Human papillomavirus and cervical cancer

Development of a digital algorithm for assessing tumor-stroma ratio, tumor budding and tumor infiltrating lymphocytes in vulvar squamous cell carcinomas

Tumor-stroma ratio (TSR), tumor budding (TB), and tumor-infiltrating lymphocytes (TILs) are prognostic markers in some cancers but with unknown significance in vulvar squamous cell carcinoma (VSCC). This pilot study primarily aimed to develop a digital method for evaluating TSR, TB and TILs in VSCC and secondarily to investigate variation in these factors by p16 status. An independent training set stained with CD3/cytokeratin and CD8/cytokeratin was used to develop a deep learning-based Application Protocol Package (APP) segmenting tissue into background, epithelium, or stroma. TSR was defined as percentage of tumor epithelium relative to total tumor area, and tumor buds were defined as clusters of 1-4 tumor cells. A second APP quantified CD3+ and CD8+ lymphocytes in the intraepithelial and stromal compartments, respectively. The digital algorithms were applied to the study cohort of 41 VSCC cases, achieving satisfactory performance without manual corrections. TSR ranged between 33 and 91% with median of 64%, and median number of buds was 4 (range: 0-48) buds/mm2. Median density and range of CD3+ lymphocytes were 222 (13-2320) cells/mm2 in the intraepithelial and 1978 (397-6683) cells/mm2 in the stromal compartment, respectively. CD8+ lymphocyte counts were lower. There was a tendency towards lower TSR and higher number of buds in p16-negative compared with p16-positive VSCC. Finally, automated measures were compared with manual evaluations showing high concordance. The developed automated method provided precise and objective measurements of TSR, TB and TILs. The algorithms should be validated in a larger cohort and correlated with clinicopathological characteristics and prognosis to determine their clinical relevance.

Participation and relative cost of attendance by direct-mail compared to opt-in invitation strategy for HPV self-sampling targeting cervical screening non-attenders: A large-scale, randomized, pragmatic study

Broad accessibility to cervical cancer screening and high participation rate is essential to reduce cervical cancer incidence. HPV self-sampling is an alternative to clinician collected cervical samples to increase accessibility and screening coverage. To inform on deployment strategies of HPV self-sampling, this large-scale, randomized, pragmatic study compared two invitation modalities; direct-mail and opt-in. The study included screening non-attenders from the Capital Region of Denmark randomly allocated (1:4) to a direct-mail or opt-in invitation for cervical screening by HPV self-sampling. Primary endpoint was screening participation; secondary endpoints were HPV prevalence and histology outcome. Adherence to follow-up and cost were also evaluated. After exclusion of hysterectomized/non-accessible women, 49,393 women were invited: 9639 by direct-mail, and 39,754 by the opt-in offer. A direct-mail invitation for HPV self-sampling yielded a significant higher participation than an opt-in invitation. HPV self-sample participation for direct-mail was 25.2% (n = 2426), opt-in participation was 20.2% (n = 8047), adjusted OR = 1.27, 95% CI 1.20-1.34. Participation increased with age (p < .0001) for both strategies and decreased with screening history of non-attendance (p < .0001). Interaction between invitation strategy and age/screening history was found; more women below 50 years of age participated by direct-mail compared to opt-in (p < .0001) and higher participation by direct-mail group was found in women with a short history of non-attendance (p < .0001). Participation of long-term unscreened women was similar between arms. The relative cost was ≈14 HPV self-sample kits distributed per additional participant by direct-mail over opt-in. HPV prevalence, adherence to follow-up, and detection of high-grade cervical intraepithelial neoplasia was similar between invitation strategies.

Addressing the cervical cancer burden in the Rio Grande Valley of Texas through a multi-component program to improve screening and diagnostic follow-up: A retrospective cohort study

BACKGROUND

Cervical cancer is preventable by following guidelines for vaccination, screening, diagnosis and treatment of preinvasive cervical lesions. We implemented a multicomponent intervention to increase rates of colposcopy after abnormal screening results in three clinic systems in the Rio Grande Valley, along the Texas-Mexico border. The goal of this study was to assess the outcomes of this program including participation in colposcopy within 90 days of screening for women with abnormal screening results, and the time between screening and colposcopy appointments during the first year (Year 1/baseline) and subsequent years (Years 2 through 4) of program implementation.

METHODS

We performed a retrospective cohort analysis of medical records of clinics participating in the program. We utilized multiple logistic regression and linear regression to assess the colposcopic outcomes of women with indication for colposcopy.

RESULTS

A total of 1556 of the 14,846 (10.5 %) women who had undergone cervical cancer screening had abnormal results and met the criteria to be referred for colposcopy. There was a significant increase in the proportion of women who underwent colposcopy (within 90 days of screening) from Year 1/baseline (82.7 %) to Year 2 (90.6 %), OR= 1.65, p-value< 0.05. Similarly, the mean interval from screening to colposcopy decreased significantly from baseline (79 days) to Year 2 (49 days), to Years 3 and 4 (40 and 41 days, respectively), p < 0.001.

CONCLUSIONS

Our results suggest that multicomponent interventions can improve and sustain appropriate and timely colposcopy among women in medically underserved regions, improving cervical cancer prevention efforts in resource-limited settings.

Deep Learning-Enhanced Hand-Driven Microfluidic Chip for Multiplexed Nucleic Acid Detection Based on RPA/CRISPR

The early detection of high-risk human papillomavirus (HR-HPV) is crucial for the assessment and improvement of prognosis in cervical cancer. However, existing PCR-based screening methods suffer from inadequate accessibility, which dampens the enthusiasm for screening among grassroots populations, especially in resource-limited areas, and contributes to the persistently high mortality rate of cervical cancer. Here, a portable system is proposed for multiplexed nucleic acid detection, termed R-CHIP, that integrates Recombinase polymerase amplification (RPA), CRISPR detection, Hand-driven microfluidics, and an artificial Intelligence Platform. The system can go from sample pre-processing to results readout in less than an hour with simple manual operation. Optimized for sensitivity of 10-17 M for HPV-16 and 10-18 M for HPV-18, R-CHIP has an accuracy of over 95% in 300 tests on clinical samples. In addition, a smartphone microimaging system combined with the ResNet-18 deep learning model is used to improve the readout efficiency and convenience of the detection system, with initial prediction accuracies of 96.0% and 98.0% for HPV-16 and HPV-18, respectively. R-CHIP, as a user-friendly and intelligent detection platform, has great potential for community-level HR-HPV screening in resource-constrained settings, and contributes to the prevention and early diagnosis of other diseases.

Association of peripheral vestibular disorder with human papillomavirus infections

PURPOSE

Emerging research indicates that viral infections may contribute to the development of certain vestibular disorders. This study aimed to explore the association of peripheral vestibular disorders (PVDs) with human papillomavirus (HPV) using a comprehensive population-based dataset from Taiwan's Longitudinal Health Insurance Database 2010.

METHODS

We examined a cohort comprising 94,215 patients with a new diagnosis of PVDs and 471,075 propensity-score matched controls, utilizing propensity score matching. Multiple logistic regressions were carried out to evaluate the potential link between HPV infections and PVDs.

RESULTS

Results revealed a statistically significant higher prevalence of prior HPV infections in patients with PVDs (10.6%) than controls (7.7%). The adjusted odds ratio for prior HPV infections in patients with PVDs was 1.440 (95% CI = 1.407 ~ 1.474) compared to the controls. Additionally, we analyzed the association across different types of PVDs: Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis, and other peripheral vestibular disorders, with adjusted odds ratios of 1.342 (95% CI = 1.253 ~ 1.437), 1.445 (95% CI = 1.359 ~ 1.536), 1.484 (95% CI = 1.370 ~ 1.607), and 1.452 (95% CI = 1.410 ~ 1.494), respectively.

CONCLUSION

The findings of the present study suggest a noteworthy association between HPV infections and PVDs. These insights highlight the importance of further exploring the interplay between HPV and PVDs, which could potentially lead to novel preventative and therapeutic measures in public health.

Single-cell profiling reveals the intratumor heterogeneity and immunosuppressive microenvironment in cervical adenocarcinoma

Background

Cervical adenocarcinoma (ADC) is more aggressive compared to other types of cervical cancer (CC), such as squamous cell carcinoma (SCC). The tumor immune microenvironment (TIME) and tumor heterogeneity are recognized as pivotal factors in cancer progression and therapy. However, the disparities in TIME and heterogeneity between ADC and SCC are poorly understood.

Methods

We performed single-cell RNA sequencing on 11 samples of ADC tumor tissues, with other 4 SCC samples served as controls. The immunochemistry and multiplexed immunofluorescence were conducted to validate our findings.

Results

Compared to SCC, ADC exhibited unique enrichments in several sub-clusters of epithelial cells with elevated stemness and hyper-malignant features, including the Epi_10_CYSTM1 cluster. ADC displayed a highly immunosuppressive environment characterized by the enrichment of regulatory T cells (Tregs) and tumor-promoting neutrophils. The Epi_10_CYSTM1 cluster recruits Tregs via ALCAM-CD6 signaling, while Tregs reciprocally induce stemness in the Epi_10_CYSTM1 cluster through TGFβ signaling. Importantly, our study revealed that the Epi_10_CYSTM1 cluster could serve as a valuable predictor of lymph node metastasis for CC patients.

Conclusions

This study highlights the significance of ADC-specific cell clusters in establishing a highly immunosuppressive microenvironment, ultimately contributing to the heightened aggressiveness and poorer prognosis of ADC compared to SCC.

Funding

Funded by the National Natural Science Foundation of China (82002753; 82072882; 81500475) and the Natural Science Foundation of Hunan Province (2021JJ40324; 2022JJ70103).

Association of intrauterine device use and risk of abnormal cervical cytology

OBJECTIVE

To determine whether intrauterine device (IUD) use is associated with a significantly increased risk of abnormal cervical cytology.

METHODS

A retrospective cohort study was carried out at the University of Campinas, Campinas, SP, Brazil. Data came from medical records of 2,963 women from a family planning clinic who had undergone at least one cervical cytology for screening between 1990 and 2017. Women were split into three groups: users of either copper (Cu)- or the levonorgestrel 52 mg-IUD (2,305) and users of other contraceptive methods (658). The dependent variable was the cytological results as normal and abnormal, based on the Bethesda System. The most severe cytological result of each participant was considered and when all her results were normal, the last one was considered.

RESULTS

IUD use was associated with a lower risk of abnormal cervical cytology after adjusting for the number of cytology assessments per participant (RR 0.74; 95% CI 0.55;0.99; p = 0.049). Abnormal cervical cytology was more common in women with multiple cytology assessments and a longer duration since sexual debut. For each additional cytology test, the risk increased by 33.8% (p < 0.001), and for every additional year since sexual debut, the risk increased by 6.2% (p < 0.001). A lower incidence of abnormal cervical cytology was observed among women with a history of caesarean delivery, with a 24.9% reduction in risk per additional caesarean (p < 0.001). IUD users underwent more cervical cytology assessments than non-IUD users.

CONCLUSION

We identified low risk of abnormal cervical cytology among IUD users.

Association between folate level and cervical intraepithelial neoplasia risk: a systematic review and meta-analysis

There were several studies about the association between folate level and the risk of cervical intraepithelial neoplasia (CIN). This meta-analysis was conducted to evaluate whether folate deficiency is related to a high risk of CIN and cervical cancer. Odds ratios (ORs)/relative risks and 95% confidence intervals (CIs) were summarized regarding the association between folate level and risk of CIN or cervical cancer. The meta-analysis indicated that higher serum folate levels (the second, third, and fourth quartiles of serum folate) were associated with a lower risk of CIN, as demonstrated by a random-effects model (OR = 0.42, 95% CI: 0.28-0.62). Conversely, no significant association was found between erythrocyte folate levels and the risk of CIN, as indicated by a random-effects model (OR = 0.69, 95% CI: 0.43-1.12). In addition, random-effects models demonstrated that higher serum folate levels (the second, third, and fourth quartiles of serum folate) were associated with lower risks of CIN grade 1 and CIN grades 2 or 3, compared with the lowest quartile of serum folate (CIN grade 1: OR = 0.52, 95% CI: 0.29-0.93; CIN grades 2 or 3: OR = 0.33, 95% CI: 0.19-0.58). Higher serum folate levels (the second, third, and fourth quartiles of serum folate) were associated with a lower risk of cervical cancer, compared with the lowest quartile of serum folate (OR = 0.53, 95% CI: 0.36-0.79). Serum low folate levels could increase the risk of CIN and cervical cancer, while erythrocyte folate concentration was not associated with the risk of CIN.

Circulating human papillomavirus DNA sequencing as a biomarker of response in advanced cervical cancer

OBJECTIVE

Despite intense multi-modal treatment, the prognosis for advanced cervical cancer remains poor. The recent increase in cervical cancer cases worldwide highlights an urgent need for clinically validated biomarkers to guide patient management. Our pilot study investigates the utility of human papillomavirus (HPV) circulating tumor deoxy ribonucleic acid (ctDNA) in metastatic and recurrent cervical cancer. We investigated the association of HPV ctDNA levels, early kinetics, and detection of viral-host integration sites with response and outcomes.

METHODS

Serial plasma samples were prospectively collected from 21 patients with metastatic/recurrent cervical cancer. HPV ctDNA genotyping and quantification were conducted using a previously validated hybrid capture next-generation sequencing-based method. Mutation profiles within ctDNA were investigated simultaneously using a bespoke panel. In addition, high-confidence HPV integration was detected and quantified in ctDNA using SearcHPV. Differences in progression-free survival and overall survival were also evaluated between patients with high-confidence integration sites detected at baseline and those with low or no-confidence integration sites using the Kaplan-Meier method and log-rank tests to compare groups.

RESULTS

This pilot study cohort included 21 patients with HPV-associated cervical cancer. Treatments included front-line platinum-based chemotherapy without (n = 4) or with (n = 5) bevacizumab, bevacizumab monotherapy (n = 2), or subsequent therapy (n = 7). A total of 3 previously treated patients were included to study HPV kinetics during observation. At baseline, HPV ctDNA was detected in 20 of 21 patients (95.2%). From baseline to the first assessment, a change in HPV ctDNA was significantly associated with type of response in patients on treatment (n = 18) (p = .049) and across all patients (n = 21) (p = .008). A total of 26 unique mutations were detected in either plasma or tissue. Of these, 11 of 26 were only detected in plasma, 9 of 26 were only detected in tissue, and 6 of 26 were detected in plasma and tissue. Patients with a high-confidence HPV integration site detected within ctDNA at baseline have inferior overall survival compared with patients with low-confidence or undetectable integration.

CONCLUSIONS

In this pilot study, a decrease in HPV ctDNA was associated with response to treatment in metastatic and recurrent cervical cancer. HPV site integration and mutation-based ctDNA may have application to personalized therapy and should be evaluated in larger studies.

Generalizable deep neural networks for image quality classification of cervical images

Successful translation of artificial intelligence (AI) models into clinical practice, across clinical domains, is frequently hindered by the lack of image quality control. Diagnostic models are often trained on images with no denotation of image quality in the training data; this, in turn, can lead to misclassifications by these models when implemented in the clinical setting. In the case of cervical images, quality classification is a crucial task to ensure accurate detection of precancerous lesions or cancer; this is true for both gynecologic-oncologists' (manual) and diagnostic AI models' (automated) predictions. Factors that impact the quality of a cervical image include but are not limited to blur, poor focus, poor light, noise, obscured view of the cervix due to mucus and/or blood, improper position, and over- and/or under-exposure. Utilizing a multi-level image quality ground truth denoted by providers, we generated an image quality classifier following a multi-stage model selection process that investigated several key design choices on a multi-heterogenous "SEED" dataset of 40,534 images. We subsequently validated the best model on an external dataset ("EXT"), comprising 1,340 images captured using a different device and acquired in different geographies from "SEED". We assessed the relative impact of various axes of data heterogeneity, including device, geography, and ground-truth rater on model performance. Our best performing model achieved an area under the receiver operating characteristics curve (AUROC) of 0.92 (low quality, LQ vs. rest) and 0.93 (high quality, HQ vs. rest), and a minimal total %extreme misclassification (%EM) of 2.8% on the internal validation set. Our model also generalized well externally, achieving corresponding AUROCs of 0.83 and 0.82, and %EM of 3.9% when tested out-of-the-box on the external validation ("EXT") set. Additionally, our model was geography agnostic with no meaningful difference in performance across geographies, did not exhibit catastrophic forgetting upon retraining with new data, and mimicked the overall/average ground truth rater behavior well. Our work represents one of the first efforts at generating and externally validating an image quality classifier across multiple axes of data heterogeneity to aid in visual diagnosis of cervical precancer and cancer. We hope that this will motivate the accompaniment of adequate guardrails for AI-based pipelines to account for image quality and generalizability concerns.

Validation of a simplified HPV genotyping assay designed for cervical screening in low-resource settings

Human papillomavirus (HPV) genotype predicts cervical cancer risk, and genotyping could help guide the management of HPV positives as part of cervical screening. An isothermal amplification HPV extended genotyping test (ScreenFire HPV RS assay) can assay up to 96 samples/controls in 1 hour plus preparation time. A novel format with pre-aliquoted reagents and an anti-contamination component (Zebra BioDome) could simplify the HPV testing process and reduce the chances of post-amplification contamination. We validated the Zebra BioDome formulation prior to its clinical use. Residual provider-collected cervical samples (n = 450) from a population-based study in rural Nigeria were retested with ScreenFire, once using the standard assay version (liquid reagents combined onsite) and twice with Zebra BioDome. HPV results with adequate DNA (N = 427) were analyzed channel-by-channel and using the cervical cancer risk-based hierarchy of HPV type channels (HPV16, else 18/45, else 31/33/35/52/58, else 39/51/56/59/68, else high-risk HPV negative) to evaluate Zebra BioDome repeatability and accuracy against the standard version. Zebra BioDome reduced the number of pipetting steps to run the ScreenFire HPV assay. Following amplification, the BioDome material formed a sealant layer above the reaction components. Zebra BioDome had excellent repeatability and agreement with the standard version, both at the channel-specific analysis (positive percent agreement between 88.4% [HPV39/51/56/59/68] and 100% [HPV16]; negative percent agreement between 97.8% [HPV31/33/35/52/58] and 100% [HPV39/51/56/59/68]) and hierarchical analysis (overall agreement 97.2%). The assay version utilizing Zebra BioDome performed similarly to the previously validated standard version of the ScreenFire HPV assay and is now undergoing field evaluation. This solution has the potential to reduce assay preparation time and risk of contamination, providing a simpler, low-cost, near-point-of-care HPV testing and extended genotyping solution for cervical screening in lower-resource settings. The potential application of Zebra BioDome technology to other PCR assays should be considered.

IMPORTANCE

This work validates a novel pre-packed formulation for the ScreenFire human papillomavirus (HPV) assay, which has the potential to simplify the HPV testing process and to reduce the chances of post-amplification contamination, providing a simpler, low-cost, near-point-of-care HPV testing, and extended genotyping solution for cervical screening in resource-limited settings as part of the ultimate public health goal to accelerate cervical cancer prevention. This technology can also have broad applications for other DNA amplification assays beyond HPV.

An updated understanding of the natural history of cervical human papillomavirus infection-clinical implications

Recently, the International Papillomavirus Society convened a working group on cervical human papillomavirus latency, which resulted in an updated understanding of the human papillomavirus natural history. While the previous human papillomavirus natural history model considered human papillomavirus detection to be a result of human papillomavirus acquisition or possibly reinfection, and loss of human papillomavirus detection to be a result of viral clearance, the updated understanding of the human papillomavirus natural history is more nuanced. Thus, human papillomavirus detection may occur as a result of autoinoculation, deposition from a recent sex act, or as a redetection of a previously acquired infection. Similarly, loss of human papillomavirus detection likely reflects immune control rather than complete viral clearance. As it is practically impossible to identify the "true" source of a new human papillomavirus detection or determine why human papillomavirus is no longer detectable, we propose that healthcare providers and researchers use the terminology human papillomavirus detected vs human papillomavirus not detected. Moreover, we describe the updated understanding in a clinical context. Specifically, we discuss the potential implications of the updated understanding regarding clinical counseling in screening, recommendations on cervical screening, and human papillomavirus vaccination. We also suggest key phrases that healthcare providers may use when counseling women attending routine human papillomavirus-based cervical screening.

Cer-ConvN3Unet: an end-to-end multi-parametric MRI-based pipeline for automated detection and segmentation of cervical cancer

BACKGROUND

We established and validated an innovative two-phase pipeline for automated detection and segmentation on multi-parametric cervical cancer magnetic resonance imaging (MRI) and investigated the clinical efficacy.

METHODS

The retrospective multicenter study included 125 cervical cancer patients enrolled in two hospitals for 14,547 two-dimensional images. All the patients underwent pelvic MRI examinations consisting of diffusion-weighted imaging (DWI), T2-weighted imaging (T2WI), and contrast-enhanced T1-weighted imaging (CE-T1WI). The deep learning framework involved a multiparametric detection module utilizing ConvNeXt blocks and a subsequent segmentation module utilizing 3-channel DoubleU-Nets. The pipeline was trained and tested (80:20 ratio) on 3,077 DWI, 2,990 T2WI, and 8,480 CE-T1WI slices.

RESULTS

In terms of reference standards from gynecologic radiologists, the first automated detection module achieved overall results of 93% accuracy (95% confidence interval 92-94%), 93% precision (92-94%), 93% recall (92-94%), 0.90 κ (0.89-0.91), and 0.93 F1-score (0.92-0.94). The second-stage segmentation exhibited Dice similarity coefficients and Jaccard values of 83% (81-85%) and 71% (69-74%) for DWI, 79% (75-82%), and 65% (61-69%) for T2WI, 74% (71-76%) and 59% (56-62%) for CE-T1WI.

CONCLUSION

Independent experiments demonstrated that the pipeline could get high recognition and segmentation accuracy without human intervention, thus effectively reducing the delineation burden for radiologists and gynecologists.

RELEVANCE STATEMENT

The proposed pipeline is potentially an alternative tool in imaging reading and processing cervical cancer. Meanwhile, this can serve as the basis for subsequent work related to tumor lesions. The pipeline contributes to saving the working time of radiologists and gynecologists.

KEY POINTS

An AI-assisted multiparametric MRI-based pipeline can effectively support radiologists in cervical cancer evaluation. The proposed pipeline shows high recognition and segmentation performance without manual intervention. The proposed pipeline may become a promising auxiliary tool in gynecological imaging.

Advances in human papillomavirus detection for cervical cancer screening and diagnosis: challenges of conventional methods and opportunities for emergent tools

Human papillomavirus (HPV) infection is the main cause of cervical cancer and other cancers such as anogenital and oropharyngeal cancers. The prevention screening and treatment of cervical cancer has remained one of the top priorities of the World Health Organization (WHO). In 2020, the WHO came up with the 90-70-90 strategy aimed at eliminating cervical cancers as a public health problem by the year 2030. One of the key priorities of this strategy is the recommendation for countries to ensure that 70% of their women are screened using a high-performance test by the age of 35, and again by the age of 45. Over the years, several traditional methods (notably, Pap smear and nucleic acid-based techniques) have been used for the detection of cervical cancer. While these methods have significantly reduced the incidence of cervical cancer and death, they still come short of excellence for the total eradication of HPV infection. The challenges include low sensitivity, low specificity, poor reproducibility, the need for high-level specialists, and the high cost of access to the facilities, to mention a few. Interestingly, however, several efforts are being made today to mitigate these challenges. In this review, we discussed the pros and cons of the traditional screening and testing of HPV infections, the efforts being made to improve their performances, and the emergent tools (especially, the electrochemical methods) that promise to revolutionize the screening and testing of HPV infections. The main aim of the review is to provide some novel clues to researchers that would allow for the development of high-performance, affordable, and triage-suitable electrochemical-based diagnostic tools for HPV and cervical cancer.

Preparation and evaluation of IgY against human papillomavirus

Human papillomavirus (HPV) infection is a major global health challenge and is closely related to the occurrence of diseases such as cervical cancer. Unfortunately, effective treatments are still lacking. In view of the advantages of antibody drugs, antibody-targeted therapy may become one of the means of treatment and prevention of HPV infection. This study explores the potential of antibody-targeted therapy using immunization with HPV nine-valent vaccine in Leghorn chickens. The resulting egg yolk antibodies (IgY) was extracted from eggs using the bitter-ammonium sulfate method and confirmed through SDS-PAGE analysis. The neutralizing titer was performed by pseudovirus-neutralizing antibody experiments, which could reach 1:2000 (18.2 μg/mL). This successful preparation of IgY against HPV 6/11/16/18/31/33/45/52/58-L1 protein showed its potential as a therapeutic agent, particularly post-HPV16 infection. This work lays the groundwork for HPV-specific IgY preparation and contributes to advancing targeted therapies for cervical cancer, prompting further research in HPV-related therapeutic approaches.

MCM10: A potential biomarker for cervical cancer and precancerous lesions

Cervical cancer remains a significant health burden worldwide, emphasizing the need for early detection and intervention. DNA replication is perturbed in cancer cells, and the minichromosome maintenance protein 10 plays an important role in origin firing. By analyzing the MCM10 mRNA expression in healthy controls, precancerous lesions, and cervical cancer using qRT-PCR, we can infer if it can be considered a biomarker. We collected cervical smear samples from patients and performed MCM10 expression analysis to set up thresholds for risk stratification. We also investigated the HPV status among the patient samples with precancerous lesions and cervical cancer and found 70 % of them to be positive. Our results demonstrated a significant upregulation of MCM10 mRNA expression in tumor samples (n = 40, 7.83 ± 1.2) and precancerous lesions (n = 54, 5.69 ± 1.4) compared to normal (n = 50, 4.27 ± 0.80) with a R2 value of 0.59, confirming its role in the progression and development of cervical cancer. In conclusion, this study emphasizes the potential role of MCM10 as a biomarker. Our study would improve early detection rates, and we propose MCM10-based community screening for risk stratification, prevention, and prognosis.

HPV 16/18 E7 oncoprotein detection as a promising triage strategy for HPV 16/18-positive patients: A prospective multicenter study with a 2-year follow up

OBJECTIVE

To explore the effectiveness of HPV 16/18 E7 oncoprotein in detecting high-grade cervical intraepithelial neoplasia (CIN) and predicting disease outcomes in HPV 16/18-positive patients.

METHODS

The present study was a cross-sectional study with a 2-year follow up. We collected 915 cervical exfoliated cell samples from patients who tested positive for HPV 16/18 in gynecologic clinics of three tertiary hospitals in Beijing from March 2021 to October 2022 for HPV 16/18 E7 oncoprotein testing. Subsequently, 2-year follow up of 408 patients with baseline histologic CIN1 or below were used to investigate the predictive role of HPV 16/18 E7 oncoprotein in determining HPV persistent infection and disease progression.

RESULTS

The positivity rate of the HPV 16/18 E7 oncoprotein assay was 42.06% (249/592) in the inflammation/CIN 1 group and 85.45% (277/324) in the CIN2+ group. For CIN2+ detection, using the HPV 16/18 E7 oncoprotein assay combined with HPV 16/18 testing, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.45%, 57.94%, 52.57%, and 87.95%, respectively. During the 2-year follow up, the sensitivity, specificity, PPV, and NPV for predicting persistent HPV infection were 48.44%, 58.21%, 34.64%, and 71.18% in the baseline inflammation and CIN1 group.

CONCLUSIONS

As a triage method for high-grade CIN screening in HPV 16/18-positive patients, HPV 16/18 E7 oncoprotein demonstrated a relatively high NPV, making it suitable for clinical use in triaging HPV 16/18-positive cases and potentially reducing the colposcopic referral rate. HPV 16/18 E7 oncoprotein exhibited a preferably predictive value in determining HPV infection outcomes and disease progression.

High rate of persistent HPV detection after diagnostic cervical excision in older screen-positive women

INTRODUCTION

Diagnostic work-up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post-treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test.

MATERIAL AND METHODS

We conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow-up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval-censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age.

RESULTS

A total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow-up. Median age was 67.4 years, and median follow-up time was 2.9 years. At the end of follow-up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92-3.10). Women aged 65-84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28-0.87).

CONCLUSIONS

In older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high-grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown.

SOX21-AS1 Augmented Cervical Cancer Growth by Triggering FZD3 to Activate the Wnt/β-Catenin Signaling Pathway

Long non-coding RNA (LncRNA) SOX21-AS1 has been reported that it plays an important role in biological processes of several cancers. However, how it functions in cervical cancer (CC) still remain unclear. This investigation seeks to explore the impact of SOX21-AS1 on CC cell proliferation, invasion and migration and its association to the FZD3 and the Wnt/β-catenin signaling pathway. SOX21-AS1 expression levels were detected using real-time quantitative PCR in 20 cases of cervical cancer together with its adjacent tissues and several cervical cancer cell lines. Transgenic technology and functional experiments were conducted to confirm the carcinogenic properties of SOX21-AS1, and western blot was utilized to analyze the regulatory network composed of SOX21-AS1, FZD3 and the Wnt/β-catenin signaling pathway in CC. Through bioinformatics analysis, we found that the expression of SOX21-AS1 in CC was the highest among 16 kinds of tumor tissues. Moreover, clinical specimens confirmed that both CC tissues and cell lines possessed elevated SOX21-AS1 expressions (P < 0.01). CC cells which stably expressed upregulated SOX21-AS1 were noted to possesses higher rates of metastasis, invasion and proliferation, lower apoptotic rates and higher expression of FZD3,β-catenin and c-myc (P < 0.01). Conversely, the use of small interfering RNA to inhibit the expression of SOX21-AS1 yielded the opposite results (P < 0.01). SOX21-AS1 functions as an oncogenic LncRNA which enhances CC cell metastasis, invasion and proliferation through FZD3 upregulation via Wnt/β-catenin-signaling pathway activation. This LncRNA may represent an important biomarker for CC patients.

Risk of residual/recurrent cervical diseases in HPV-positive women post-conization depends on HPV integration status

BACKGROUND

It is crucial to identify post-operative patients with HPV infection who are at high risk for residual/recurrent disease. This study aimed to evaluate the association between HPV integration and clinical outcomes in HPV-positive women after cervical conization, as well as to identify HPV integration breakpoints.

METHODS

This retrospective study analyzed data of 791 women who underwent cervical conization for cervical intraepithelial neoplasia grades 2-3 (CIN2-3) between September 2019 and September 2023, sourced from the Fujian and Hubei cervical lesion screening cohorts. Among these, 73 women with HPV infection post-conization underwent HPV integration test within 3 months after a positive HPV test. HPV integration test was performed using the high-throughput viral integration detection (HIVID), a sensitive method for genome-wide survey of HPV integration breakpoints.

RESULTS

Among the 73 participants with HPV infection post-conization, 10 cases (13.7%) were positive for HPV integration. The logistic regression analysis showed a higher residual/recurrent lesions risk in patients with HPV integration (OR = 3.917, p = 0.048). According to the Kaplan-Meier analysis, age ≥ 45 years (p = 0.016) and HPV integration (p = 0.035) were associated with a higher risk of residual/recurrent CIN at the 1-year follow-up. HPV 52 accounted for the majority of HPV integration genotype (3/10, 30.0%). Surprisingly, HPV 16 had the highest number of HPV average integration sequencing reads (n = 129), followed by HPV 31, 58, 52, 59, 35, and 39. The study also identified 13 HPV breakpoints, including TP63, TLR4, USP10, etc. CONCLUSIONS: HPV integration was identified as an independent risk factor for residual/recurrent CIN in HPV-positive women post-conization. Women with positive HPV integration should pay attention to careful post-treatment follow-up.

Human Papillomavirus Infection and Cytological Atypia in Female Allogeneic Hematopoietic Stem Cell Transplantation Recipients

BACKGROUND

Female recipients of allogeneic hematopoietic stem cell transplantation are at high risk of developing human papillomavirus (HPV)-associated lesions and (pre)cancer. We describe the results of a cervical cancer screening program in these women.

METHODS

From 2010 to 2022, 70 female recipients of allogeneic hematopoietic stem cell transplantation in our institution entered a standardized protocol of gynecological evaluation. HPV testing, Papanicolaou smear, and thorough gynecological examinations were conducted in all the women.

RESULTS

The cumulative prevalence of HPV infection was 21.4% (15/70). Ten of 70 women (14.3%) had a positive HPV test result in the first gynecological evaluation and 5 additional women (7.1%) became positive during follow-up. Thirteen women (18.5%) presented cytohistological lesions (3 high-grade lesions and 10 low-grade lesions). Twenty-nine women (41.4%) showed HPV-negative reactive atypical abnormalities related to the conditioning treatment, which closely mimicked HPV-associated lesions, which spontaneously disappeared during follow-up.

CONCLUSIONS

Gynecological evaluation should be maintained over time, as a significant proportion of these women may become HPV positive during follow-up. Reactive benign, atypical changes related to the treatment, which closely mimic HPV-associated lesions, are a frequent finding in these women. HPV testing is a key tool for the evaluation of these patients, as it allows for identifying women at risk and excluding cytological mimickers.

Associations of lifestyle factors with oral cancer risk: An umbrella review

BACKGROUND

Oral cancer is a common head and neck cancer malignancy that seriously affects patients' quality of life and increases the health care burden. Moreover, there is a lack of comprehensive reviews of previous research on factors associated with oral cancer. The aim of the current umbrella review was to provide a comprehensive and systematic summary of relevant studies, to grade the quality of evidence of relevant studies, and to provide guidance for the prevention of oral cancer.

METHODS

The PubMed, Web of Science, Medline, Cochrane Library, Embase and CNKI databases were searched for relevant meta-analyses and systematic reviews. Two authors extracted the data separately and assessed the quality of the studies using the AMSTAR-2(A Measurement Tool to Assess Systematic Reviews-2) scale.

RESULTS

A total of 28 meta-analyses were included in this review:13 meta-analyses of dietary factors and 8 meta-analyses of behavioural habits and 7 meta-analyses of factors that were difficult to categorise as dietary and behavioural. Alcohol, tobacco (chewing tobacco/secondhand smoke exposure), betel quid , processed meat, periodontal disease, HPV (especially HPV16 and HR-HPV) infection, and chronic mechanical irritation were positively correlated with the risk of oral cancer. Vitamin C-rich citrus fruits were negatively associated with the risk of oral cancer . Fish, milk and dairy products except butter, coffee and tea intake may be negatively associated with the risk of oral cancer, but subgroup analyses of studies of fish and milk revealed significant effects only for European populations. Additionally, green tea showed the strongest protective effect among teas. High and moderate coffee intake was negatively associated with the risk of oral cancer. Oral hygiene maintenance was also negatively associated with the risk of oral cancer.

CONCLUSION

Reducing or eliminating alcohol consumption, refraining from direct or indirect exposure to tobacco products, and reducing betel quid chewing may lead to a reduced risk of oral cancer. Reducing the intake of processed meat, moderate intake of coffee, the consumption of green tea of appropriate temperature and strength, fish and citrus fruit intake, and oral hygiene, preventing periodontal diseases and HPV infections, and reducing mechanical stimulation of the oral mucosa caused by various reasons can exert protective effects against oral cancer.

Endocervical adenocarcinomas and HPV genotyping in an HIV endemic milieu - a retrospective study

BACKGROUND

Cervical cancer is the most prevalent cancer in Mozambique, with endocervical adenocarcinoma accounting for approximately 5.5% of cases. Knowledge regarding the most prevalent HPV genotypes in endocervical adenocarcinoma is limited, within this setting. This study aimed to investigate human papillomavirus (HPV) prevalence and genotypes within a cohort of endocervical adenocarcinoma patients in the context of Mozambique's recently introduced vaccination programme, considering the country's HIV-endemic setting.

METHODS

Forty consecutive cases of endocervical adenocarcinoma diagnosed at Maputo Central Hospital between 2017 and 2018, with limited clinical data available, were included. Human immunodeficiency virus (HIV) status was determined through serological data or in situ hybridisation on histopathological slides. HPV detection was performed using a multi-methodological approach, including Anyplex II, in-house polymerase chain reaction (PCR), and chromogenic and fluorescent in situ hybridisation techniques.

RESULTS

All 40 cases exhibited HPV-dependent morphology. Fourteen of the 40 patients were HIV-positive. No significant differences were observed between the two groups regarding age, stage, or histopathological type. hrHPV16, 18, or 45 were detected in all cases. Notably, multiple hrHPV infections were identified exclusively in HIV-negative cases (10/26, p = 0.0075), with hrHPV18/45 co-infection being the most common (n = 8).

CONCLUSIONS

These findings suggest that the newly implemented quadrivalent vaccination programme has the potential to prevent morbidity and mortality from endocervical adenocarcinoma, irrespective of HIV infection status, in Mozambique's HIV-endemic environment.

PAX1/SOX1 DNA Methylation Versus Cytology and HPV16/18 Genotyping for the Triage of High-Risk HPV-Positive Women in Cervical Cancer Screening: Retrospective Analysis of Archival Samples

OBJECTIVE

To compare the performance of cytology, HPV16/18 genotyping and PAX1/SOX1 methylation for the triage of high-risk HPV-positive cervical samples.

DESIGN

Retrospective analyses of archival samples collected from a large-scale prospective randomised controlled trial.

SETTING/SAMPLE

HPV-positive women recruited from the general cervical screening population.

METHODS

403 HPV-positive samples including 113 normal, 173 low-grade cervical intraepithelial neoplasia (LG-CIN), 114 HG-CIN and three cervical cancers. All samples were assessed by liquid-based cytology, HPV genotyping and PAX1/SOX1 methylation.

MAIN OUTCOME MEASURES

AUC (area under the curve), sensitivity and specificity for cytology, HPV16/18 genotyping and PAX1/SOX1 methylation for high-grade (HG) premalignant cervical lesions.

RESULTS

PAX1 was more sensitive than cytology and HPV16/18 genotyping in detecting a HG lesion (CIN2+). The sensitivity for PAX1, SOX1, cytology and HPV16/18 were 73.5% (95% CI: 65.5-81.5), 41.9% (95% CI: 32.9-50.8), 48.7% (95% CI: 39.7-57.8) and 36.8% (95% CI: 28.0-45.5), respectively, and their respective specificities were 70.3% (95% CI: 65.0-75.6), 83.6% (95% CI: 79.3-87.9), 77.6% (95% CI: 72.8-82.5) and 67.1% (95% CI: 61.7-72.6), respectively. Overall, PAX1 gave the best AUC at 0.72. Adding SOX1 to PAX1 did not improve the AUC (0.68). Three hundred and twenty-two women who did not have a HG lesion at baseline were followed up for two rounds of screening. Fewer women developed a HG lesion with a normal baseline PAX1 compared to women with a normal baseline cytology or negative HPV16/18 (8.4% vs. 14.5% and 17.5%, respectively).

CONCLUSION

PAX1 triage for referral to colposcopy in HPV-positive women may be superior to cytology and HPV16/18 genotyping.

Programmable Multiplexed Nucleic Acid Detection by Harnessing Specificity Defect of CRISPR-Cas12a

CRISPR-Cas12a works like a sophisticated algorithm in nucleic acid detection, yet its challenge lies in sometimes failing to distinguish targets with mismatches due to its specificity limitations. Here, the mismatch profiles, including the quantity, location, and type of mismatches in the CRISPR-Cas12a reaction, are investigated and its various tolerances to mismatches are discovered. By harnessing the specificity defect of the CRISPR-Cas12a enzyme, a dual-mode detection strategy is designed, which includes approximate matching and precise querying of target sequences and develop a programmable multiplexed nucleic acid assay. With the assay, 14 high-risk human papillomavirus (HPV) subtypes are simultaneously detected, collectively responsible for 99% of cervical cancer cases, with attomolar sensitivity. Specifically, the assay not only distinguishes HPV16 and HPV18, the two most common subtypes but also detects 12 other high-risk pooled HPV subtypes. To enable low-cost point-of-care testing, the assay is incorporated into a paper-based microfluidic chip. Furthermore, the clinical performance of the paper-based microfluidic chip is validated by testing 75 clinical swab samples, achieving performance comparable to that of PCR. This programmable multiplexed nucleic acid assay has the potential to be widely applied for sensitive, specific, and simultaneous detection of different pathogens.

MicroRNAs and human viral diseases: A focus on the role of microRNA-29

The viral replication can impress through cellular miRNAs. Indeed, either the antiviral responses or the viral infection changes through cellular miRNAs resulting in affecting many regulatory signaling pathways. One of the microRNA families that is effective in human cancers, diseases, and viral infections is the miR-29 family. Members of miR-29 family are effective in different viral infections as their roles have appeared in regulation of immunity pathways either in innate immunity including interferon and inflammatory pathways or in adaptive immunity including activation of T-cells and antibodies production. Although miR-29a affects viral replication by suppressing antiviral responses, it can inhibit the expression of viral mRNAs via binding to their 3'UTR. In the present work, we discuss the evidence related to miR-29a and viral infection through host immunity regulation. We also review roles of other miR-29 family members by focusing on their role as biomarkers for diagnosing and targets for viral diseases management.

Awareness regarding human papillomavirus and willingness for vaccination among college students with or without medical background in Guizhou Province

This cross-sectional epidemiological study aimed to investigate awareness regarding human papillomavirus (HPV) and willingness for vaccination among college students with or without medical background in Guizhou Province, China. A logistic regression model was used for univariate and multivariate analyses of cognition to determine factors influencing willingness for vaccination. In total, 2,540 questionnaires were collected, of which 2,360 were valid. The medical and nonmedical groups included 737 (31.2%) and 1,623 (68.8%) individuals, respectively. The medical group had heard of HPV and its vaccines more frequently than the nonmedical group, with the former also having greater awareness than the latter (P < .001). Females (1,325, 56.1%) had heard of HPV and its vaccines more frequently than males (1,035, 43.9%), with the former also having greater awareness than the latter. The cost, safety, and efficacy of the HPV vaccine and lack of knowledge regarding HPV and its vaccines were the main barriers for vaccination. The overall level of knowledge regarding HPV and its vaccines was lower in the nonmedical group and males than in the medical group and females. To help promote willingness for vaccination among the nonmedical group and males, strategies that deepen their knowledge regarding the HPV vaccine are needed.

Viral Oncogenesis: Synergistic Role of Genome Integration and Persistence

Persistence is a strategy used by many viruses to evade eradication by the immune system, ensuring their permanence and transmission within the host and optimizing viral fitness. During persistence, viruses can trigger various phenomena, including target organ damage, mainly due to an inflammatory state induced by infection, as well as cell proliferation and/or immortalization. In addition to immune evasion and chronic inflammation, factors contributing to viral persistence include low-level viral replication, the accumulation of viral mutants, and, most importantly, maintenance of the viral genome and reliance on viral oncoprotein production. This review focuses on the process of genome integration, which may occur at different stages of infection (e.g., HBV), during the chronic phase of infection (e.g., HPV, EBV), or as an essential part of the viral life cycle, as seen in retroviruses (HIV, HTLV-1). It also explores the close relationship between integration, persistence, and oncogenesis. Several models have been proposed to describe the genome integration process, including non-homologous recombination, looping, and microhomology models. Integration can occur either randomly or at specific genomic sites, often leading to genome destabilization. In some cases, integration results in the loss of genomic regions or impairs the regulation of oncogene and/or oncosuppressor expression, contributing to tumor development.

Entropy-Driven Molecular Beacon Assisted Special RCA Assay with Enhanced Sensitivity for Room Temperature DNA Biosensing

The Phi29 DNA polymerase is renowned for its processivity in synthesizing single-stranded DNA amplicons by rolling around a circularized DNA template. However, DNA synthesis rolling circle amplification (RCA) is significantly hindered by the secondary structure in the circular template. To overcome this limitation, an engineered circular template without secondary structure could be utilized to improve the sensitivity of RCA-based assays without increasing its complexity. We herein proposed an entropy-driven special RCA technology for the detection of HPV16 E7 gene at room temperature. The strategy is composed of a molecular beacon containing a loop region for nucleic acid target recognition and a stem region to initiate RCA. With the target analyte, the stem region of the molecular beacon will be exposed and then hybridized with a special circular template to initiate the DNA amplification. We tested different designs of the molecular beacon sequence and optimized the assay's working conditions. The assay achieved a sensitivity of 1 pM in 40 min at room temperature. The sensitivity of this assay, at 1 pm, is about a hundred-fold greater than that of conventional linear RCA performed in solution. Our proposed sensor can be easily reprogrammed for detecting various nucleic acid markers by altering the molecular beacon's loop. Its simplicity, rapid assay time, and low cost make it superior to RCA sensors that utilize similar strategies.

Prevalence and genotypic distribution of high-risk human papillomavirus (HPV) among ever-married women in coastal regions of Bangladesh

BACKGROUND

Understanding the distribution of type specific human papillomavirus (HPV) genotypes in screen-detected lesions is crucial to differentiate women who are at a higher risk of developing cervical cancer. This study aimed to find out high-risk HPV genotype distribution among women of the coastal districts of Bangladesh.

METHODS

This cross-sectional study conducted from January 2023 to December 2023 aimed to investigate the prevalence and distribution patterns of high-risk HPV genotypes among ever-married women aged 30-60 years residing in three coastal districts of Bangladesh. Sampling was purposive, with 300 participants per district. Exclusion criteria included prior cervical precancer or cancer treatment, hysterectomy, cervical amputation, and pregnancy. HPV DNA specimens were collected and tested using Cobas 4800. Positive cases underwent further genotype analysis with GenoFlowTM HPV Array Test Kit. Statistical analysis utilized SPSS version 25.0, employing Chi-square and Fisher's Exact tests.

RESULTS

Among 900 participants HR-HPV prevalence was 2.56%. HPV 16 was the most prevalent genotype (38.46%), followed by HPV 66 and HPV 68 (11.54% each). Single infections of HPV 16 predominated (39.13%), while for co-infections HPV 66 and HPV 68 were most common (13.04%). HR-HPV positivity increased with age, peaking at 5.5% in the 55-60 years' age group. Participants education level, occupation, income, and reproductive history showed no significant association with HPV positivity. District-wise prevalence varied insignificantly, with Jhalokathi exhibiting the highest (3.0%), followed by Cox's Bazar (2.7%), and Bagerhat (2.0%). HPV 16 was the predominant genotype across districts, with Cox's Bazar and Jhalokathi demonstrating greater genotype diversity than Bagerhat.

CONCLUSION

The study concludes that among ever-married women in the coastal districts of Bangladesh, there is a low prevalence of high-risk HPV. The predominant high-risk HPV genotypes identified were HPV 16, followed by HPV 66 and 68. These findings hold significant implications for policy makers, providing guidance for targeted screening strategies and vaccination programs.

Assessing the risk of high-grade squamous intraepithelial lesions (HSIL+) in women with LSIL biopsies: a machine learning-based study

OBJECTIVE

This study aims to analyze factors associated with the missed diagnosis of high-grade squamous intraepithelial lesions (HSIL+) in patients initially diagnosed with low-grade squamous intraepithelial lesions (LSIL) through colposcopic biopsy and to develop a predictive model for assessing the risk of missed HSIL+.

METHODS

We conducted a retrospective analysis of 505 patients who underwent loop electrical excision procedure (LEEP) following an LSIL diagnosis by colposcopic biopsy. Logistic regression was used to identify demographic and pathological parameters associated with missed diagnoses of HSIL+. Additionally, several machine learning methods were employed to construct and assess the performance of the risk prediction models.

RESULTS

The overall rate of missed diagnoses for HSIL+ was 15.2%. Independent risk factors identified were HPV16/18 infection (OR 2.071; 95% CI 1.039-4.127; p = 0.039), TCT ≥ ASC-H (OR 4.147; 95% CI 1.392-12.355; p = 0.011), TZ3 (OR 1.966; 95% CI 1.003-3.853; p = 0.049) and Colposcopic impression G2 (OR 3.627; 95% CI 1.350-9.743; p = 0.011). Among the models tested, the Decision Tree algorithm demonstrated superior performance with an accuracy of 94.7%, sensitivity of 80.0%, specificity of 96.9%, and an area under the curve (AUC) of 0.936 in the validation set.

CONCLUSION

Key independent risk factors for the missed diagnosis of HSIL  in patients with LSIL include HPV16/18 infection, TCT ≥ ASC-H, TZ3, and colposcopic impression G2. The Decision Tree model offers a cost-effective, reliable, and clinically valuable tool for accurately predicting the risk of missed diagnosis of HSIL+, facilitating early intervention and management.

The HPV101 E7 protein shares host cellular targets and biological activities with high-risk HPV16 E7

Human papillomaviruses (HPVs) are a diverse family of viruses with over 450 members that have been identified and fully sequenced. They are classified into five phylogenetic genera: alpha, beta, gamma, mu, and nu. The high-risk alpha HPVs, such as HPV16, have been studied the most extensively due to their medical significance as cancer-causing agents. However, while nearly 70% of all HPVs are members of the gamma genus, they are almost entirely unstudied. This is because gamma HPVs have been considered medically irrelevant commensals as most of them infect the skin and are not known to cause significant clinical lesions in immunocompetent individuals. Members of the gamma 6 HPVs, however, have been detected in the anogenital tract mucosa and HPV101 has been isolated from a premalignant cervical lesion. Moreover, gamma 6 HPVs have a unique genome structure. They lack E6 proteins but in place of E6, they encode unique, small hydrophobic proteins without any close viral or cellular homologs that have been termed E10. Here, we report that HPV101 E7 shares biochemical activities with the high-risk alpha HPV16 E7, including the ability to target the pRB and PTPN14 tumor suppressors for degradation. This study underscores the importance of further characterizing HPV101 and other unstudied HPV species.

The role of transforming growth factor β in cervical carcinogenesis

Human papillomavirus (HPV) is involved in virtually all cases of cervical cancer. However, HPV alone is not sufficient to cause malignant development. The effects of chronic inflammation and the interaction of immune components with the microenvironment infected with the high-risk HPV type (HR) may contribute to cancer development. Transforming growth factor β (TGFB) appears to play an important role in cervical carcinogenesis. Protein and mRNA levels of this cytokine gradually increase as normal tissue develops into malignant tissue and are closely related to the severity of HPV infection. At the onset of infection, TGFB can inhibit the proliferation of infected cells and viral amplification by inhibiting cell growth and downregulating the transcriptional activity of the long control region (LCR) of HPV, thereby reducing the expression of early genes. When infected cells progress to a malignant phenotype, the response to the cell growth inhibitory effect of TGFB1 is lost and the suppression of E6 and E7 expression decreases. Subsequently, TGFB1 expression is upregulated by high levels of E6 and E7 oncoproteins, leading to an increase in TGFB1 in the tumor microenvironment, where this molecule promotes epithelial-to-mesenchymal transition (EMT), cell motility, angiogenesis, and immunosuppression. This interaction between HPV oncoproteins and TGFB1 is an important mechanism promoting the development and progression of cervical cancer.

Meeting report: Considerations for trial design and endpoints in licensing therapeutic HPV16/18 vaccines to prevent cervical cancer

Cervical cancer is a major cause of morbidity and mortality globally with a disproportionate impact on women in low- and middle-income countries. In 2021, the World Health Organization (WHO) called for increased vaccination, screening, and treatment to eliminate cervical cancer. However, even with widespread rollout of human papillomavirus (HPV) prophylactic vaccines, millions of women who previously acquired HPV infections will remain at risk for progression to cancer for decades to come. The development and licensing of an affordable, accessible therapeutic HPV vaccine, designed to clear or control carcinogenic HPV and/or to induce regression precancer could significantly contribute to the elimination efforts, particularly benefiting those who missed out on the prophylactic vaccine. One barrier to development of such vaccines is clarity around the regulatory pathway for licensure. In Washington, D.C. on September 12-13, 2023, a meeting was convened to provide input and guidance on trial design with associated ethical and regulatory considerations. This report summarizes the discussion and conclusions from the meeting. Expert presentation topics included the current state of research, potential regulatory challenges, WHO preferred product characteristics, modeling results of impact of vaccine implementation, epidemiology and natural history of HPV infection, immune responses related to viral clearance and/or precancer regression including potential biomarkers, and ethical considerations. Panel discussions were held to explore specific trial design recommendations to support the licensure process for two vaccine indications: (1) treatment of prevalent HPV infection or (2) treatment of cervical precancers. Discussion covered inclusion/exclusion criteria, study endpoints, sample size and power, safety, study length, and additional data needed, which are reported here. Further research of HPV natural history is needed to address identified gaps in regulatory guidance, especially for therapeutic vaccines intended to treat existing HPV infections.

What are the essential determinants of human papillomavirus carcinogenesis?

Human papillomavirus (HPV) infection is the leading viral cause of cancer. Over the past several decades, research on HPVs has provided remarkable insight into human cell biology and into the pathology of viral and non-viral cancers. The HPV E6 and E7 proteins engage host cellular proteins to establish an environment in infected cells that is conducive to virus replication. They rewire host cell signaling pathways to promote proliferation, inhibit differentiation, and limit cell death. The activity of the "high-risk" HPV E6 and E7 proteins is so potent that their dysregulated expression is sufficient to drive the initiation and maintenance of HPV-associated cancers. Consequently, intensive research efforts have aimed to identify the host cell targets of E6 and E7, in part with the idea that some or all of the virus-host interactions would be essential cancer drivers. These efforts have identified a large number of potential binding partners of each oncoprotein. However, over the same time period, parallel research has revealed that a relatively small number of genetic mutations drive carcinogenesis in most non-viral cancers. We therefore propose that a high-priority goal is to identify which of the many targets of E6 and E7 are critical drivers of HPV carcinogenesis. By identifying the cancer-driving targets of E6 and E7, it should be possible to better understand the distinct roles of other targets, perhaps in the viral life cycle, and to focus efforts to develop anti-cancer therapies on the subset of virus-host interactions for which therapeutic intervention would have the greatest impact.

ZNF281 Facilitates the Invasion of Cervical Cancer Cell Both In Vivo and In Vitro †

Background: Cervical cancer is the fourth most common cancer among women worldwide. The zinc finger transcription factor 281 (ZNF281)/ZBP-99 protein specifically binds to GC-rich DNA sequences and regulates gene expression, and it has been shown to promote tumor progression. In this study, we aim to investigate the function and molecular mechanism of ZNF281 in uterine cervical carcinoma. Methods: We conducted immunohistochemistry and Western blot assays to determine the expression of ZNF281 in eight human cervical cancer tissues. And, xenograft experiments involving the injection of HeLa cells into nude mice was used to determine the function of ZNF281 on proliferation. Transwell assays were used to detect the migration and invasion of HeLa cells after indicated that ZNF281 overexpression. Results: Our results indicated that ZNF281 protein levels were higher in cervical cancer tissues compared to normal cervical tissues. Additionally, ZNF281 was expressed in human cervical carcinoma cell lines, including HeLa, SiHa, C-33 A, CaSki, and HT-3, and is localized in both the cell nucleus and cytoplasm. ZNF281 overexpression did not influence HeLa cell proliferation or tumor size in situ. Moreover, nude mice injected with ZNF281-overexpressing cell lines developed more tumor lesions in the lungs compared to those injected with control cell lines. Conclusions: These findings suggest that ZNF281 is associated with tumor metastasis without affecting cell proliferation, both in vivo and in vitro.

A Narrative Review of the Putative Etiologic Role and Diagnostic Utility of the Cervicovaginal Microbiome in Human Papillomavirus-Associated Cervical Carcinogenesis

The cervicovaginal microbiome (CVM) may contribute to human papillomavirus (HPV)-associated cervical carcinogenesis. We summarized the literature on the CVM in cervical carcinogenesis by searching Medline, Web of Science, and Embase for articles that sequenced the CVM using metagenomics. Additionally, we identified studies assessing the diagnostic role of the CVM in cervical carcinogenesis by searching PubMed. We performed an environmental scan of Google and Google Scholar to review common CVM characterization techniques. Twenty-eight records presented or summarized associations between the CVM and HPV acquisition, prevalence, persistence, clearance, and cervical lesions or cancer, while three studies identified bacterial taxa detecting high-risk HPV prevalence or cervical lesions. The area under the curve ranged from 0.802 to 0.952. 16S ribosomal RNA gene sequencing and whole metagenome sequencing have sufficient resolution to study the CVM bacteriome. Bacterial communities may have important implications in cervical cancer; however, there is a need for methodological standardization for CVM characterization.

Optimization of HPV-positive women triage with p16/Ki67 dual staining cytology in an organized cervical cancer screening program in the center region of Portugal

BACKGROUND

Organized cervical cancer (CxCa) screening is the most effective secondary prevention method to decrease the disease incidence and mortality. Screening for infection with 14 high-risk HPV genotypes (hrHPV) is recommended as primary screening test. Since only ca. 6 % of HPV-positive (HPV+) women will develop a high-grade lesion in 5 years, triage is critical for risk stratification and management of colposcopy resources. Dual staining (DS) p16/Ki67 cytology is an alternative to Papanicolau cytology (PAP) for triage of HPV+women, with potential improvements in sensitivity and specificity, and optimization of colposcopy referrals.

OBJECTIVES

To compare PAP vs DS cytology in terms of (i) optimization of referrals for colposcopy and (ii) risk stratification to better define the follow-up interval.

STUDY DESIGN

Retrospective analysis of the CxCa screening database of Centro Hospitalar Universitário de Coimbra (CHUC), one of the centralized diagnostic laboratories for the CxCa screening program of the central region of Portugal, between July 2019 and May 2023. At CHUC, since July 2019, all samples from hrHPV+women have been triaged with liquid PAP and tested with DS cytology.

RESULTS

At baseline (1032 HPV+women), 1028 women were tested with DS: 739 women were DS negative (DS-) [70.7 % with normal PAP cytology (NILM) and 29.3 % with abnormal PAP cytology (ASC-US+)], and 289 were DS positive (DS+) (1.1 % NILM and 98.6 % ASC-US+). DS positivity as referral criterion for colposcopy instead of ASC-US+would have reduced the number of colposcopies by 39.4 % overall and by 48.3 % for other 12 hrHPV, while improving the number of colposcopies per HSIL (3.9 vs. 2.4 overall and 4.9 vs. 2.9 for other 12 hrHPV). In this cohort, if the follow-up interval for women positive for other 12 hrHPV+and DS- would have been extended from 1 to 3 years, 799 follow-up consultations, 799 HPV re-tests, and 277 colposcopies (-64.7 %) would have been avoided, with an overall risk of missed HSIL lesions of 2.2 %.

CONCLUSIONS

Triage with DS allows the optimization of colposcopy referrals and a safe extension of the follow-up interval to 3 years for other 12 hrHPV+/DS- women, eliminating the need for annual re-testing for many women.

Does HPV-18 co-infection increase the risk of cervical pathology in individuals with HPV-16?

OBJECTIVE

We aimed to investigate differences between HPV-16 mono- and HPV-16/18 co-infections in terms of cervical dysplasia and invasive cancer.

METHODS

This multicentre, retrospective study spanned from December 2017 to December 2020, involving women who visited gynaecological oncology clinics for colposcopy with either HPV-16 or HPV-16/18 positivity. A total of 736 patients, 670 in Group 1 (HPV-16 positivity) and 66 in Group 2 (HPV-16/18 positivity), were compared for the presence of CIN2+ lesions detected by colposcopic biopsy or endocervical curettage (ECC). Exclusions included hysterectomized patients, those with prior gynaecological cancers, and patients with HPV positivity other than types 16 and 18.

RESULTS

Among the included patients, 42.4% had a diagnosis of CIN2+ lesions. The cytology results demonstrated abnormal findings in 45.3% in Group 1 and 42.2% in Group 2, with no significant difference between the groups. ECC revealed CIN2+ lesion in 49 (8.7%) patients in group 1, while only 1 (1.7%) patient had CIN2+ lesion in group 2. There was no difference between 2 groups in terms of ECC result (p = 0.052). In group 1, 289 (43.1%) patients had CIN2+ lesion, while 23 (34.8%) patients had CIN2+ lesions in group 2. There was no difference between group 1 and 2 in terms of diagnosis of CIN2+ lesions (p = 0.19).

CONCLUSION

This multicentre retrospective study found no significant differences between HPV-16 mono- and HPV-16/18 co-infections regarding cervical pathologies. Larger studies are needed to validate and further explore these findings.

Association of HOTAIR rs7958904 Polymorphism with Cervical Cancer Risk

Cervical cancer (CC) has been the prominent cause of cancer-associated fatalities among women in developing countries. In terms of occurrence and mortality, it is ranked second in Bangladesh. Although different genetic polymorphisms linked with this cancer have been investigated over time, the association between the HOTAIR rs7958904 variant and cervical cancer is being reported for the first time in Bangladeshi women. RT-PCR-based TaqMan assay was employed to perform this case-control study on 200 cervical cancer patients and 148 healthy volunteers. Both cases and controls had average ages of 57.5 and 52.5 years, respectively. According to Hardy-Weinberg equilibrium, the rs7958904 allele of HOTAIR gene pretended no deviation for both cases and control groups. The genotyping results showed that rs7958904 has a significant correlation to the development of cervical cancer in different genetic association models, such as co-dominant 1 (CC vs. GG: OR = 1.67, p = 0.0435), co-dominant 2 (CC vs. GG: OR = 3.13, p = 0.0006), co-dominant 3 (CC vs. CG: OR = 1.88, p = 0.0384), dominant (CG + CC vs. GG: OR = 1.98, p = 0.004), recessive (CC vs. GG + CG: OR = 2.25, p = 0.005), and allele model (C vs. G: OR = 1.70, p = 0.0006). In conclusion, the HOTAIR rs7958904 variant has a substantial role in cervical cancer development in Bangladeshi women. Further functional studies with a larger population size are required to support our findings.

Precision therapy for cancer prevention by targeting carcinogenesis

Cancer represents a major global public health burden, with new cases estimated to increase from 14 million in 2012 to 24 million by 2035. Primary prevention is an effective strategy to reduce the costs associated with cancer burden. For example, measures to ban tobacco consumption have dramatically decreased lung cancer incidence and vaccination against human papillomavirus can prevent cervical cancer development. Unfortunately, the etiological factors of many cancer types are not completely clear or are difficult to actively control; therefore, the primary prevention of such cancers is not practical. In this review, we update the progress on precision therapy by targeting the whole carcinogenesis process, especially for three high-risk groups: (1) those with chronic inflammation, (2) those with inherited germline mutations, and (3) those with precancerous lesions like polyps, gastritis, actinic keratosis or dysplasia. We believe that attenuating chronic inflammation, treating precancerous lesions, and removing high-risk tissues harboring germline mutations are precision methods for cancer prevention.

A cervical cancer control strategy for lower-resource settings: interventions to complement one-dose HPV vaccination

One-dose prophylactic HPV vaccination of pre-adolescents may reduce cervical cancer deaths dramatically in lower-resource settings, but the benefits of achieving immediate high coverage among pre-adolescents would not be realized for 20 to 40 years. Prophylactic vaccine efficacy is reduced after sexual debut, and current therapeutic intervention candidates designed to treat existing HPV infections or precancerous lesions have yielded insufficient evidence to warrant widespread use. However, we are developing a feasible, scalable, high-quality cervical screening approach that could prevent hundreds of thousands of deaths, while we work to achieve high coverage of one-dose vaccination for adolescent cohorts. A time-limited "one screen" campaign approach for lower-resource settings could complement parallel efforts to achieve high coverage with one-dose vaccination. This screen-triage-treat strategy would target the highest risk groups of screening age (ie, 25 to 49 years) for once-in-a-lifetime HPV testing of self-collected samples using a low-cost accurate HPV test; subsequent triage relying on extended genotyping and a validated deep-learning algorithm for automated visual evaluation (AVE) would stratify management based on risk to provide treatment for those most likely to develop cancer without overburdening health care systems. Early efficacy of this approach has been demonstrated in 9 countries within the HPV-AVE (PAVE) Study Consortium. We estimate that the cost per death averted of a screen-triage-treat campaign is of similar magnitude to prophylactic vaccination. We do not envision perpetual investment in ubiquitous brick-and-mortar screening programs if "one dose, one screen" is implemented with high coverage and targets the highest-risk populations. In collaboration with in-country stakeholders, efforts to ensure acceptability, risk communication, and cost-effectiveness are underway.

High-risk human papillomavirus diversity among indigenous women of western Botswana with normal cervical cytology and dysplasia

BACKGROUND

Cervical cancer remains a public health problem despite heavy global investment in health systems especially in low-and-middle-income countries (LMIC). Prophylactic vaccines against the most commonly detected human papillomavirus (HPV) types in cervical cancers are available and decisions on the selection of vaccine design depends on the prevalence of high-risk (hr) HPV genotypes for a particular region. In 2015, Botswana adopted the use of a quadrivalent HPV vaccine as a primary prevention strategy. Secondary prevention includes cervical smear screening whose uptake remains notably low among indigenous and marginalized communities despite efforts to improve access.

AIM

To determine the prevalence of hrHPV genotypes and cervical lesions' burden in women from the indigenous and marginalized communities of Botswana.

METHODS

This prospective survey enrolled 171 non-HPV vaccinated women aged 21 years and older. Face-to-face interviews, Pap smear screening, hr-HPV and Human Immuno-deficiency virus (HIV) testing were carried out. Conventional Papanicolau smears were analyzed and cervical brushes were preserved for hrHPV testing using the Ampfire Multiplex HR-HPV protocol which detects the following genotypes: HPV 16, 18, 31, 35, 39, 45, 51, 52, 53, 56, 58, 59 and 68.

RESULTS

In this study, 168/171 (98.6%) of the women consented to HIV testing; 53/171 (31%) were living with HIV and self-reported enrolment on antiretroviral therapy. Among the women examined, 23/171 (13.5%) had cervical dysplasia with most presenting with Atypical Squamous Cells of Undetermined Significance 8/23 (35%), Low-Grade Squamous Intraepithelial Lesions 8/23 (35%), Atypical Squamous Cells-High Grade 4/23 (17%), Atypical Endocervical Cells 2/23 (9%) and Atypical Endocervical Cell favoring neoplasia 1/23(4%). However, no High-Grade Squamous Intraepithelial Lesions (HSIL) or squamous cell carcinoma (SCC) were detected. Overall hrHPV prevalence in this study was at 56/171 (32.7%). The most commonly detected hrHPV genotypes in women with cervical dysplasia were HPV39 (6.25%), HPV51 (14.5%), HPV52 (12.5%) and HPV56 (4%). Notably, HPV 16 and 18 were not found in women with cervical dysplasia.

CONCLUSIONS

Our study provides valuable insights into the prevalence and distribution of hrHPV genotypes in indigenous and marginalized communities in Botswana, and the need for further investigation of their potential role in cervical carcinogenesis in this population. These results may also serve as baseline data to facilitate future evaluation of the HPV vaccine needs.

Early Cervical Cancer Diagnosis with SWIN-Transformer and Convolutional Neural Networks

Introduction: Early diagnosis of cervical cancer at the precancerous stage is critical for effective treatment and improved patient outcomes. Objective: This study aims to explore the use of SWIN Transformer and Convolutional Neural Network (CNN) hybrid models combined with transfer learning to classify precancerous colposcopy images. Methods: Out of 913 images from 200 cases obtained from the Colposcopy Image Bank of the International Agency for Research on Cancer, 898 met quality standards and were classified as normal, precancerous, or cancerous based on colposcopy and histopathological findings. The cases corresponding to the 360 precancerous images, along with an equal number of normal cases, were divided into a 70/30 train-test split. The SWIN Transformer and CNN hybrid model combines the advantages of local feature extraction by CNNs with the global context modeling by SWIN Transformers, resulting in superior classification performance and a more automated process. The hybrid model approach involves enhancing image quality through preprocessing, extracting local features with CNNs, capturing the global context with the SWIN Transformer, integrating these features for classification, and refining the training process by tuning hyperparameters. Results: The trained model achieved the following classification performances on fivefold cross-validation data: a 94% Area Under the Curve (AUC), an 88% F1 score, and 87% accuracy. On two completely independent test sets, which were never seen by the model during training, the model achieved an 80% AUC, a 75% F1 score, and 75% accuracy on the first test set (precancerous vs. normal) and an 82% AUC, a 78% F1 score, and 75% accuracy on the second test set (cancer vs. normal). Conclusions: These high-performance metrics demonstrate the models' effectiveness in distinguishing precancerous from normal colposcopy images, even with modest datasets, limited data augmentation, and the smaller effect size of precancerous images compared to malignant lesions. The findings suggest that these techniques can significantly aid in the early detection of cervical cancer at the precancerous stage.

Distribution of 14 High-Risk HPV Types and p16/Ki67 Dual-Stain Status in Post-Colposcopy Histology Results: Negative, Low- and High-Grade Cervical Squamous Intraepithelial Lesions

BACKGROUND

Determining the distribution of high-risk human papillomavirus (HR-HPV) types in histologic low-(LSIL) and high-grade (HSIL/CIN2+) squamous intraepithelial lesions through a diagnostic process in a cervical cancer prevention provides one of the key etiological factors behind further progression and persistence. Incorporating novel high-grade cervical lesion biomarkers such as p16/Ki67 dual staining (DS) alongside HPV typing has become important in detecting cervical precancers.

METHODS

Among 28,525 screening tests and 602 histology results, 559 cases with HR-HPV and histology results obtained from colposcopic biopsy were retrospectively analyzed, together with DS status. The χ2 test with Bonferroni correction evaluated the differences in HR-HPV type prevalence and DS positivity across three histologic study groups.

RESULTS

A statistically significant difference in the prevalence of HPV 16 was observed between negative and HSIL/CIN2+ (p = 0.00027) groups, as well as between the LSIL/CIN1 and HSIL/CIN2+ groups (p = 0.00041). However, no significant difference was found between the negative and LSIL/CIN1 groups. Similarly, the DS positivity difference was significant between the negative and HSIL/CIN2+ (p < 0.0001) and between the LSIL/CIN1 and HSIL/CIN2+ groups (p < 0.0001), but there was no significant difference between the negative and LSIL/CIN1 groups.

CONCLUSIONS

The study highlights the heterogeneous nature of HPV-related cervical pathologies, and the distinct risks associated with different cervical lesion grades, emphasizing the importance of HR-HPV type distribution and DS status.

Assessing generalizability of an AI-based visual test for cervical cancer screening

A number of challenges hinder artificial intelligence (AI) models from effective clinical translation. Foremost among these challenges is the lack of generalizability, which is defined as the ability of a model to perform well on datasets that have different characteristics from the training data. We recently investigated the development of an AI pipeline on digital images of the cervix, utilizing a multi-heterogeneous dataset of 9,462 women (17,013 images) and a multi-stage model selection and optimization approach, to generate a diagnostic classifier able to classify images of the cervix into "normal", "indeterminate" and "precancer/cancer" (denoted as "precancer+") categories. In this work, we investigate the performance of this multiclass classifier on external data not utilized in training and internal validation, to assess the generalizability of the classifier when moving to new settings. We assessed both the classification performance and repeatability of our classifier model across the two axes of heterogeneity present in our dataset: image capture device and geography, utilizing both out-of-the-box inference and retraining with external data. Our results demonstrate that device-level heterogeneity affects our model performance more than geography-level heterogeneity. Classification performance of our model is strong on images from a new geography without retraining, while incremental retraining with inclusion of images from a new device progressively improves classification performance on that device up to a point of saturation. Repeatability of our model is relatively unaffected by data heterogeneity and remains strong throughout. Our work supports the need for optimized retraining approaches that address data heterogeneity (e.g., when moving to a new device) to facilitate effective use of AI models in new settings.

A health decision analytical model to evaluate the cost-effectiveness of female genital schistosomiasis screening strategies: The female genital schistosomiasis SCREEN framework

Female genital schistosomiasis is a chronic gynaecological disease caused by the waterborne parasite Schistosoma (S.) haematobium. It affects an estimated 30-56 million girls and women globally, mostly in sub-Saharan Africa where it is endemic, and negatively impacts their sexual and reproductive life. Recent studies found evidence of an association between female genital schistosomiasis and increased prevalence of HIV and cervical precancer lesions. Despite the large population at risk, the burden and impact of female genital schistosomiasis are scarcely documented, resulting in neglect and insufficient resource allocation. There is currently no standardised method for individual or population-based female genital schistosomiasis screening and diagnosis which hinders accurate assessment of disease burden in endemic countries. To optimise financial allocations for female genital schistosomiasis screening, it is necessary to explore the cost-effectiveness of different strategies by combining cost and impact estimates. Yet, no economic evaluation has explored the value for money of alternative screening methods. This paper describes a novel application of health decision analytical modelling to evaluate the cost-effectiveness of different female genital schistosomiasis screening strategies across endemic settings. The model combines a decision tree for female genital schistosomiasis screening strategies, and a Markov model for the natural history of cervical cancer to estimate the cost per disability-adjusted life-years averted for different screening strategies, stratified by HIV status. It is a starting point for discussion and for supporting priority setting in a data-sparse environment.

HPV Infection and Prevention in Patients With Immune-Mediated Inflammatory Diseases: A Scoping Review

BACKGROUND/HISTORICAL PERSPECTIVE

Human papillomavirus (HPV) infections are a significant public health concern as they cause various cancers, including those of the cervix, vulva, vagina, anus, penis, and oropharynx, in both women and men.

SUMMARY INTEGRATING THE CURRENT PUBLISHED LITERATURE

Individuals with immune-mediated inflammatory diseases, particularly systemic lupus erythematosus, have an increased risk of developing persistent HPV infection and subsequent precancerous lesions due to their immunosuppression.

MAJOR CONCLUSIONS

Vaccination and screening for precancerous lesions are 2 central management strategies that must be implemented in patients with immune-mediated inflammatory diseases. Although HPV vaccination has been proven to be safe and effective in these patients, coverage remains low and should be encouraged. Screening for cervical cancer should be more widely implemented in this population, as recommended in guidelines for other immunosuppressed patients.

FUTURE RESEARCH DIRECTIONS

Catch-up vaccination, vaginal self-sampling screening for HPV detection, and therapeutic vaccination are new options that should be considered.

Distillation of multi-class cervical lesion cell detection via synthesis-aided pre-training and patch-level feature alignment

Automated detection of cervical abnormal cells from Thin-prep cytologic test (TCT) images is crucial for efficient cervical abnormal screening using computer-aided diagnosis systems. However, the construction of the detection model is hindered by the preparation of the training images, which usually suffers from issues of class imbalance and incomplete annotations. Additionally, existing methods often overlook the visual feature correlations among cells, which are crucial in cervical lesion cell detection as pathologists commonly rely on surrounding cells for identification. In this paper, we propose a distillation framework that utilizes a patch-level pre-training network to guide the training of an image-level detection network, which can be applied to various detectors without changing their architectures during inference. The main contribution is three-fold: (1) We propose the Balanced Pre-training Model (BPM) as the patch-level cervical cell classification model, which employs an image synthesis model to construct a class-balanced patch dataset for pre-training. (2) We design the Score Correction Loss (SCL) to enable the detection network to distill knowledge from the BPM model, thereby mitigating the impact of incomplete annotations. (3) We design the Patch Correlation Consistency (PCC) strategy to exploit the correlation information of extracted cells, consistent with the behavior of cytopathologists. Experiments on public and private datasets demonstrate the superior performance of the proposed distillation method, as well as its adaptability to various detection architectures.

High risk human papillomavirus prevalence and genotype distribution in Reunion Island

OBJECTIVE

The primary objective of this study was to assess the prevalence and genotypes of human papilloma virus (HPV) in Reunion Island.

STUDY DESIGN

In this retrospective study, data were collected from the database of microbiology and anatomopathology laboratories from August 1st 2020 to July 31st 2021.

RESULTS

The overall prevalence of human papillomavirus (HPV) in Reunion Island was 14.5 %. The most common HPV genotypes in Reunion Island, were as follows: cluster of HPV 56 + 59 + 66, representing 3.3 % of all samples, cluster of HPV 35 + 39 + 68 (3.2 %), HPV 16 (2.9 %), HPV 33 + 58 (2.3 %) and HPV 52 (2.2 %). HPV types contained in the vaccine accounted for 59.3 % of HPV-positive samples and significantly resulted in more severe cytological lesions compared to HPV types that were not included in the vaccine (p < 0.01). Cervical dysplasia were identified in 57.3 % of HPV-positive cases. Multiple infections were detected in 23.2 % of the cases and were more frequent among younger women (<30 years) and in pathological smears (p < 0.001).

CONCLUSION

In this study, we highlighted that HPV genotypes contained in the vaccine are the most represented in Réunion Island and are the most likely to generate significant cytological abnormalities. Therefore, continuous efforts are necessary to increase HPV vaccination coverage, which is currently in the island among the lowest in developed countries, despite the high mortality rate associated with cervical cancer. Furthermore, considering the inequal offensive capacity of each HPV, identifying patients' HPV infection subtype, could allow customized management and follow-up.