1
|
Differential Urinary Proteomic Analysis of High-Risk Cervical Intraepithelial Neoplasia. Int J Mol Sci 2023; 24:ijms24032531. [PMID: 36768853 PMCID: PMC9916937 DOI: 10.3390/ijms24032531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
Human papillomavirus (HPV)-associated lesions and malignancies exhibit alterations in the composition and functionality of the extracellular matrix (ECM) that represent the complex molecular pathways present between infection and disease. A total of 20 urine samples were used, including from 10 patients with cervical intraepithelial neoplasia grade 3 (CIN3) and 10 healthy controls to perform the label-free quantitative analysis using the nano-HPLC and ESI-MS ion trap mass analyzer and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF/MS) fast screening. Among 476 identified/quantified proteins, 48 were significantly changed (log2-fold change ≥1.0 or ≤-1.0, -log10 (bbinominal, p-value ≥ 1.3), of which were 40 proteins (down-regulated) and 8 proteins (up-regulated) in CIN3, in comparison to healthy controls. The biological function and key pathway enrichment of the gene set using gen set enrichment analysis (GSEA) were analyzed. The ECM-receptor interaction pathway (NES = -1.64, p = 0.026) was down-regulated by 13 proteins (HSPG2, COL6A1, COL6A3, SPP1, THBS1, TNC, DAG1, FN1, COMP, GP6, VTN, SDC1, and CD44; log2 FC range from -0.03 to -1.48) for the CIN3 group in the KEGG database. The MALDI-TOF/MS screening showed the difference of protein profiles between the control and CIN3 groups, i.e., using the scatter plot with a well-separated shape, as well as effectively distinguishing both groups (control and CIN3) using genetic algorithms (GA) with cross-validation (51.56%) and recognition capability (95.0%). Decreased levels of ECM-receptor interaction proteins may cause disturbances in the interactions of cells with the ECM and play an important role in the development and progression of cervical cancer.
Collapse
|
2
|
Cho HW, Shim SR, Lee JK, Hong JH. Accuracy of human papillomavirus tests on self-collected urine versus clinician-collected samples for the detection of cervical precancer: a systematic review and meta-analysis. J Gynecol Oncol 2021; 33:e4. [PMID: 34783207 PMCID: PMC8728664 DOI: 10.3802/jgo.2022.33.e4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The human papillomavirus (HPV) test is an effective screening tool to prevent cervical cancer. Urinary sampling for HPV detection improves the accessibility and participation of screening services and reduces the cost and burden on physicians. The clinical accuracy of urinary HPV test has yet to be determined via meta-analysis. This study assessed the clinical accuracy of these tests to detect cervical intraepithelial neoplasia (CIN) 2 or worse. Methods Relevant studies were identified using the PubMed, Embase, and Cochrane databases. Research eligibility was based on the clinical accuracy of HPV test on clinician-collected samples as a comparator test, and urine as an index test. The reference standard was the presence of CIN2 or worse. The pooled absolute, relative sensitivity, and specificity of the urinary HPV test versus clinician-collected samples were assessed using a bivariate model. Results The pooled sensitivity of urinary HPV test was significantly lower than that of clinician-collected samples (ratio=0.84, 95% confidence interval [CI]=0.78–0.91). However, some polymerase chain reaction (PCR)-based HPV test such as GP5+/6+ (relative sensitivity=0.98, 95% CI=0.91–1.05), SPF10 (relative sensitivity=0.98, 85% CI=0.88–1.08) and non GP5+/6+ PCR (relative sensitivity=1.00, 95% CI=0.88–1.14) showed similar sensitivity in both the urine and clinician-collected samples. Conclusion Our findings indicate that HPV test with some PCR-based assay on urine versus clinician-collected samples demonstrate similar clinical accuracy to detect CIN2 or worse. It suggests that urinary HPV test may present itself as a decent alternative screening tool for the detection of cervical pre-cancer. Trial Registration PROSPERO identifier: CRD42021227901 Some polymerase chain reaction-based human papillomavirus (HPV) tests showed similar accuracy in urine and cervical samples. Signal amplification or messenger RNA HPV test on urine is less sensitive than cervical test. High-risk HPV assays is the only significant factor to affect test accuracy. Urinary HPV test may be an alternative option for cervical cancer screening.
Collapse
Affiliation(s)
- Hyun-Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| |
Collapse
|
3
|
Ørnskov D, Jochumsen K, Steiner PH, Grunnet IM, Lykkebo AW, Waldstrøm M. Clinical performance and acceptability of self-collected vaginal and urine samples compared with clinician-taken cervical samples for HPV testing among women referred for colposcopy. A cross-sectional study. BMJ Open 2021; 11:e041512. [PMID: 33674367 PMCID: PMC7939007 DOI: 10.1136/bmjopen-2020-041512] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To increase effectiveness of the cervical cancer screening program, self-sampling can be an option. Both self-collected vaginal samples (SCV) and urine samples may be useful alternatives to clinician-taken cervical samples (CS). DESIGN Cross-sectional study. SETTING Colposcopy clinic. PARTICIPANTS Women (n=305) referred to colposcopy after abnormal cervical screening result or conditions like postcoital bleeding. INTERVENTION All women self-collected a urine and a vaginal sample prior to colposcopy, where a CS and biopsies were taken. All samples were tested for high-risk human papillomavirus (HPV) using the Cobas HPV assay. The gold standard was histology diagnoses (CIN2+/CIN3+) from biopsies obtained at the same examination. PRIMARY OUTCOME Absolute and relative sensitivity and specificity of HPV testing on SCV and urine to detect CIN2+/CIN3+ compared with the CS. SECONDARY OUTCOME The acceptability by women of self-sampling. RESULTS Both the vaginal and urine sample were comparable to the CS in identifying severe intraepithelial neoplasia (CIN2+/CIN3+). Absolute sensitivity ranged from 93% for urine samples to 96% for SCV for detecting CIN2+, which is comparable to the sensitivity of CS (overlapping 95% CI).The relative sensitivity for detecting CIN2+ was 1.00 (95% CI 0.96 to 1.04) for SCV and 0.96 (95% CI 0.91 to 1.03) for urine samples. At CIN3+, the relative sensitivity was 1.00 (95% CI 0.96 to 1.08) and 0.97 (95% CI 0.89 to 1.07) for SCV and urine samples, respectively. There were no statistical differences between the self-collected samples and the CS (McNemar's test >0.05). The relative specificity was also similar (1.03 (95% CI 0.95 to 1.12) for SCV and 0.98 (95% CI 0.89 to 1.09) for urine samples) (McNemar's test >0.05).The acceptability of self-sampling was evaluated by questionnaire. The women found the instructions on sample collection easy to understand and were positive about self-sampling with a preference for the urine sample. CONCLUSION Self-sampling by SCV and urine is a clinically safe alternative to CS with a high degree of acceptability.
Collapse
Affiliation(s)
- Dorthe Ørnskov
- Clinical Pathology, Sygehus Lillebalt Vejle Sygehus, Vejle, Denmark
| | - Kirsten Jochumsen
- Department of Gynecology, Odense University Hospital, Odense, Denmark
| | | | | | | | | |
Collapse
|
4
|
Padhy RR, Davidov A, Madrigal L, Alcide G, Spahiu A. Detection of high-risk human papillomavirus RNA in urine for cervical cancer screening with HPV 16 & 18/45 genotyping. Heliyon 2020; 6:e03745. [PMID: 32346629 PMCID: PMC7182776 DOI: 10.1016/j.heliyon.2020.e03745] [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: 11/12/2019] [Revised: 01/16/2020] [Accepted: 04/01/2020] [Indexed: 12/31/2022] Open
Abstract
Objective To detect high-risk human papillomavirus (hrHPV) messenger-RNA (mRNA) in urine samples, compare their concordance with cervical samples including HPV 16 & 18/45 genotyping, and to determine the utility in detecting ≥ CIN 2 lesions. Methods A cohort of 189 non-pregnant patients (age ≥ 25) was recruited in three groups: Group 1 with abnormal pap-smears and hrHPV positivity, Group 2 with normal pap-smears and hrHPV positivity, and Group 3 with normal pap-smears and hrHPV negativity. Urine samples were tested for hrHPV-mRNA and subsequent hrHPV-mRNA genotype if positive. High-risk HPV detection and genotyping were performed using Aptima assays which are validated for cervical HPV testing. Colposcopy results from groups 1 & 2 were analyzed. Results The sensitivity of urine hrHPV-mRNA detection was 31.5% while the specificity and PPV were above 95% (96.9% & 95.1% respectively) (p < 0.001). The kappa agreement with cervical samples was fair (0.22, p = 0.04). The sensitivity and specificity of urine hrHPV-mRNA genotyping were 20.0% & 100% respectively (p < 0.001) with 100% genotype-specific concordance. The kappa agreement with cervical samples was fair (0.25, p = 0.16). For urine hrHPV-mRNA detection of ASC-H/HSIL when grouped by age ≥ 30, the sensitivity and specificity were 45.4% & 63.9% respectively (p = 0.009). For urine hrHPV-mRNA detection of ≥ CIN 2 for all ages, the sensitivity and specificity were 45.5% & 75.0% respectively (p = 0.03). Conclusion Using the Aptima Assay, urine hrHPV-mRNA detection is suboptimal for cervical cancer screening but given the high specificity, it has the potential to identify high-grade lesions (≥ CIN 2). Urine hrHPV-mRNA genotyping via this modality is not beneficial in triage settings of normal or abnormal cytology to determine the need for colposcopy.
Collapse
Affiliation(s)
- Radha Rani Padhy
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Adi Davidov
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Louise Madrigal
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Gina Alcide
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Almir Spahiu
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| |
Collapse
|
5
|
Detection of HPV E6 oncoprotein from urine via a novel immunochromatographic assay. PLoS One 2020; 15:e0232105. [PMID: 32320451 PMCID: PMC7176116 DOI: 10.1371/journal.pone.0232105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
Cervical cancer is a significant public health problem, especially in low- and middle-income countries, where women have little access to cervical cancer screening; consequently 80% of cervical cancer related mortality occurs in these regions. The development of screening methods that need less infrastructure thus represents an urgent medical need. The study aims to compare the detection rates of high-risk human papillomavirus 16 and 18 E6 oncoprotein in urine, vaginal self-collected, and cervical scrapes of women using the OncoE6™ Cervical Test and compare the HPV16 and/or HPV18 E6 detection rates with the HPV DNA testing. Paired urine, vaginal self-collected and cervical specimens were collected from 124 women who participated in cervical cancer screening or treatment in this proof-of-concept study and underwent to HPV16/18-E6 testing and high-risk HPV DNA testing prior to treatment of cervical neoplasia or cancer. Concordance between urinary, vaginal and cervical HPV16/18-E6 and HPV-DNA testing was evaluated for patients classified as negative group (<CIN2) and histological positive group (CIN2, CIN3 and invasive carcinoma). Overall, HPV16/18-E6 oncoprotein was detected in 30.6% of cervical samples, 20.3% of self-collected vaginal samples and 21% of urine samples. Regarding the clinical sensitivity, the HPV16/18-E6 oncoprotein was not detected in CIN2 cases, and was detected at low rates in CIN3 cases. The clinical sensitivity of the HPV16/18-E6 oncoprotein for detecting invasive cervical cancer was 70% for cervical scrapes, 55% for self-collected vaginal samples and 52% for urine samples. This study reports the urinary detection of E6 oncoprotein in vivo for the first time and our results suggest that this detection is only for invasive/microinvasive lesions. Then, further protocol development and standardization to achieve a clinical sensitivity for CIN2/3 detection close to what can be achieved for invasive lesions using the physician collected cervical is needed.
Collapse
|
6
|
Rohner E, McGuire FH, Liu Y, Li Q, Miele K, Desai SA, Schmitt JW, Knittel A, Nelson JAE, Edelman C, Sivaraman V, Baker A, Romocki LS, Rahangdale L, Smith JS. Racial and Ethnic Differences in Acceptability of Urine and Cervico-Vaginal Sample Self-Collection for HPV-Based Cervical Cancer Screening. J Womens Health (Larchmt) 2020; 29:971-979. [PMID: 32212991 DOI: 10.1089/jwh.2019.8132] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: We compared women's acceptability of urine and cervico-vaginal sample self-collection for high-risk (oncogenic) human papillomavirus (hrHPV) testing and assessed whether acceptability varied across racial/ethnic groups. Methods: As part of a test accuracy study of urine-based hrHPV testing, we recruited a convenience sample of women 25-65 years of age at two colposcopy clinics in North Carolina between November 2016 and January 2019. After self-collection of urine and cervico-vaginal samples, women completed a questionnaire on the acceptability of the sample collection methods. We coded open-ended questions inductively. All results are presented stratified by racial/ethnic group. Results: We included 410 women (119 Hispanic, 115 non-Hispanic Black, 154 non-Hispanic White, and 22 women with other racial identities). Most women (79%, 95% confidence interval [CI] = 76%-83%) had positive feelings about urine-based hrHPV testing. Women generally preferred urine (78%, 95% CI = 74%-82%) over cervico-vaginal self-collection (18%, 95% CI = 14%-22%), but the degree differed by racial/ethnic group, increasing from 75% in non-Hispanic Black to 82% in Hispanic women (p = 0.011). Most women reported at least one positive aspect of urine (89%) and cervico-vaginal self-collection (85%) for hrHPV testing with the most common positive aspect being easy sample collection, although 16% of women were concerned about performing the cervico-vaginal self-collection correctly. Conclusions: Self-collection for hrHPV-based cervical cancer screening is highly acceptable to women across different racial/ethnic groups in the United States, and most women in our study would be more likely to attend future cervical cancer screening appointments if screening were urine based. Urine-based hrHPV testing is a promising approach to improve cervical cancer screening coverage.
Collapse
Affiliation(s)
- Eliane Rohner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - F Hunter McGuire
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Yutong Liu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Quefeng Li
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Kate Miele
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Samveg A Desai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - John W Schmitt
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Andrea Knittel
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Julie A E Nelson
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Claire Edelman
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Vijay Sivaraman
- Department of Biological and Biomedical Sciences, North Carolina Central University, Durham, North Carolina
| | - Anna Baker
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - LaHoma S Romocki
- Department of Public Health Education, North Carolina Central University, Durham, North Carolina
| | - Lisa Rahangdale
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
7
|
Rohner E, Rahangdale L, Sanusi B, Knittel AK, Vaughan L, Chesko K, Faherty B, Tulenko SE, Schmitt JW, Romocki LS, Sivaraman V, Nelson JAE, Smith JS. Test Accuracy of Human Papillomavirus in Urine for Detection of Cervical Intraepithelial Neoplasia. J Clin Microbiol 2020; 58:e01443-19. [PMID: 31896666 PMCID: PMC7041584 DOI: 10.1128/jcm.01443-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/12/2019] [Indexed: 01/22/2023] Open
Abstract
The objective was to assess the diagnostic test accuracy of high-risk human papillomavirus (hrHPV) testing of self-collected urine and cervicovaginal samples for the detection of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). We recruited a convenience sample of women 25 to 65 years of age who were undergoing clinically indicated colposcopy at two medical centers in North Carolina between November 2016 and January 2019. Women with normal cytology results and positive hrHPV results were also recruited. Urine samples, self-collected cervicovaginal samples, provider-collected cervical samples, and cervical biopsy samples were obtained from all enrolled women. Samples were tested for hrHPV DNA using the Onclarity assay (Becton Dickinson, Sparks, MD). Biopsy samples were histologically graded as CIN2+ or
Collapse
Affiliation(s)
- Eliane Rohner
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Busola Sanusi
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrea K Knittel
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Kirsty Chesko
- Becton, Dickinson and Company, Sparks, Maryland, USA
| | - Brian Faherty
- Becton, Dickinson and Company, Sparks, Maryland, USA
| | - Samantha E Tulenko
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John W Schmitt
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - LaHoma S Romocki
- Department of Public Health Education, North Carolina Central University, Durham, North Carolina, USA
| | - Vijay Sivaraman
- Department of Biological and Biomedical Sciences, North Carolina Central University, Durham, North Carolina, USA
| | - Julie A E Nelson
- Department of Microbiology and Immunology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
8
|
Xu H, Yu Y, George W, Smith JS, Hu S, Dang L, Zhang X, Pan Q, Qiao Y, Zhao F. Comparison of the performance of paired urine and cervical samples for cervical cancer screening in screening population. J Med Virol 2019; 92:234-240. [DOI: 10.1002/jmv.25597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Huifang Xu
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing China
| | - Yanqin Yu
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing China
| | - Whitney George
- Department of HistoryUniversity of Chicago CollegeChicago Illinois
| | - Jennifer S. Smith
- Department of EpidemiologyUNC Gillings School of Global Public HealthChapel Hill North Carolina
- Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel Hill North Carolina
| | - Shangying Hu
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing China
| | - Le Dang
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing China
| | - Xun Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing China
| | - Qinjing Pan
- Department of Cytopathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing China
| | - Youlin Qiao
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing China
| | - Fanghui Zhao
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing China
| |
Collapse
|
9
|
Buchegger K, Viscarra T, Andana A, Ili C, López J, Zanella L, Carmona-López MI, Fernández JJ, Espinel IC, Sánchez R, Roa JC, Brebi P. Detection and genotyping of human papillomavirus virus (HPV): a comparative analysis of clinical performance in cervical and urine samples in Chilean women. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:5413-5421. [PMID: 31949624 PMCID: PMC6963012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/22/2018] [Indexed: 06/10/2023]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infectious agent and is the main cause of cervical cancer (CC). In Chile, CC is the second leading cause of death by cancer in women aged 20-44 years, four times higher than in developed countries. Currently, the detection of HPV infection using a cervical brush is recommended; however, this is an invasive procedure that many women try to avoid. The aim of this study was to evaluate the clinical performance of a self-collected, urine-based HPV detection method using conventional PCR followed by a reverse line blot. A PCR-based HPV genotyping was performed on 190 paired cervical and urine samples from gynecological exams at public health centers in the Araucania Region, Chile. HPV DNA detection and genotyping were performed by PCR and reverse line blot assay. Carcinogenic HPV types were present in 64.7% and 65.8% of the cervical and urine samples; the infection rates of HPV16 were 34.7% and 33.2%, respectively. The overall percent agreement between carcinogenic HPV detection in cervical and urine samples was 73.7%, with a moderate concordance rate of carcinogenic HPV detection (kappa = 0.42). Clinical sensitivities for cervical and urine-based sampling methods to diagnose cervical intraepithelial neoplasia 2/3 (CIN2/3) by histology were 93.4% and 90.2%, respectively. These results suggest that both cervical brush and urine-based sampling show a good clinical performance in the detection of HPV infection. The urine-based sampling method represents a valuable alternative with a great impact on public health, allowing increased cervical cancer screening coverage among women who do not undergo pelvic examinations.
Collapse
Affiliation(s)
- Kurt Buchegger
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Tamara Viscarra
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Alejandra Andana
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Carmen Ili
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Jaime López
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Louise Zanella
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - María Inés Carmona-López
- Instituto de Ciencias Biomédicas (ICBM) y Centro de Investigaciones Multidisciplinares de La Araucanía (CIMA)Universidad Autónoma de Chile
| | - Juan José Fernández
- Instituto de Ciencias Biomédicas (ICBM) y Centro de Investigaciones Multidisciplinares de La Araucanía (CIMA)Universidad Autónoma de Chile
| | - Irene Cartas Espinel
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Raúl Sánchez
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Department of Preclinical Science, School of Medicine, Universidad de La FronteraTemuco, Chile
| | - Juan Carlos Roa
- Department of Pathology, UC Centre for Investigational Oncology (CITO), Advanced Centre for Chronic Diseases (ACCDiS), Pontificia Universidad Católica de ChileSantiago de Chile, Chile
| | - Priscilla Brebi
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| |
Collapse
|
10
|
High-Risk Human Papillomavirus Detection in Urine Samples From a Referral Population With Cervical Biopsy-Proven High-Grade Lesions. J Low Genit Tract Dis 2018; 22:17-20. [PMID: 29271852 DOI: 10.1097/lgt.0000000000000352] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the study was to evaluate the performance of the HPV-HR test to detect high-risk human papillomavirus (HPV) in urine samples in comparison with a commercial molecular HPV test. MATERIALS AND METHODS This is a prospective study, in which 350 patients diagnosed previously with cervical intraepithelial neoplasia (CIN) grade 2 or higher were enrolled. Urine and cervical specimens were collected. Urine was tested with the HPV-HR test and cervical specimens were tested with the Cobas. RESULTS Of the 336 evaluable patients, there were 271 cases of CIN 2+, of which 202 were CIN 3+ and the remaining 65 patients were less than CIN 2. Positivity was 77.1% (95% confidence interval [CI] = 72.5-81.5) for the urine samples and 83.6% (95% CI = 79.6-87.6) for the cervical samples. Agreement between cervical and urine samples for HPV detection was 79.8% (κ = 0.363; 95% CI = 0.243-0.484). Sensitivity for CIN 2+ was 83.4% (95% CI = 78.4-87.6) for urine and 90.8% (95% CI = 86.7-92.9) for cervical samples. The sensitivity for CIN 3+ was 85.6% (95% CI = 80.0-90.2) for urine and 92.6% (95% CI = 88.0-95.8) for cervical samples. Specificity for worse than CIN 2 was 50.8% (95% CI = 33.7-59.0) and 46.2% (95% CI = 33.7-59.0) for urine and cervical samples, respectively. CONCLUSIONS Although these results demonstrated slightly higher detection rates for HR-HPV and clinical sensitivity in cervical samples than in urine, when compared with histological diagnoses, urine sampling is a viable alternative to access women who do not participate in routine screening programs.
Collapse
|
11
|
Cuzick J, Cadman L, Ahmad AS, Ho L, Terry G, Kleeman M, Lyons D, Austin J, Stoler MH, Vibat CRT, Dockter J, Robbins D, Billings PR, Erlander MG. Performance and Diagnostic Accuracy of a Urine-Based Human Papillomavirus Assay in a Referral Population. Cancer Epidemiol Biomarkers Prev 2017; 26:1053-1059. [PMID: 28223432 DOI: 10.1158/1055-9965.epi-16-0960] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/04/2017] [Accepted: 01/31/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Human papillomavirus (HPV) testing from clinician-collected cervical and self-collected cervico-vaginal samples is more sensitive for detecting CIN2+/CIN3+ than cytology-based screening, stimulating interest in HPV testing from urine. The objective was to determine the performance of the Trovagene HPV test for the detection of CIN2+ from urine and PreservCyt cervical samples.Methods: Women referred for colposcopy at St Mary's Hospital (London, United Kingdom), following abnormal cytology, were recruited to this diagnostic accuracy study by convenience sampling (September 2011 to April 2013). A total of 501 paired urine and cervical samples were collected. Primary outcomes were sensitivity for CIN2+/CIN3+ and specificity for
Collapse
Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
| | - Louise Cadman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Amar S Ahmad
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Linda Ho
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - George Terry
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Michelle Kleeman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Deirdre Lyons
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Janet Austin
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Mark H Stoler
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | | | | | - David Robbins
- Trovagene Inc., San Diego, California
- Genomind Inc. King of Prussia, Pennsylvania
| | | | | |
Collapse
|
12
|
Tshomo U, Franceschi S, Tshokey T, Tobgay T, Baussano I, Tenet V, Snijders PJF, Gheit T, Tommasino M, Vorsters A, Clifford GM. Evaluation of the performance of Human Papillomavirus testing in paired urine and clinician-collected cervical samples among women aged over 30 years in Bhutan. Virol J 2017; 14:74. [PMID: 28390433 PMCID: PMC5385028 DOI: 10.1186/s12985-017-0744-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/29/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Urine sampling may offer a less invasive solution than cervical sampling to test for human papillomavirus (HPV) for HPV vaccine impact monitoring. METHODS Paired samples of urine and exfoliated cervical cells were obtained for 89 women with history of high-risk (HR) HPV-positive normal cytology in Bhutan. Urine sampling protocol included self-collection of first-void urine immediately into a conservation medium and procedures to optimize DNA yield. Colposcopical abnormalities were biopsied. Two HPV assays were used: a multiplex type-specific PCR (E7-MPG) and a less analytically sensitive GP5+/6+ PCR followed by reverse line blot. RESULTS HPV positivity for 21 types common to both assays was similar in urine and cells by E7-MPG (62.9% and 57.3%, respectively, p = 0.32) but lower in urine by GP5+/6+ (30.3% and 40.4%, p = 0.05). HPV6/11/16/18 positivity did not significantly differ between urine and cells by either assay. Sensitivity of urine (using cells as gold standard) to detect 21 HPV types was 80% and 58% for E7-MPG and GP5+/6+, respectively, with specificity 61% and 89%. HPV type distribution in urine and cells was similar, regardless of assay. The 5 detected CIN3+ were HR-HPV positive in cells by both assays, compared to 4 and 3 by E7-MPG and GP5+/6+, respectively, in urine samples. CONCLUSION For the monitoring of vaccine impact, we demonstrate validity of a urine sampling protocol to obtain HPV prevalence data that are broadly comparable to that from cervical cells. However, detection of HPV in urine varies according to assay sensitivity, presumably because low level infections are frequent.
Collapse
Affiliation(s)
- Ugyen Tshomo
- Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Silvia Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | - Tshokey Tshokey
- Department of Pathology & Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Tashi Tobgay
- Department of Pathology & Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Iacopo Baussano
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | - Vanessa Tenet
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | - Peter J. F. Snijders
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Tarik Gheit
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | - Massimo Tommasino
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Gary M. Clifford
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| |
Collapse
|
13
|
Guerrero-Preston R, Valle BL, Jedlicka A, Turaga N, Folawiyo O, Pirini F, Lawson F, Vergura A, Noordhuis M, Dziedzic A, Pérez G, Renehan M, Guerrero-Diaz C, De Jesus Rodríguez E, Diaz-Montes T, Rodríguez Orengo J, Méndez K, Romaguera J, Trock BJ, Florea L, Sidransky D. Molecular Triage of Premalignant Lesions in Liquid-Based Cervical Cytology and Circulating Cell-Free DNA from Urine, Using a Panel of Methylated Human Papilloma Virus and Host Genes. Cancer Prev Res (Phila) 2016; 9:915-924. [DOI: 10.1158/1940-6207.capr-16-0138] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022]
|
14
|
Cómbita AL, Gheit T, González P, Puerto D, Murillo RH, Montoya L, Vorsters A, Van Keer S, Van Damme P, Tommasino M, Hernández-Suárez G, Sánchez L, Herrero R, Wiesner C. Comparison between Urine and Cervical Samples for HPV DNA Detection and Typing in Young Women in Colombia. Cancer Prev Res (Phila) 2016; 9:766-71. [PMID: 27417431 DOI: 10.1158/1940-6207.capr-16-0038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/24/2016] [Indexed: 11/16/2022]
Abstract
Urine sampling for HPV DNA detection has been proposed as an effective method for monitoring the impact of HPV vaccination programs; however, conflicting results have been reported. The goal of this study was to evaluate the performance of optimized urine HPV DNA testing in women aged 19 to 25 years. Optimization process included the use of first void urine, immediate mixing of urine with DNA preservative, and the concentration of all HPV DNA, including cell-free DNA fragments. Urine and cervical samples were collected from 535 young women attending cervical screening at health centers from two Colombian cities. HPV DNA detection and genotyping was performed using an HPV type-specific multiplex genotyping assay, which combines multiplex polymerase chain reaction with bead-based Luminex technology. Concordance between HPV DNA detection in urine and cervical samples was determined using kappa statistics and McNemar tests. The accuracy of HPV DNA testing in urine samples was evaluated measuring sensitivity and specificity using as reference the results obtained from cervical samples. Statistical analysis was performed using STATA11.2 software. The findings revealed an overall HPV prevalence of 60.00% in cervical samples and 64.72% in urine samples, HPV-16 being the most frequent HPV type detected in both specimens. Moreover, our results indicate that detection of HPV DNA in first void urine provides similar results to those obtained with cervical samples and can be used to monitor HPV vaccination trials and programs as evidenced by the substantial concordance found for the detection of the four vaccine types. Cancer Prev Res; 9(9); 766-71. ©2016 AACR.
Collapse
Affiliation(s)
- Alba Lucía Cómbita
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia. Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Paula González
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Guanacaste, Costa Rica
| | - Devi Puerto
- Grupo de Investigación en Salud Pública y Vigilancia Epidemiológica, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Raúl Hernando Murillo
- Grupo de Investigación en Salud Pública y Vigilancia Epidemiológica, Instituto Nacional de Cancerología (INC), Bogotá, Colombia. Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Luisa Montoya
- Unidad de Análisis, Subdirección de Investigaciones, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerpen, Belgium
| | - Severien Van Keer
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerpen, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerpen, Belgium
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Gustavo Hernández-Suárez
- Grupo de Investigación en Salud Pública y Vigilancia Epidemiológica, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Laura Sánchez
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Rolando Herrero
- Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Carolina Wiesner
- Grupo de Investigación en Salud Pública y Vigilancia Epidemiológica, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| |
Collapse
|
15
|
Senkomago V, Des Marais AC, Rahangdale L, Vibat CRT, Erlander MG, Smith JS. Comparison of urine specimen collection times and testing fractions for the detection of high-risk human papillomavirus and high-grade cervical precancer. J Clin Virol 2015; 74:26-31. [PMID: 26655264 DOI: 10.1016/j.jcv.2015.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/27/2015] [Accepted: 11/01/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Urine testing for high-risk human papillomavirus (HR-HPV) detection could provide a non-invasive, simple method for cervical cancer screening. OBJECTIVES We examined whether HR-HPV detection is affected by urine collection time, portion of urine stream, or urine fraction tested, and assessed the performance of HR-HPV testing in urine for detection of cervical intraepithelial neoplasia grade II or worse (CIN2+). STUDY DESIGN A total of 37 female colposcopy clinic attendees, ≥ 30 years, provided three urine samples: "first void" urine collected at home, and "initial stream" and "mid-stream" urine samples collected at the clinic later in the day. Self- and physician-collected brush specimens were obtained at the same clinic visit. Colposcopy was performed and directed biopsies obtained if clinically indicated. For each urine sample, HR-HPV DNA testing was conducted for unfractionated, pellet, and supernatant fractions using the Trovagene test. HR-HPV mRNA testing was performed on brush specimens using the Aptima HPV assay. RESULTS HR-HPV prevalence was similar in unfractionated and pellet fractions of all urine samples. For supernatant urine fractions, HR-HPV prevalence appeared lower in mid-stream urine (56.8%[40.8-72.7%]) than in initial stream urine (75.7%[61.9-89.5%]). Sensitivity of CIN2+ detection was identical for initial stream urine and physician-collected cervical specimen (89.9%[95%CI=62.7-99.6%]), and similar to self-collected vaginal specimen (79.1%[48.1-96.6%]). CONCLUSION This is among the first studies to compare methodologies for collection and processing of urine for HR-HPV detection. HR-HPV prevalence was similar in first void and initial stream urine, and was highly sensitive for CIN2+ detection. Additional research in a larger and general screening population is needed.
Collapse
Affiliation(s)
- V Senkomago
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - A C Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - L Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | - J S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| |
Collapse
|