(s)
- Mariano A Molina
- Department of Microbiology, Faculty of Science, Radboud University , Nijmegen, The Netherlands.,Department of Medical Microbiology, Radboud university medical center , Nijmegen, The Netherlands
| | | | - Marina Castany Quintana
- Department of Medical Microbiology, Radboud university medical center , Nijmegen, The Netherlands
| | - Willem Jg Melchers
- Department of Medical Microbiology, Radboud university medical center , Nijmegen, The Netherlands
| | - Karolina M Andralojc
- Department of Medical Microbiology, Radboud university medical center , Nijmegen, The Netherlands.,Department of Biochemistry, Radboud Institute for Molecular Life Sciences , Nijmegen, The Netherlands
| |
Collapse
|
8
|
Berggrund M, Gustavsson I, Aarnio R, Lindberg JH, Sanner K, Wikström I, Enroth S, Bunikis I, Olovsson M, Gyllensten U. Temporal changes in the vaginal microbiota in self-samples and its association with persistent HPV16 infection and CIN2. Virol J 2020; 17:147. [PMID: 33028395 PMCID: PMC7541248 DOI: 10.1186/s12985-020-01420-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vaginal microbiota has been reported to be associated with HPV infection and cervical cancer. This study was performed to compare the vaginal microbiota at two timepoints in women performing self-sampling and had a persistent or transient HPV16 infection. The women were tested for 12 high-risk HPV (hrHPV) types but only women with single type (HPV16) were included to reduce confounding variables. Methods In total 96 women were included in this study. Of these, 26 were single positive for HPV16 in the baseline test and HPV negative in the follow-up test and 38 were single positive for HPV16 in both tests and diagnosed with CIN2+ in histology. In addition, 32 women that were negative for all 12 HPV tested were included. The samples of vaginal fluid were analyzed with the Ion 16S™ Metagenomics Kit and Ion 16S™ metagenomics module within the Ion Reporter™ software. Results K-means clustering resulted in two Lactobacillus-dominated groups, one with Lactobacillus sp. and the other specifically with Lactobacillus iners. The two remaining clusters were dominated by a mixed non-Lactobacillus microbiota. HPV negative women had lower prevalence (28%) of the non-Lactobacill dominant cluster in the baseline test, as compared to women with HPV16 infection (42%) (p value = 0.0173). Transition between clusters were more frequent in women with persistent HPV16 infection (34%) as compared in women who cleared the HPV16 infection (19%) (p value = 0.036). Conclusions The vaginal microbiota showed a higher rate of transitioning between bacterial profiles in women with persistent HPV16 infection as compared to women with transient infection. This indicate an instability in the microenvironment in women with persistent HPV infection and development of CIN2+.
Collapse
Affiliation(s)
- Malin Berggrund
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Julia Hedlund Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Ignas Bunikis
- Uppsala Genome Center, Science for Life Laboratory, Department of Immunology, Genetics, and Pathology, Uppsala University, BMC, Box 815, 752 37, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden.
| |
Collapse
|
9
|
Evaluation of the concordance in HPV type between self- and physician-collected samples using a brush-based device and a PCR-based HPV DNA test in Japanese referred patients with abnormal cytology or HPV infection. Int J Clin Oncol 2020; 25:1854-1860. [PMID: 32583223 PMCID: PMC7498480 DOI: 10.1007/s10147-020-01727-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/11/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND To adopt HPV self-sampling in Japan, we assessed the concordance between self- and physician-collected human papillomavirus (HPV) samples from Japanese patients and examined the performance of HPV self-sampling for cervical intraepithelial neoplasia grade 2 or worse (CIN2+). METHODS Patients who had previously tested negative for intraepithelial lesions or malignancy/HPV-positive, and patients with atypical squamous cells of undetermined significance or worse (ASCUS+) cytology were eligible for this cross-sectional study. Participants performed HPV self-sampling using an Evalyn brush, which was submitted at the Fukui Prefectural Health Care Association. The Evalyn brush heads were stored in ThinPrep vials. The physician, however, performed HPV and cell sampling using an endocervical brush and immediately stored the brush heads in ThinPrep vials. All participants underwent colposcopy and biopsy. Histopathological diagnoses were made by pathologists at Fukui University Hospital. HPV infection was confirmed using a PCR-based Cobas 4800 HPV DNA test. Cytological analysis was performed at Fukui Prefectural Health Care Association. RESULTS HPV-positive rates for physician-collected samples and self-collected samples were 51 and 50%, respectively. The perfect match rate of HPV type between the groups was 88% (κ = 0.76). HPV16/18 showed higher agreement rates than other HPVs (99%, kappa 0.96 and 89% kappa 0.77, respectively). Both groups showed 100% sensitivity to CIN2+, but specificity was 57.0 and 58.1%, respectively. CONCLUSION For HPV typing, a good concordance rate was seen between self- and physician-collected samples. Self-sampling showed high sensitivity for CIN2+. Self-sampling using the Evalyn brush and Cobas 4800 may be feasible for screening Japanese individuals.
Collapse
|
10
|
Patzi-Churqui M, Terrazas-Aranda K, Liljeqvist JÅ, Lindh M, Eriksson K. Prevalence of viral sexually transmitted infections and HPV high-risk genotypes in women in rural communities in the Department of La Paz, Bolivia. BMC Infect Dis 2020; 20:204. [PMID: 32143643 PMCID: PMC7060520 DOI: 10.1186/s12879-020-4931-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bolivia has the highest prevalence of cervical cancer in South America and the prevalence of viral sexually transmitted infections (STIs) among people in urban cities is increasing. Little is known about the prevalence of viral STIs in rural communities, which generally have limited access to health care. In order to study the prevalence of viral STIs in rural Bolivia, we recruited women from villages and towns in the Department of La Paz in Bolivia. Methods Three hundred ninety-four female participants were assessed for IgG-antibodies to herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and hepatitis B virus (HBV, anti-HBc), as well as for the presence of HBV surface antigen (HBsAg) in dried blood spots. The prevalence of 12 high-risk types of human papillomavirus (HPV) was assessed by qPCR in dried cervicovaginal cell spots from 376 of these women. χ2 test was used to compare variables between the populations and binary logistic regression was used to identify risk factors associated with the positivity of the tests. Results The seroprevalence of HSV-2 was 53% and of HBV 10.3%. HBAg was detected in 15.8% of women with anti-HBV antibodies indicating chronic infection. The frequency of high-risk HPV infection was 27%, with the most prevalent high-risk HPV types being HPV 56, 39 and 31 followed by HPV 16 and 18. Finally, none of the 394 women were seropositive for HIV, and about 64% of the studied population was positive for at least one of the viral infections. Conclusions Women in Bolivian rural communities in La Paz show a high prevalence of HBV, HPV and, in particular, HSV-2. In contrast, none of the women were HIV positive, suggesting that the HIV prevalence in this population is low. The pattern of high-risk HPV types differed from many other countries with a predominance of HPV-types not included in the Gardasil vaccine which was officially introduced in Bolivia in April 2017.
Collapse
Affiliation(s)
- Marianela Patzi-Churqui
- Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Box 480, S-405 30, Gothenburg, Sweden. .,Unidad de Virología, Inmunidad e Infección, Insituto SELADIS, Facultad de Ciencias Farmacéuticas y Bioquímicas, Universidad Mayor de San Andrés, La Paz, Bolivia.
| | - Katty Terrazas-Aranda
- Unidad de Virología, Inmunidad e Infección, Insituto SELADIS, Facultad de Ciencias Farmacéuticas y Bioquímicas, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Jan-Åke Liljeqvist
- Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kristina Eriksson
- Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Box 480, S-405 30, Gothenburg, Sweden
| |
Collapse
|
11
|
Cui T, Enroth S, Ameur A, Gustavsson I, Lindquist D, Gyllensten U. Invasive cervical tumors with high and low HPV titer represent molecular subgroups with different disease etiology. Carcinogenesis 2019; 40:269-278. [PMID: 30596972 DOI: 10.1093/carcin/bgy183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 11/13/2022] Open
Abstract
Invasive cervical cancer (ICC) with very low titer of high-risk human papillomavirus (HPV) has worse clinical outcome than cases with high titer, indicating a difference in molecular etiology. Fresh-frozen ICC tumors (n = 49) were classified into high- and low-HPV-titer cases using real-time PCR-based HPV genotyping. The mutation spectra were studied using the AmpliSeq Comprehensive Cancer Panel and the expression profiles using total RNA sequencing, and the results were validated using the AmpliSeq Transcriptome assay. HPV DNA genotyping and RNA sequencing showed that 16.6% of ICC tumors contained very low levels of HPV DNA and HPV transcripts. Tumors with low HPV levels had more mutations with a high allele frequency and fewer mutations with low allele frequency relative to tumors with high HPV titer. A number of genes showed significant expression differences between HPV titer groups, including genes with somatic mutations. Gene ontology and pathway analyses implicated the enrichment of genes involved in DNA replication, cell cycle control and extracellular matrix in tumors with low HPV titer. The results indicate that in low titer tumors, HPVs act as trigger of cancer development whereas somatic mutations are clonally selected and become drivers of the tumor development process. In contrast, in tumors with high HPV titer the expression of HPV oncoproteins plays a major role in tumor development and the many low frequency somatic mutations represent passengers. This putative subdivision of invasive cervical tumors may explain the higher radiosensitivity of ICC tumors with high HPV titer and thereby have consequences for clinical management.
Collapse
Affiliation(s)
- Tao Cui
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Adam Ameur
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - David Lindquist
- Department of Radiation Sciences, Umeå University Hospital, Umeå, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| |
Collapse
|
12
|
Berggrund M, Gustavsson I, Aarnio R, Hedlund-Lindberg J, Sanner K, Wikström I, Enroth S, Olovsson M, Gyllensten U. HPV viral load in self-collected vaginal fluid samples as predictor for presence of cervical intraepithelial neoplasia. Virol J 2019; 16:146. [PMID: 31771594 PMCID: PMC6880361 DOI: 10.1186/s12985-019-1253-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study was performed to evaluate the use of high-risk HPV (hrHPV) viral load in screening tests for cervical cancer to predict persistent infection and presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). METHODS We followed women between 30 and 60 years of age who performed self-sampling of vaginal fluid and subsequently a hrHPV test. Women who were hrHPV positive in their screening test repeated the hrHPV test 3-6 months later and were included in the present study. RESULTS Our results show that women with a persistent HPV16 infection had higher HPV viral load in their primary screening test than women with transient infections (p = 5.33e-03). This was also true for sum of viral load for all hrHPV types in the primary screening test (p = 3.88e-07). 48% of women with persistent HPV16 infection and CIN2+ had an increase in HPV16 titer in the follow-up test, as compared to only 20% of women with persistent infection but without CIN2+ lesions. For the sum of all hrHPV types, 41% of women with persistent infection and CIN2+ had an increase in titer as compared to 26% of women without CIN2 + . CONCLUSIONS The results show that hrHPV viral load in the primary screening HPV test is associated with the presence of CIN2+ and could be used in triaging hrHPV positive women for different follow-up strategies or recall times. Serial testing of hrHPV viral load has the potential to distinguish women with CIN2+ lesions from women with persistent infection but without CIN2+ lesions.
Collapse
Affiliation(s)
- Malin Berggrund
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Inger Gustavsson
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Julia Hedlund-Lindberg
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Stefan Enroth
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ulf Gyllensten
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden.
| |
Collapse
|
13
|
Gustavsson I, Aarnio R, Myrnäs M, Hedlund-Lindberg J, Taku O, Meiring T, Wikström I, Enroth S, Williamson AL, Olovsson M, Gyllensten U. Clinical validation of the HPVIR high-risk HPV test on cervical samples according to the international guidelines for human papillomavirus DNA test requirements for cervical cancer screening. Virol J 2019; 16:107. [PMID: 31438976 PMCID: PMC6704622 DOI: 10.1186/s12985-019-1216-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background The indicating FTA card is a dry medium used for collection of cervical samples. HPVIR is a multiplex real-time PCR test that detects 12 high-risk human papillomavirus types (hrHPV) and provides single genotype information for HPV16, − 31, − 35, − 39, − 51, − 56, and − 59 and pooled type information for HPV18/45 and HPV33/52/58. The aim of this study was to evaluate whether a strategy with cervical samples collected on the FTA card and subsequently analysed with the HPVIR test complies with the criteria of the international guidelines for a clinically validated method for cervical screening. Methods We performed a non-inferiority test comparing the clinical sensitivity and specificity of the candidate test (FTA card and HPVIR) with a clinically validated reference test (Cobas® HPV test) based on liquid-based cytology (LBC) samples. Two clinical samples (LBC and FTA) were collected from 896 participants in population-based screening. For evaluation of the specificity we used 799 women without ≥ CIN2, and for clinical sensitivity we used 67 women with histologically confirmed ≥ CIN2. The reproducibility was studied by performing inter- and intra-laboratory tests of 558 additional clinical samples. Results The clinical sensitivity and specificity for samples collected on the FTA card and analysed using the HPVIR test were non-inferior to samples analysed with the Cobas® HPV test based on LBC samples (non-inferiority test score, p = 1.0 × 10− 2 and p = 1.89 × 10− 9, respectively). Adequate agreement of > 87% was seen in both the intra- and inter-laboratory comparisons. Conclusions Samples collected on the indicating FTA card and analysed with HPVIR test fulfil the requirements of the international guidelines and can therefore be used in primary cervical cancer screening.
Collapse
Affiliation(s)
- Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Box 815, SE-75108, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Mattias Myrnäs
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Julia Hedlund-Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Box 815, SE-75108, Uppsala, Sweden
| | - Ongeziwe Taku
- Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Tracy Meiring
- Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Box 815, SE-75108, Uppsala, Sweden
| | - Anna-Lise Williamson
- Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Box 815, SE-75108, Uppsala, Sweden.
| |
Collapse
|
14
|
El-Zein M, Bouten S, Louvanto K, Gilbert L, Gotlieb WH, Hemmings R, Behr MA, Franco EL. Predictive Value of HPV Testing in Self-collected and Clinician-Collected Samples Compared with Cytology in Detecting High-grade Cervical Lesions. Cancer Epidemiol Biomarkers Prev 2019; 28:1134-1140. [PMID: 31015201 DOI: 10.1158/1055-9965.epi-18-1338] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/11/2019] [Accepted: 04/11/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Self-sampling has become an attractive proposition now that human papillomavirus (HPV) primary testing is being incorporated into cervical cancer screening programs worldwide. We compared predictive values of HPV testing based on self- and physician-collected samples, and cytology, in detecting high-grade cervical intraepithelial neoplasia (CIN). METHODS The Cervical And Self-Sample In Screening (CASSIS) study enrolled 1,217 women ages 16-70 years prior to scheduled colposcopies. Vaginal specimens were self-collected using the validated HerSwab device. Cervical specimens were collected by gynecologists. Specimens were tested for presence of high-risk HPV (hrHPV) by the Cobas 4800 HPV test. We estimated positive predictive values (PPV) and negative predictive values (NPV) and 95% confidence intervals (CI) for a subset of women (n = 700) who underwent cervical biopsy and cytology at the actual CASSIS visit. RESULTS hrHPV was detected in 329 women (47%) with HerSwab and in 327 (46.7%) with physician sampling. Respective values for HPV16/18 were 119 (17%) and 121 (17.3%). On histology, 134 women had CIN1, 49 had CIN2, 48 had CIN3, 5 had CIN2/CIN3, and 3 had cancers. PPVs for CIN2+ of any hrHPV were 28% (95% CI, 23.2-33.1) and 29.7% (95% CI, 24.8-34.9) for HerSwab and physician samples, respectively. Corresponding values for HPV16/18 were 43.7% (95% CI, 34.6-53.1) and 43.8% (95% CI, 34.8-53.1). PPV of cytology (ASC-US+) was 26.6% (95% CI, 21.6-32.0). Corresponding NPVs (same order as PPVs) were 96.4% (95% CI, 93.9-98.1), 97.8% (95% CI, 95.6-99), 90.9% (95% CI, 88.2-93.1), 91% (95% CI, 88.4-93.2), and 94.7% (95% CI, 91.8-96.8). CONCLUSIONS Our results confirm that HPV self-sampling has comparable performance with a physician-collected sample in detecting cervical lesions. IMPACT HPV self-sampling has the potential to increase coverage in cervical cancer screening.
Collapse
Affiliation(s)
- Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Canada.
| | - Sheila Bouten
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Karolina Louvanto
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Lucy Gilbert
- Gynecologic Cancer Service, McGill University Health Centre - Glen Site Cedars Cancer Centre, Montreal, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology and Colposcopy, McGill University - Jewish General Hospital, Montreal, Canada
| | - Robert Hemmings
- Department of Obstetrics and Gynecology, McGill University Health Centre - St. Mary's Hospital Centre, Montreal, Canada
| | - Marcel A Behr
- Department of Microbiology, McGill University Health Centre, Montreal, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | | |
Collapse
|
15
|
Hillemanns P, Friese K, Dannecker C, Klug S, Seifert U, Iftner T, Hädicke J, Löning T, Horn L, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Sroczynski G, Sauerbrei W, Beckmann MW, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Kaufmann A, Petry KU, Schäfer APA, Pawlita M, Weis J, Mehnert A, Fehr M, Grimm C, Reich O, Arbyn M, Kleijnen J, Wesselmann S, Nothacker M, Follmann M, Langer T, Jentschke M. Prevention of Cervical Cancer: Guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017) - Part 2 on Triage, Treatment and Follow-up. Geburtshilfe Frauenheilkd 2019; 79:160-176. [PMID: 30792546 PMCID: PMC6379166 DOI: 10.1055/a-0828-7722] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
Aims Annual opportunistic screening for cervical carcinoma has been done in Germany since 1971. The creation of this S3 guideline meets an important need, outlined in the National Cancer Plan, with regard to screening for cervical cancer, as this guideline aims to provide important information and support for planned organized screening for cervical cancer in Germany. Methods With the financial support of German Cancer Aid, 21 professional societies developed evidence-based statements and recommendations (classified using the GRADE system) for the screening, management and treatment of precancerous conditions of the cervix. Two independent scientific institutes compiled systematic reviews for this guideline. Recommendations The second part of this short summary deals with the triage, treatment and follow-up care of cervical dysplasia. With regard to those women who do not participate in screening, the guideline authors recommend sending out repeat invitation letters or an HPV self-collection kit. Colposcopy should be carried out for further investigation if cytology findings are Pap II-p and HPV test results are positive or if the results of an HPV 16 or HPV 18 screening test are positive. A single abnormal Pap smear should be triaged and investigated using HPV testing or p16/Ki67 dual staining.
Collapse
Affiliation(s)
- Peter Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany
| | - Stefanie Klug
- Lehrstuhl für Epidemiologie, Technische Universität München, München, Germany
| | - Ulrike Seifert
- Tumorepidemiologie, Universitäts KrebsCentrum (UCC), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Thomas Iftner
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Juliane Hädicke
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Thomas Löning
- Institut für Pathologie, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Lars Horn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dietmar Schmidt
- Institut für Pathologie, Referenzzentrum für Gynäkopathologie, Mannheim, Germany
| | - Hans Ikenberg
- CytoMol - MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - Manfred Steiner
- Facharzt für Frauenheilkunde und Geburtshilfe, Ihringen, Germany
| | - Ulrich Freitag
- Facharzt für Frauenheilkunde und Geburtshilfe, Wismar, Germany
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.,Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Willi Sauerbrei
- Institut für Med. Biometrie und Statistik (IMBI), Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Karsten Münstedt
- Frauenklinik, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Achim Schneider
- Medizinisches Versorgungszentrum im Fürstenberg-Karree, Berlin, Germany
| | - Andreas Kaufmann
- Klinik für Gynäkologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Joachim Weis
- Klinik für Tumorbiologie, Klinik für Onkologische Rehabilitation - UKF Reha gGmbH, Freiburg, Germany
| | - Anja Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Mathias Fehr
- Gynäkologie & Geburtshilfe in Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | | | - Olaf Reich
- Privatklinik Graz Ragnitz, Graz, Austria
| | - Marc Arbyn
- Cancer Center, Sciensano, Brüssel, Belgium
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| |
Collapse
|
16
|
Arbyn M, Smith SB, Temin S, Sultana F, Castle P. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ 2018; 363:k4823. [PMID: 30518635 PMCID: PMC6278587 DOI: 10.1136/bmj.k4823] [Citation(s) in RCA: 401] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of high-risk human papillomavirus (hrHPV) assays on self samples and the efficacy of self sampling strategies to reach underscreened women. DESIGN Updated meta-analysis. DATA SOURCES Medline (PubMed), Embase, and CENTRAL from 1 January 2013 to 15 April 2018 (accuracy review), and 1 January 2014 to 15 April 2018 (participation review). REVIEW METHODS Accuracy review: hrHPV assay on a vaginal self sample and a clinician sample; and verification of the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by colposcopy and biopsy in all enrolled women or in women with positive tests. Participation review: study population included women who were irregularly or never screened; women in the self sampling arm (intervention arm) were invited to collect a self sample for hrHPV testing; women in the control arm were invited or reminded to undergo a screening test on a clinician sample; participation in both arms was documented; and a population minimum of 400 women. RESULTS 56 accuracy studies and 25 participation trials were included. hrHPV assays based on polymerase chain reaction were as sensitive on self samples as on clinician samples to detect CIN2+ or CIN3+ (pooled ratio 0.99, 95% confidence interval 0.97 to 1.02). However, hrHPV assays based on signal amplification were less sensitive on self samples (pooled ratio 0.85, 95% confidence interval 0.80 to 0.89). The specificity to exclude CIN2+ was 2% or 4% lower on self samples than on clinician samples, for hrHPV assays based on polymerase chain reaction or signal amplification, respectively. Mailing self sample kits to the woman's home address generated higher response rates to have a sample taken by a clinician than invitation or reminder letters (pooled relative participation in intention-to-treat-analysis of 2.33, 95% confidence interval 1.86 to 2.91). Opt-in strategies where women had to request a self sampling kit were generally not more effective than invitation letters (relative participation of 1.22, 95% confidence interval 0.93 to 1.61). Direct offer of self sampling devices to women in communities that were underscreened generated high participation rates (>75%). Substantial interstudy heterogeneity was noted (I2>95%). CONCLUSIONS When used with hrHPV assays based on polymerase chain reaction, testing on self samples was similarly accurate as on clinician samples. Offering self sampling kits generally is more effective in reaching underscreened women than sending invitations. However, since response rates are highly variable among settings, pilots should be set up before regional or national roll out of self sampling strategies.
Collapse
Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J Wytsmanstreet 14, B1050 Brussels, Belgium
| | - Sara B Smith
- Global Coalition Against Cervical Cancer, Durham, NC, USA
| | - Sarah Temin
- Department of Cancer Policy and Advocacy, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Farhana Sultana
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Registries and Research, Victorian Cytology Service Registries, Victorian Cytology Service Ltd, Carlton South, Australia
| | - Philip Castle
- Global Coalition Against Cervical Cancer, Durham, NC, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
17
|
Gustavsson I, Aarnio R, Berggrund M, Hedlund-Lindberg J, Sanner K, Wikström I, Enroth S, Olovsson M, Gyllensten U. Randomised study of HPV prevalence and detection of CIN2+ in vaginal self-sampling compared to cervical specimens collected by medical personnel. Int J Cancer 2018; 144:89-97. [PMID: 29943822 DOI: 10.1002/ijc.31637] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 12/27/2022]
Abstract
We conducted a randomised study to compare vaginal self-sampling with assisted sampling by medical personnel on the cervix for HPV testing in primary screening. The first aim was to determine if the HPV prevalence is independent of sampling location (vagina versus cervix) and the person performing the sampling. The second aim was to evaluate if the two sampling strategies differed in the detection rate of CIN2+. In total, 19,523 women were randomised into two groups, with 9926 invited to perform self-sampling (SS arm) using the Rover VIBA-brush and 9597 offered assisted sampling using the cytobrush (AS arm). All samples were applied to the indicating FTA elute card and analysed for high-risk HPV using the hpVIR real-time PCR assay. The outcome for the first aim was HPV prevalence and for the second aim the number of CIN2+ based on histology. In the SS arm, 52.7% of invited women participated in the study, as compared to 34.2% in the AS arm. All samples contained sufficient amount of nuclear DNA for a valid HPV result, with vaginal samples having a higher DNA amount than cervical samples (p < 4.62 × 10-11 ). HPV prevalence was 4.6% in the SS arm and 4.1% in the AS arm (p = 5.5 × 10-2 ), and the distribution of HPV types similar between arms. There was no difference in the prevalence of CIN2+ per 1000 women screened between arms (p = 0.86). The results show that vaginal self-sampling is an equivalent alternative to sampling by medical personnel for HPV typing and identification of CIN2+.
Collapse
Affiliation(s)
- Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Malin Berggrund
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Julia Hedlund-Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| |
Collapse
|
18
|
Randomised study shows that repeated self-sampling and HPV test has more than two-fold higher detection rate of women with CIN2+ histology than Pap smear cytology. Br J Cancer 2018; 118:896-904. [PMID: 29438367 PMCID: PMC5886121 DOI: 10.1038/bjc.2017.485] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/08/2022] Open
Abstract
This corrects the article DOI: 10.1038/bjc.2017.85.
Collapse
|
19
|
Leinonen MK, Schee K, Jonassen CM, Lie AK, Nystrand CF, Rangberg A, Furre IE, Johansson MJ, Tropé A, Sjøborg KD, Castle PE, Nygård M. Safety and acceptability of human papillomavirus testing of self-collected specimens: A methodologic study of the impact of collection devices and HPV assays on sensitivity for cervical cancer and high-grade lesions. J Clin Virol 2017; 99-100:22-30. [PMID: 29289814 DOI: 10.1016/j.jcv.2017.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/08/2017] [Accepted: 12/15/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Comparative data on different self-collection methods is limited. OBJECTIVES To assess the impact of hrHPV testing of two self-collection devices for detection of cervical carcinoma and high-grade lesions. STUDY DESIGN Three hundred ten patients collected two cervicovaginal specimens using a brush (Evalyn®Brush) and a swab (FLOQSwabs™), and filled a questionnaire at home. Then, a physician at the clinic took a cervical specimen into PreservCyt® buffer for hrHPV testing and cytology. All specimens were tested using Anyplex™ II HPV28, Cobas® 4800 HPV Test and Xpert®HPV. RESULTS Performance comparison included 45 cervical carcinomas and 187 patients with premalignant lesions. Compared to the physician-specimen, hrHPV testing of Evalyn®Brush showed non-inferior sensitivity for CIN3+ (relative sensitivity of Anyplex™ 0.99; Cobas® 0.96; Xpert®HPV 0.97) while hrHPV testing of FLOQSwabs™ showed inferior sensitivity (relative sensitivity of Anyplex™ 0.91; Cobas® 0.92; Xpert®HPV 0.93). Similar results were observed for invasive carcinomas albeit that FLOQSwabs™ was statistically non-inferior to the physician-specimen. Self-collection by either Evalyn®Brush or FLOQSwabs™ was more sensitive for CIN3+ than LSIL or worse cytology. Significant decrease in sensitivity for CIN3+ were observed for FLOQSwabs™ when specimens were preprocessed for hrHPV testing after 28 days. Both devices were well accepted, but patients considered Evalyn®Brush easier and more comfortable than FLOQSwabs™. CONCLUSIONS Self-collection is comparable to current screening practice for detecting cervical carcinoma and CIN3+ but device and specimen processing effects exist. Only validated procedure including collection device, hrHPV assay and specimen preparation should be used.
Collapse
Affiliation(s)
- Maarit K Leinonen
- Department of Research, Cancer Registry of Norway, 0379 Oslo, Norway.
| | - Kristina Schee
- Department of Research, Cancer Registry of Norway, 0379 Oslo, Norway
| | - Christine M Jonassen
- Center for Laboratory Medicine, Østfold Hospital Trust, 1714 Grålum, Norway; Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, 1432 Ås, Norway
| | - A Kathrine Lie
- Center for Laboratory Medicine, Østfold Hospital Trust, 1714 Grålum, Norway
| | - Camilla F Nystrand
- Center for Laboratory Medicine, Østfold Hospital Trust, 1714 Grålum, Norway
| | - Anbjørg Rangberg
- Center for Laboratory Medicine, Østfold Hospital Trust, 1714 Grålum, Norway
| | - Ingegerd E Furre
- Department of Pathology, Oslo University Hospital, 0379 Oslo, Norway
| | | | - Ameli Tropé
- Department of Cervical Cancer Screening, Cancer Registry of Norway, 0379 Oslo, Norway; Department of Gynecologic Cancer, Division of Cancer Medicine, Oslo University Hospital, 0379 Oslo, Norway
| | - Katrine D Sjøborg
- Department of Obstetrics and Gynaecology, Østfold Hospital Trust, 1714 Grålum, Norway
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, 0379 Oslo, Norway
| |
Collapse
|
20
|
Van Ostade X, Dom M, Tjalma W, Van Raemdonck G. Candidate biomarkers in the cervical vaginal fluid for the (self-)diagnosis of cervical precancer. Arch Gynecol Obstet 2017; 297:295-311. [PMID: 29143101 PMCID: PMC5778162 DOI: 10.1007/s00404-017-4587-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
Purpose Despite improvement in vaccines against human papilloma virus (HPV), the causative agent of cervical cancer, screening women for cervical precancer will remain indispensable in the coming 30–40 years. A simple test that could be performed at home or at a doctor’s practice and that informs the woman whether she is at risk would significantly help make a broader group of patients who aware that they need medical treatment. Cervical vaginal fluid (CVF) is a body fluid that is very well suited for such a test. Methods Narrative review of cervical (pre)cancer candidate biomarkers from cervicovaginal fluid, is based on a detailed review of the literature. We will also discuss the possibilities that these biomarkers create for the development of a self-test or point-of-care test for cervical (pre)cancer. Results Several DNA, DNA methylation, miRNA, and protein biomarkers were identified in the cervical vaginal fluid; however, not all of these biomarkers are suited for development of a simple diagnostic assay. Conclusions Proteins, especially alpha-actinin-4, are most suited for development of a simple assay for cervical (pre)cancer. Accuracy of the test could further be improved by combination of several proteins or by combination with a new type of biomarker, e.g., originating from the cervicovaginal microbiome or metabolome.
Collapse
Affiliation(s)
- Xaveer Van Ostade
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium. .,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium.
| | - Martin Dom
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
| | - Wiebren Tjalma
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Geert Van Raemdonck
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
21
|
Dong L, Lin C, Li L, Wang M, Cui J, Feng R, Liu B, Wu Z, Lian J, Liao G, Chen W, Qiao Y. An evaluation of clinical performance of FTA cards for HPV 16/18 detection using cobas 4800 HPV Test compared to dry swab and liquid medium. J Clin Virol 2017; 94:67-71. [DOI: 10.1016/j.jcv.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/25/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
|
22
|
Peluso AL, Cozzolino I, Bottiglieri A, Lucchese L, Di Crescenzo RM, Langella M, Selleri C, Zeppa P. Immunoglobulin heavy and light chains and T-cell receptor beta and gamma chains PCR assessment on cytological samples. A study comparing FTA cards and cryopreserved lymph node fine-needle cytology. Cytopathology 2016; 28:203-215. [DOI: 10.1111/cyt.12402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 01/14/2023]
Affiliation(s)
- A. L. Peluso
- Anatomia Patologica; University of Salerno; Salerno Italy
- DEA; University “G. Marconi” of Rome; Rome
| | - I. Cozzolino
- Department of Public Health; University of Naples ‘Federico II’; Naples Italy
| | - A. Bottiglieri
- Anatomia Patologica; University of Salerno; Salerno Italy
| | - L. Lucchese
- Anatomia Patologica; University of Salerno; Salerno Italy
| | - R. M. Di Crescenzo
- Department of Public Health; University of Naples ‘Federico II’; Naples Italy
| | - M. Langella
- UOC Haematology and Transplantation; AOU San Giovanni di Dio e Ruggi D’Aragona; Salerno Italy
| | - C. Selleri
- Department of Medicine and Surgery; University of Salerno; Salerno Italy
| | - P. Zeppa
- Anatomia Patologica; University of Salerno; Salerno Italy
| |
Collapse
|
23
|
Barth H, Morel A, Mougin C, Averous G, Legrain M, Fender M, Risch S, Fafi-Kremer S, Velten M, Oudet P, Baldauf JJ, Stoll-Keller F. Long-term storage and safe retrieval of human papillomavirus DNA using FTA elute cards. J Virol Methods 2016; 229:60-5. [DOI: 10.1016/j.jviromet.2015.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/14/2015] [Accepted: 12/19/2015] [Indexed: 11/29/2022]
|
24
|
Maurer K, Luo H, Shen Z, Wang G, Du H, Wang C, Liu X, Wang X, Qu X, Wu R, Belinson J. Evaluation of a new solid media specimen transport card for high risk HPV detection and cervical cancer prevention. J Clin Virol 2016; 76:14-9. [PMID: 26774544 DOI: 10.1016/j.jcv.2015.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/17/2015] [Accepted: 12/29/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Solid media transport can be used to design adaptable cervical cancer screening programs but currently is limited by one card with published data. OBJECTIVE To develop and evaluate a solid media transport card for use in high-risk human papillomavirus detection (HR-HPV). STUDY DESIGN The Preventative Oncology International (POI) card was constructed using PK 226 paper(®) treated with cell-lysing solution and indicating dye. Vaginal samples were applied to the POI card and the indicating FTA (iFTA) elute card. A cervical sample was placed in liquid media. All specimens were tested for HR-HPV. Color change was assessed at sample application and at card processing. Stability of the POI card and iFTA elute card was tested at humidity. RESULTS 319 women were enrolled. Twelve women had at least one insufficient sample with no difference between media (p=0.36). Compared to liquid samples, there was good agreement for HR-HPV detection with kappa of 0.81 (95% CI 0.74-0.88) and 0.71 (95% CI 0.62-0.79) for the POI and iFTA elute card respectively. Sensitivity for ≥CIN2 was 100% (CI 100-100%), 95.1% (CI 92.7-97.6%), and 93.5% (CI 90.7-96.3%) for the HR-HPV test from the liquid media, POI card, and iFTA elute card respectively. There was no color change of the POI card noted in humidity but the iFTA elute card changed color at 90% humidity. CONCLUSIONS The POI card is suitable for DNA transport and HR-HPV testing. This card has the potential to make cervical cancer screening programs more affordable worldwide.
Collapse
Affiliation(s)
- Kathryn Maurer
- Gynecologic Oncology Division, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Hongxue Luo
- Department of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Zhiyong Shen
- Hyde Biomedical Corporation, Wuhu City, Anhui, PR China
| | - Guixiang Wang
- Department of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Hui Du
- Department of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Chun Wang
- Department of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Xiaobo Liu
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Xiamen Wang
- BGI Clinical Laboratories, Shenzhen, PR China
| | - Xinfeng Qu
- BGI Clinical Laboratories, Shenzhen, PR China; Preventive Oncology International, Cleveland Heights, OH, USA
| | - Ruifang Wu
- Department of Ob/Gyn, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Jerome Belinson
- Gynecologic Oncology Division, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA; Preventive Oncology International, Cleveland Heights, OH, USA
| |
Collapse
|
25
|
Wu R, Qu X, Du H, Liu Z, Hu Q, Wang C, Zhang L, Zhao J, Wang G, Belinson JL. A Pilot Study to Evaluate an Internet-Based Cervical Cancer Screening Model Based on Self-Sampling. Health (London) 2016. [DOI: 10.4236/health.2016.87071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
26
|
Berggrund M, Ekman D, Gustavsson I, Sundfeldt K, Olovsson M, Enroth S, Gyllensten U. Protein Detection Using the Multiplexed Proximity Extension Assay (PEA) from Plasma and Vaginal Fluid Applied to the Indicating FTA Elute Micro Card™. J Circ Biomark 2016; 5:9. [PMID: 28936257 PMCID: PMC5548362 DOI: 10.5772/64000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/28/2016] [Indexed: 01/20/2023] Open
Abstract
The indicating FTA elute micro card™ has been developed to collect and stabilize the nucleic acid in biological samples and is widely used in human and veterinary medicine and other disciplines. This card is not recommended for protein analyses, since surface treatment may denature proteins. We studied the ability to analyse proteins in human plasma and vaginal fluid as applied to the indicating FTA elute micro card™ using the sensitive proximity extension assay (PEA). Among 92 proteins in the Proseek Multiplex Oncology Iv2 panel, 87 were above the limit of detection (LOD) in liquid plasma and 56 among 92 above LOD in plasma applied to FTA cards. Washing and protein elution protocols were compared to identify an optimal method. Liquid-based cytology samples showed a lower number of proteins above LOD than FTA cards with vaginal fluid samples applied. Our results demonstrate that samples applied to the indicating FTA elute micro card™ are amendable to protein analyses, given that a sensitive protein detection assay is used. The results imply that biological samples applied to FTA cards can be used for DNA, RNA and protein detection.
Collapse
Affiliation(s)
- Malin Berggrund
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Daniel Ekman
- Olink Bioscience AB, Dag Hammarskjölds väg, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Sahlgrenska Cancer Center, Gothenburg University, Gothenburg, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| |
Collapse
|
27
|
Poddighe D, Bonomelli I, Giardinetti S, Nedbal M, Bruni P. Paediatric Dengue Fever diagnosed through parents' epidemiologic report and preventive strategy during the acute phase of infection. J Travel Med 2016; 23:tav013. [PMID: 26782129 DOI: 10.1093/jtm/tav013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/12/2022]
Abstract
In Europe, Dengue Fever is one of the most frequent imported diseases and also autochthonous cases occurred in areas where the insect vector is present. Here, we describe a child returning from Philippines and diagnosed with Dengue Fever, through the information provided by parents about an ongoing outbreak in their municipality. An appropriate clinical management in the hospital was established to monitor the occurrence of complications and to cancel the risk of dengue virus transmission in the acute phase of infection.
Collapse
Affiliation(s)
- Dimitri Poddighe
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| | - Irene Bonomelli
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| | - Silvia Giardinetti
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| | - Marco Nedbal
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| | - Paola Bruni
- Department of Pediatrics, Azienda Ospedaliera di Melegnano, Vizzolo Predabissi, Milan, Italy
| |
Collapse
|
28
|
Catarino R, Vassilakos P, Bilancioni A, Vanden Eynde M, Meyer-Hamme U, Menoud PA, Guerry F, Petignat P. Randomized Comparison of Two Vaginal Self-Sampling Methods for Human Papillomavirus Detection: Dry Swab versus FTA Cartridge. PLoS One 2015; 10:e0143644. [PMID: 26630353 PMCID: PMC4668032 DOI: 10.1371/journal.pone.0143644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/05/2015] [Indexed: 12/04/2022] Open
Abstract
Background Human papillomavirus (HPV) self-sampling (self-HPV) is valuable in cervical cancer screening. HPV testing is usually performed on physician-collected cervical smears stored in liquid-based medium. Dry filters and swabs are an alternative. We evaluated the adequacy of self-HPV using two dry storage and transport devices, the FTA cartridge and swab. Methods A total of 130 women performed two consecutive self-HPV samples. Randomization determined which of the two tests was performed first: self-HPV using dry swabs (s-DRY) or vaginal specimen collection using a cytobrush applied to an FTA cartridge (s-FTA). After self-HPV, a physician collected a cervical sample using liquid-based medium (Dr-WET). HPV types were identified by real-time PCR. Agreement between collection methods was measured using the kappa statistic. Results HPV prevalence for high-risk types was 62.3% (95%CI: 53.7–70.2) detected by s-DRY, 56.2% (95%CI: 47.6–64.4) by Dr-WET, and 54.6% (95%CI: 46.1–62.9) by s-FTA. There was overall agreement of 70.8% between s-FTA and s-DRY samples (kappa = 0.34), and of 82.3% between self-HPV and Dr-WET samples (kappa = 0.56). Detection sensitivities for low-grade squamous intraepithelial lesion or worse (LSIL+) were: 64.0% (95%CI: 44.5–79.8) for s-FTA, 84.6% (95%CI: 66.5–93.9) for s-DRY, and 76.9% (95%CI: 58.0–89.0) for Dr-WET. The preferred self-collection method among patients was s-DRY (40.8% vs. 15.4%). Regarding costs, FTA card was five times more expensive than the swab (~5 US dollars (USD)/per card vs. ~1 USD/per swab). Conclusion Self-HPV using dry swabs is sensitive for detecting LSIL+ and less expensive than s-FTA. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 43310942
Collapse
Affiliation(s)
- Rosa Catarino
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Aline Bilancioni
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Vanden Eynde
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Ulrike Meyer-Hamme
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Patrick Petignat
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
29
|
Wang SM, Hu SY, Chen W, Chen F, Zhao FH, He W, Ma XM, Zhang YQ, Wang J, Sivasubramaniam P, Qiao YL. Feasibility and accuracy evaluation of three human papillomavirus assays for FTA card-based sampling: a pilot study in cervical cancer screening. BMC Cancer 2015; 15:848. [PMID: 26537356 PMCID: PMC4634578 DOI: 10.1186/s12885-015-1882-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 10/30/2015] [Indexed: 12/04/2022] Open
Abstract
Background Liquid-state specimen carriers are inadequate for sample transportation in large-scale screening projects in low-resource settings, which necessitates the exploration of novel non-hazardous solid-state alternatives. Studies investigating the feasibility and accuracy of a solid-state human papillomavirus (HPV) sampling medium in combination with different down-stream HPV DNA assays for cervical cancer screening are needed. Methods We collected two cervical specimens from 396 women, aged 25–65 years, who were enrolled in a cervical cancer screening trial. One sample was stored using DCM preservative solution and the other was applied to a Whatman Indicating FTA Elute® card (FTA card). All specimens were processed using three HPV testing methods, including Hybrid capture 2 (HC2), careHPV™, and Cobas®4800 tests. All the women underwent a rigorous colposcopic evaluation that included using a microbiopsy protocol. Results Compared to the liquid-based carrier, the FTA card demonstrated comparable sensitivity for detecting high grade Cervical Intraepithelial Neoplasia (CIN) using HC2 (91.7 %), careHPV™ (83.3 %), and Cobas®4800 (91.7 %) tests. Moreover, the FTA card showed a higher specificity compared to a liquid-based carrier for HC2 (79.5 % vs. 71.6 %, P = 0.015), comparable specificity for careHPV™ (78.1 % vs. 73.0 %, P > 0.05), but lower specificity for the Cobas®4800 test (62.4 % vs. 69.9 %, P = 0.032). Generally, the FTA card-based sampling medium’s accuracy was comparable with that of liquid-based medium for the three HPV testing assays. Conclusions FTA cards are a promising sample carrier for cervical cancer screening. With further optimization, it can be utilized for HPV testing in areas of varying economic development.
Collapse
Affiliation(s)
- Shao-Ming Wang
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Shang-Ying Hu
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Wen Chen
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Feng Chen
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Fang-Hui Zhao
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Wei He
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Xin-Ming Ma
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Yu-Qing Zhang
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Jian Wang
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China. .,Beijing Municipal Institute of Labour Protection, Beijing, 100021, China.
| | - Priya Sivasubramaniam
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China. .,Vanderbilt University School of Medicine, Nashville, TN, 37212, USA.
| | - You-Lin Qiao
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| |
Collapse
|
30
|
Daily self-sampling for high-risk human papillomavirus (HR-HPV) testing. J Clin Virol 2015; 73:1-7. [PMID: 26498105 DOI: 10.1016/j.jcv.2015.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 09/27/2015] [Accepted: 09/30/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Self-sampling for HPV as part of primary screening is a well-tolerated method for women not attending organized Pap smear screening and could increase coverage of cervical cancer screening. OBJECTIVE To investigate if the prevalence of HR-HPV varies from day to day in infected women and if one single sample is reliable for detecting an ongoing infection. STUDY DESIGN This is a prospective cohort study on 12 premenopausal and 13 postmenopausal women performing daily self-sampling for HR-HPV testing. They were all HR-HPV-positive 1-3 months ago. Postmenopausal women were sampled for 28 days and premenopausal women sampled during bleeding-free days in one menstrual cycle. A possible difference in viral load between the estrogen-dominated proliferative phase and the progesterone-dominated secretory phase was analyzed. RESULTS AND CONCLUSIONS Consistent results throughout the sampling period were observed for 19 women, with either a daily presence of HPV (14 women) or no HPV at all during the sampling period (5 women). Of 607 samples from 25 women, 596 were consistently positive or negative for HPV during the sampling period and 11 were inconsistent (2%). There was no difference in HPV copy number between the estrogen dominated proliferative or progesterone dominated secretory menstrual cycle phases. The major finding was a high degree of consistency concerning HR-HPV positivity and negativity of HR-HPV in vaginal fluid during a sustained period of daily self-sampling. It does not appear to matter whether the sample is collected in the proliferative or secretory phase.
Collapse
|
31
|
Evaluation of a new APTIMA specimen collection and transportation kit for high-risk human papillomavirus E6/E7 messenger RNA in cervical and vaginal samples. Sex Transm Dis 2015; 41:365-8. [PMID: 24825332 DOI: 10.1097/olq.0000000000000125] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND An APTIMA specimen collection and transportation (SCT) kit was developed by Hologic/Gen-Probe. OBJECTIVES To compare cervical SCT samples to PreservCyt and SurePath samples and self-collected vaginal samples to physician-collected vaginal and cervical SCT samples. To determine ease and comfort of self-collection with the kit. STUDY DESIGN Each woman (n = 580) self-collected a vaginal SCT, then filled out a questionnaire (n = 563) to determine ease and comfort of self-collection. Colposcopy physicians collected a vaginal SCT and cervical PreservCyt, SCT, and SurePath samples. Samples were tested by APTIMA HPV (AHPV) assay. RESULTS Agreement between testing of cervical SCT and PreservCyt was 91.1% (κ = 0.82), and that of SurePath samples was 86.7% (κ = 0.72). Agreement of self-collected vaginal SCT to physician-collected SCT was 84.7% (κ = 0.68), and that of self-collected vaginal to cervical SCT was 82.0% (κ = 0.63). For 30 patients with CIN2+, AHPV testing of cervical SCT was 100% sensitive and 59.8% specific compared with PreservCyt (96.6% and 66.2%) and SurePath (93.3% and 70.9%). Vaginal SCT sensitivity was 86.7% for self-collection and 80.0% for physician collection. Most patients found that vaginal self-collection was easy, 5.3% reported some difficulty, and 87.6% expressed no discomfort. CONCLUSIONS Cervical samples collected with the new SCT kit compared well to traditional liquid-based samples tested by AHPV. Although there was good agreement between self-collected and physician-collected samples with the SCT, in a limited number of 30 women, vaginal sampling identified fewer with CIN2+ precancerous cervical lesions than cervical SCT sampling. Comfort, ease of use, and detection of high-risk HPV demonstrated that the kit could be used for cervical and vaginal sampling.
Collapse
|
32
|
Wang SM, Hu SY, Chen F, Chen W, Zhao FH, Zhang YQ, Ma XM, Qiao YL. Clinical Evaluation of Human Papillomavirus Detection by careHPVTMTest on Physician-Samples and Self-Samples using The Indicating FTA Elute® Card. Asian Pac J Cancer Prev 2014; 15:7085-9. [DOI: 10.7314/apjcp.2014.15.17.7085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
33
|
Haguenoer K, Giraudeau B, Gaudy-Graffin C, de Pinieux I, Dubois F, Trignol-Viguier N, Viguier J, Marret H, Goudeau A. Accuracy of dry vaginal self-sampling for detecting high-risk human papillomavirus infection in cervical cancer screening: A cross-sectional study. Gynecol Oncol 2014; 134:302-8. [DOI: 10.1016/j.ygyno.2014.05.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/23/2014] [Accepted: 05/28/2014] [Indexed: 11/17/2022]
|
34
|
Arbyn M, Verdoodt F, Snijders PJF, Verhoef VMJ, Suonio E, Dillner L, Minozzi S, Bellisario C, Banzi R, Zhao FH, Hillemanns P, Anttila A. Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: a meta-analysis. Lancet Oncol 2014; 15:172-83. [PMID: 24433684 DOI: 10.1016/s1470-2045(13)70570-9] [Citation(s) in RCA: 449] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Screening for human papillomavirus (HPV) infection is more effective in reducing the incidence of cervical cancer than screening using Pap smears. Moreover, HPV testing can be done on a vaginal sample self-taken by a woman, which offers an opportunity to improve screening coverage. However, the clinical accuracy of HPV testing on self-samples is not well-known. We assessed whether HPV testing on self-collected samples is equivalent to HPV testing on samples collected by clinicians. METHODS We identified relevant studies through a search of PubMed, Embase, and CENTRAL. Studies were eligible for inclusion if they fulfilled all of the following selection criteria: a cervical cell sample was self-collected by a woman followed by a sample taken by a clinician; a high-risk HPV test was done on the self-sample (index test) and HPV-testing or cytological interpretation was done on the specimen collected by the clinician (comparator tests); and the presence or absence of cervical intraepithelial neoplasia grade 2 (CIN2) or worse was verified by colposcopy and biopsy in all enrolled women or in women with one or more positive tests. The absolute accuracy for finding CIN2 or worse, or CIN grade 3 (CIN3) or worse of the index and comparator tests as well as the relative accuracy of the index versus the comparator tests were pooled using bivariate normal models and random effect models. FINDINGS We included data from 36 studies, which altogether enrolled 154 556 women. The absolute accuracy varied by clinical setting. In the context of screening, HPV testing on self-samples detected, on average, 76% (95% CI 69-82) of CIN2 or worse and 84% (72-92) of CIN3 or worse. The pooled absolute specificity to exclude CIN2 or worse was 86% (83-89) and 87% (84-90) to exclude CIN3 or worse. The variation of the relative accuracy of HPV testing on self-samples compared with tests on clinician-taken samples was low across settings, enabling pooling of the relative accuracy over all studies. The pooled sensitivity of HPV testing on self-samples was lower than HPV testing on a clinician-taken sample (ratio 0·88 [95% CI 0·85-0·91] for CIN2 or worse and 0·89 [0·83-0·96] for CIN3 or worse). Also specificity was lower in self-samples versus clinician-taken samples (ratio 0·96 [0·95-0·97] for CIN2 or worse and 0·96 [0·93-0·99] for CIN3 or worse). HPV testing with signal-based assays on self-samples was less sensitive and specific than testing on clinician-based samples. By contrast, some PCR-based HPV tests generally showed similar sensitivity on both self-samples and clinician-based samples. INTERPRETATION In screening programmes using signal-based assays, sampling by a clinician should be recommended. However, HPV testing on a self-sample can be suggested as an additional strategy to reach women not participating in the regular screening programme. Some PCR-based HPV tests could be considered for routine screening after careful piloting assessing feasibility, logistics, population compliance, and costs. FUNDING The 7th Framework Programme of the European Commission, the Belgian Foundation against Cancer, the International Agency for Research on Cancer, and the German Guideline Program in Oncology.
Collapse
Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
| | - Freija Verdoodt
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
| | - Viola M J Verhoef
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
| | - Eero Suonio
- International Agency for Research on Cancer, Lyon, France
| | | | - Silvia Minozzi
- Unit of Cancer Epidemiology, Department of Oncology, Piedmont Centre for Cancer Prevention, S Giovanni University Hospital, Turin, Italy
| | - Cristina Bellisario
- Unit of Cancer Epidemiology, Department of Oncology, Piedmont Centre for Cancer Prevention, S Giovanni University Hospital, Turin, Italy
| | - Rita Banzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Peter Hillemanns
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
35
|
Bosgraaf RP, Siebers AG, De Hullu JA, Massuger LFAG, Bulten J, Bekkers RLM, Melchers WJG. The current position and the future perspectives of cervical cancer screening. Expert Rev Anticancer Ther 2013; 14:75-92. [DOI: 10.1586/14737140.2014.856273] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
36
|
Castle P, Dowdall M. Current status and future trends in cervical cancer screening. WOMENS HEALTH 2013; 10:129-33. [PMID: 24147567 DOI: 10.2217/whe.13.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
37
|
Geraets D, van Baars R, Alonso I, Ordi J, Torné A, Melchers W, Meijer C, Quint W. Clinical evaluation of high-risk HPV detection on self-samples using the indicating FTA-elute solid-carrier cartridge. J Clin Virol 2013; 57:125-9. [DOI: 10.1016/j.jcv.2013.02.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 02/19/2013] [Accepted: 02/22/2013] [Indexed: 02/08/2023]
|
38
|
Levinson KL, Abuelo C, Salmeron J, Chyung E, Zou J, Belinson SE, Wang G, Ortiz CS, Vallejos CS, Belinson JL. The Peru Cervical Cancer Prevention Study (PERCAPS): the technology to make screening accessible. Gynecol Oncol 2013; 129:318-23. [PMID: 23385153 DOI: 10.1016/j.ygyno.2013.01.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/14/2013] [Accepted: 01/26/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study utilized a combination of HPV self-sampling, iFTA elute specimen cards, and long distance transport for centralized processing of specimens to determine the feasibility of large-scale screening in remote and transient populations. METHODS This study was performed in two locations in Peru (Manchay and Iquitos). The "Just For Me" cervico-vaginal brush and iFTA elute cards were used for the collection and transport of specimens. Samples were shipped via FedEx to China and tested for 14 types of high-risk HPV using PCR based MALDI-TOF. HPV positive women were treated with cryotherapy after VIA triage, and followed-up with colposcopy, biopsy, ECC, and repeat HPV testing at 6 months. RESULTS Six hundred and forty three women registered, and 632 returned a sample over a 10 day period. Within 2 weeks, specimens were shipped, samples tested, and results received by study staff. Sixty-eight women (10.8%) tested positive, and these results were delivered over 4 days. Fifty-nine HPV positive women (87%) returned for evaluation and treatment, and 2 had large lesions not suitable for cryotherapy. At 6 months, 42 women (74%) returned for follow-up, and 3 had CIN 2 (all positive samples from the endocervical canal). Ninety eight percent of participants reported that they would participate in this type of program again. CONCLUSIONS Utilizing HPV self-sampling, solid media specimen cards for long distance transport, and centralized high throughput processing, we achieved rapid delivery of results, high satisfaction levels, and low loss to follow-up for cervical cancer screening in remote and transient populations.
Collapse
|
39
|
Guan Y, Gravitt PE, Howard R, Eby YJ, Wang S, Li B, Feng C, Qiao YL, Castle PE. Agreement for HPV genotyping detection between self-collected specimens on a FTA cartridge and clinician-collected specimens. J Virol Methods 2013; 189:167-71. [PMID: 23370404 DOI: 10.1016/j.jviromet.2012.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/05/2012] [Accepted: 11/08/2012] [Indexed: 02/03/2023]
Abstract
The current method of transporting self-collected cervicovaginal specimen for HPV DNA testing relies on liquid based medium, which is challenging and expensive to transport. A novel, dry storage and transportation device, Whatman indicating FTA™ Elute Cartridge, avoids some of the pitfalls of liquid-based medium. This method has been shown to be comparable to liquid-based collection medium, but relative performance of self-collected (SC) and clinician-collected (CC) samples onto FTA cards has not been reported. The objective of this study is to compare the analytic performance of self- and clinician-collected samples onto FTA cartridges for the detection of carcinogenic HPV using Linear Array. There was a 91% agreement, 69% positive agreement, and kappa of 0.75 between the clinician-collected and self-collected specimens for detection of any carcinogenic HPV genotype. When the HPV results were categorized hierarchically according to cervical cancer risk, there was no difference in the distribution of the HPV results for the clinician- and self-collected specimens (p=0.7). This study concludes that FTA elute cartridge is a promising method of specimen transport for cervical cancer screening programs considering using self-collected specimen and HPV testing. Larger studies with clinical endpoints are now needed to assess the clinical performance.
Collapse
Affiliation(s)
- Yaoyao Guan
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Darlin L, Borgfeldt C, Forslund O, Hénic E, Dillner J, Kannisto P. Vaginal self-sampling without preservative for human papillomavirus testing shows good sensitivity. J Clin Virol 2013; 56:52-6. [DOI: 10.1016/j.jcv.2012.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 08/30/2012] [Accepted: 09/03/2012] [Indexed: 11/30/2022]
|
41
|
Gonzalez P, Cortes B, Quint W, Kreimer AR, Porras C, Rodríguez AC, Jimenez S, Herrero R, Struijk L, Hildesheim A, Melchers W. Evaluation of the FTA carrier device for human papillomavirus testing in developing countries. J Clin Microbiol 2012; 50:3870-6. [PMID: 22993174 PMCID: PMC3503011 DOI: 10.1128/jcm.01698-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/10/2012] [Indexed: 11/20/2022] Open
Abstract
Liquid-based methods for the collection, transportation, and storage of cervical cells are cumbersome and expensive and involve laborious DNA extraction. An FTA cartridge is a solid carrier device, easier to handle and allowing simple DNA elution for human papillomavirus (HPV) testing. HPV-DNA results from cervical specimens collected in PreservCyt medium (Hologic, Inc.) and the indicating FTA elute cartridge were compared in an area where transportation and storage may affect the performance of the test. Cervical cells from 319 young adult women enrolled in the Costa Rica Vaccine Trial were collected by a nurse using a Cervex brush (Roberts), which was placed on the FTA cartridge and subsequently rinsed in 20 ml of PreservCyt medium. Two 0.5-ml PreservCyt aliquots were frozen for HPV-PCR testing; the FTA cartridges were kept at room temperature. HPV-DNA detection and typing was performed using SPF(10) PCR/DEIA (DNA enzyme immunoassay detection of amplimers)/LiPA(25) system. The percent agreement, agreement among positives, and kappas were estimated. Positivity was higher for FTA compared to PreservCyt specimens (54.5% versus 45.8%, P < 0.001). For oncogenic types, the overall agreement was 0.92, the agreement between positives was 0.74, and the kappa was 0.79. For individual HPV types, the overall agreement ranged from 0.97 to 1.00. We did not observe reduced cytology adequacy when specimen collection for cytology was preceded by FTA collection for HPV testing. HPV-DNA detection from FTA cartridges is broadly comparable to detection from PC medium. The higher HPV detection observed for FTA-collected specimens should be explored further. FTA cartridges could provide a simpler and more cost-effective method for cervical cell collection, storage, and transportation for HPV-DNA detection in research settings in developing countries.
Collapse
Affiliation(s)
- Paula Gonzalez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Primary high-risk HPV screening for cervical cancer in post-menopausal women. Gynecol Oncol 2012; 125:343-5. [DOI: 10.1016/j.ygyno.2012.01.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 11/19/2022]
|