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Daponte N, Valasoulis G, Michail G, Magaliou I, Daponte AI, Garas A, Grivea I, Bogdanos DP, Daponte A. HPV-Based Self-Sampling in Cervical Cancer Screening: An Updated Review of the Current Evidence in the Literature. Cancers (Basel) 2023; 15:1669. [PMID: 36980555 PMCID: PMC10046242 DOI: 10.3390/cancers15061669] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Identifying and reaching women at higher risk for cervical cancer is all-important for achieving the ambitious endpoints set in 2020 by the WHO for global cervical cancer control by 2030. HPV-based (vaginal) self-sampling (SS) represents a cost-effective screening strategy, which has been successfully implemented during the last decade both in affluent and constrained settings. Among other advantages, SS strategies offer convenience, diminished costs, flexibility to obtain a sample in the office or home, avoiding a pelvic exam and uncomfortable appointment with a healthcare professional, as well as social and cultural acceptability. SS implementation has been globally boosted during the COVID-19 pandemic. In pragmatic terms, social distancing, local lockdowns, discontinuation of clinics and reallocation of human and financial resources challenged established clinician-based screening; self-collection strategies apparently surpassed most obstacles, representing a viable and flexible alternative. With time, sufficient reassuring data has accumulated regarding specially designed SS devices, aspects of sample preparation, transport and storage and, importantly, optimization of validated PCR-based HPV testing platforms for self-collected specimens. Suboptimal rates of clinical follow-up post-SS screening, as well as overtreatment with reliance solely on molecular assays, have both been documented and remain concerning. Therefore, effective strategies are still required to ensure linkage to follow-up testing and management following positive SS results by trained health professionals with knowledge of HPV biology and management algorithms. Because of the prolonged SS screening intervals, implementation data are limited regarding subsequent screening rounds of SS-screened individuals; however, these are accumulating gradually. With further refinement of assays and validation of novel biomarkers in self-collected samples, there is a clear potential for increasing SS accuracy and PPV. The potential differentiation of self-collection protocols for vaccinated versus non-vaccinated individuals also represents an open issue. In conclusion, HPV-based self-collection techniques can effectively address limited uptake alongside other conventional cervical screening drawbacks; however, assays, logistics and infrastructures need further optimization to increase the efficacy, effectiveness and cost-effectiveness of SS approaches.
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Affiliation(s)
- Nikoletta Daponte
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - George Valasoulis
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
- Hellenic National Public Health Organization-ECDC, Marousi, 15123 Athens, Greece
- Department of Midwifery, School of Health Sciences, University of Western Macedonia, 50100 Kozani, Greece
| | - Georgios Michail
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Ioulia Magaliou
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
- Department of Midwifery, School of Health Sciences, University of Western Macedonia, 50100 Kozani, Greece
| | - Athina-Ioanna Daponte
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, 54124 Thessaloniki, Greece
| | - Antonios Garas
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Ioanna Grivea
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
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He Y, Shi J, Zhao H, Wang Y, Zhang C, Han S, He Q, Li X, Li S, Wang W, Yi M, Hu X, Xing Z, Han H, Gao Y, Zhou Q, Lu L, Guo J, Cao H, Lu C, Hou Y, Chen D, Yang F, Lei P, Di W, Qian J, Xia Y, Zhang Y, Deng Y, Zhu J, Xu C. p16 INK4A flow cytometry of exfoliated cervical cells: Its role in quantitative pathology and clinical diagnosis of squamous intraepithelial lesions. Clin Transl Med 2023; 13:e1209. [PMID: 36881611 PMCID: PMC9991008 DOI: 10.1002/ctm2.1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/26/2023] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND P16INK4A is a surrogate signature compensating for the specificity and/or sensitivity deficiencies of the human papillomavirus (HPV) DNA and Papanicolaou smear (Pap) co-test for detecting high-grade cervical squamous intraepithelial lesions or worse (HSIL+). However, traditional p16INK4A immunostaining is labour intensive and skill demanding, and subjective biases cannot be avoided. Herein, we created a high-throughput, quantitative diagnostic device, p16INK4A flow cytometry (FCM) and assessed its performances in cervical cancer screening and prevention. METHODS P16INK4A FCM was built upon a novel antibody clone and a series of positive and negative (p16INK4A -knockout) standards. Since 2018, 24 100-women (HPV-positive/-negative, Pap-normal/-abnormal) have been enrolled nationwide for two-tier validation work. In cross-sectional studies, age- and viral genotype-dependent expression of p16INK4A was investigated, and optimal diagnostic parameter cut-offs (using colposcopy and biopsy as a gold standard) were obtained. In cohort studies, the 2-year prognostic values of p16INK4A were investigated with other risk factors by multivariate regression analyses in three cervicopathological conditions: HPV-positive Pap-normal, Pap-abnormal biopsy-negative and biopsy-confirmed LSIL. RESULTS P16INK4A FCM detected a minimal ratio of 0.01% positive cells. The p16INK4A -positive ratio was 13.9 ± 1.8% among HPV-negative NILM women and peaked at the ages of 40-49 years; after HPV infection, the ratio increased to 15.1 ± 1.6%, varying with the carcinogenesis of the viral genotype. Further increments were found in women with neoplastic lesions (HPV-negative: 17.7 ± 5.0-21.4 ± 7.2%; HPV-positive: 18.0 ± 5.2-20.0 ± 9.9%). Extremely low expression of p16INK4A was observed in women with HSILs. As the HPV-combined double-cut-off-ratio criterion was adopted, a Youden's index of 0.78 was obtained, which was significantly higher than that (0.72) of the HPV and Pap co-test. The p16INK4A -abnormal situation was an independent HSIL+ risk factor for 2-year outcomes in all three cervicopathological conditions investigated (hazard ratios: 4.3-7.2). CONCLUSIONS FCM-based p16INK4A quantification offers a better choice for conveniently and precisely monitoring the occurrence of HSIL+ and directing risk-stratification-based interventions.
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Affiliation(s)
- Yifeng He
- Department of Obstetrics and GynecologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
- Department of Obstetrics and GynecologyPudong HospitalFudan UniversityShanghaiChina
| | - Jun Shi
- Department of Obstetrics and GynecologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Hui Zhao
- Department of GynecologyTaiyuan Maternal and Child Health HospitalTaiyuanShanxiChina
| | - Yuefei Wang
- Department of GynecologyObstetrics and Gynecology HospitalFudan UniversityShanghaiChina
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghaiChina
| | - Chi Zhang
- Department of GynecologyTaiyuan Maternal and Child Health HospitalTaiyuanShanxiChina
| | - Sai Han
- Department of Obstetrics and GynecologyQilu HospitalShandong UniversityJinanShandongChina
| | - Qizhi He
- Department of PathologyFirst Maternity and Infant Health HospitalTongji UniversityShanghaiChina
| | - Xiaolan Li
- Department of Obstetrics and GynecologyThe Second People's Hospital, Three Gorges UniversityYichangHubeiChina
| | - Shangji Li
- Department of Obstetrics and GynecologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Wenjing Wang
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Muhua Yi
- Department of PathologyDongguan HospitalSouthern Medical UniversityDongguanGuangdongChina
| | - Xiaoling Hu
- Department of Obstetrics and GynecologyYongcheng People's HospitalYongchengHenanChina
| | - Zhihua Xing
- Department of Obstetrics and GynecologyZouping People's HospitalZoupingShandongChina
| | - Hao Han
- Department of Obstetrics and GynecologyZouping People's HospitalZoupingShandongChina
| | - Yinshuang Gao
- Department of Obstetrics and GynecologyZouping People's HospitalZoupingShandongChina
| | - Qing Zhou
- Department of PathologyThe Central Hospital of Zibo Mining Group Co. Ltd.ZiboShandongChina
| | - Linlin Lu
- Department of Obstetrics and GynecologyThe Central Hospital of Zibo Mining Group Co. Ltd.ZiboShandongChina
| | - Jianfen Guo
- Department of Obstetrics and GynecologyChifeng College Affiliated HospitalChifengInner MongoliaChina
| | - Hui Cao
- Department of Clinical LaboratorySongjiang Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Caiping Lu
- Department of Clinical LaboratorySongjiang Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Yanqiang Hou
- Department of Clinical LaboratorySongjiang Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Dan Chen
- Fosun Diagnostic Technology (Shanghai) Co., LtdShanghaiChina
| | - Fengyun Yang
- Department of Cervical DiseasesJiading Maternal and Child Health Care HospitalShanghaiChina
| | - Ping Lei
- Department of GynecologyZhuhai Center for Maternal and Child Health CareZhuhaiGuangdongChina
| | - Wen Di
- Department of Obstetrics and GynecologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Laboratory of Gynecologic OncologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
- State Key Laboratory of Oncogene and Related GenesShanghai Cancer InstituteRen Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Ji Qian
- State Key Laboratory of Genetic EngineeringInstitute of Genetics, School of Life Sciences, Fudan UniversityShanghaiChina
| | - Yi Xia
- Department of Clinical LaboratorySongjiang Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Youzhong Zhang
- Department of Obstetrics and GynecologyQilu HospitalShandong UniversityJinanShandongChina
| | - Yang Deng
- Department of GynecologyTaiyuan Maternal and Child Health HospitalTaiyuanShanxiChina
| | - Jianlong Zhu
- Department of Obstetrics and GynecologyPudong HospitalFudan UniversityShanghaiChina
| | - Congjian Xu
- Department of GynecologyObstetrics and Gynecology HospitalFudan UniversityShanghaiChina
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghaiChina
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Valasoulis G, Michail G, Pouliakis A, Androutsopoulos G, Panayiotides IG, Kyrgiou M, Daponte A, Paraskevaidis E. Effect of Condom Use after CIN Treatment on Cervical HPV Biomarkers Positivity: Prolonged Follow Up Study. Cancers (Basel) 2022; 14:cancers14143530. [PMID: 35884589 PMCID: PMC9317636 DOI: 10.3390/cancers14143530] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Several factors contribute in the cervical healing process following local surgical treatment; in a previous work our group has documented a beneficial mid-term role of regular condom use immediately postoperatively in terms of CIN relapse prevention and expression of active viral biomarkers. Materials and Methods: Aiming to investigate whether the favorable contribution of consistent condom use could be extrapolated in the longer term, we conducted a prospective single center observational study including women scheduled to undergo conservative excisional treatment for CIN (LLETZ procedure). In all women a strong recommendation for consistent use for the first 6 months was given. For 204 women who underwent the procedure and completed successfully the two-year follow up a complete dataset of HPV biomarkers’ results obtained six months and two years postoperatively was available. Patients were asked to complete a questionnaire to assess condom use compliance. A 90% compliance rate represented the threshold for consistent use. An LBC sample was obtained and tested for HPV genotyping, E6 & E7 mRNA by NASBA technique as well as flow cytometry, and p16 at 0 (pre-treatment), 6 and 24 months. HPV DNA and other related biomarkers status at 6 and 24 months, treatment failures at 24 months and condom use compliance rates represented study outcomes. Results: Six months post-operatively we documented a reduction in the rates of HPV DNA positivity, which was detected in only 23.2% of compliant condom users in comparison to 61.9% in the non-compliant group (p < 0.001, OR: 0.19, 95%CI: 0.1−0.36). For the HPV mRNA test, either assessed with the NASBA method or with flow cytometry, reduced positivity percentages were observed in the compliant group, in particular 1.6% vs. 8% for NASBA and 7.1% vs. 16.4% using flow cytometry, although these differences were not statistically significant (p = 0.1039 and 0.0791, respectively). Finally, reduced p16 positivity rates were documented in the compliant group. At the two year follow up, a more pronounced difference in HPV DNA positivity rates was observed, specifically only 13% positivity among the compliant women compared with 71% of the non-compliant (p < 0.0001); this illustrates a further decreasing trend compared with the 6th month in the compliant group as opposed to an increasing tendency in the non-compliant group, respectively (difference: 9.0%, 95% CI: 0% to 20.6%, p = 0.1523). At that time, 80% of the failed treatments were HPV mRNA positive compared to 10% positivity for the cases treated successfully (OR: 34, 95%CI: 6.8−173, p < 0.0001), a finding indicative that HPV mRNA E6 & E7 positivity accurately predicts treatment failure; p16 positivity was also observed at higher rates in cases with treatment failure. Conclusions: Consistent condom use following conservative excisional CIN treatment appears to significantly reduce rates of CIN recurrence and biomarkers of HPV expression. Additional HPV vaccination at the time of treatment could further enhance the positive effect of consistent condom use.
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Affiliation(s)
- George Valasoulis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece;
- Hellenic National Public Health Organization-ECDC, 15123 Athens, Greece
- Correspondence: ; Tel.: +30-6946-308-060
| | - Georgios Michail
- Department of Obstetrics & Gynaecology, University Hospital of Patras, 26504 Patras, Greece; (G.M.); (G.A.)
| | - Abraham Pouliakis
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (I.G.P.)
| | - Georgios Androutsopoulos
- Department of Obstetrics & Gynaecology, University Hospital of Patras, 26504 Patras, Greece; (G.M.); (G.A.)
| | - Ioannis. G. Panayiotides
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (I.G.P.)
| | - Maria Kyrgiou
- West London Gynaecological Cancer Centre, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction-Surgery and Cancer, Imperial College London, London W12 0NN, UK
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece;
| | - Evangelos Paraskevaidis
- Department of Obstetrics & Gynaecology, University Hospital of Ioannina, 45500 Ioannina, Greece;
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The Role of p16/Ki-67 Immunostaining, hTERC Amplification and Fibronectin in Predicting Cervical Cancer Progression: A Systematic Review. BIOLOGY 2022; 11:biology11070956. [PMID: 36101337 PMCID: PMC9312145 DOI: 10.3390/biology11070956] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/11/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
Human papillomaviruses (HPVs) are common sexually transmitted infectious agents responsible for several anogenital and head and neck cancers. Cervical cancer (CC) is the fourth leading cause of death in women with cancer. The progression of a persistent HPV infection to cancer takes 15–20 years and can be preventable through screening. Cervical cytology (Pap smear) is the standard screening test for CC and precancerous lesions. For ASC-US and ASC-H lesions, a combination of Pap smear and HR-HPV analysis is recommended as a triage step before colposcopy. However, these tests cannot predict progression to CC. For this purpose, we summarized current scientific data on the role of p16/Ki-67 immunohistostaining, telomerase and fibronectin in predicting progression to CC. p16 and p16/Ki-67 dual staining (DS) were more specific than HR-HPV DNA testing for the detection of CIN2+/CIN3+ in women with ASC-US and LSIL. Similarly, hTERC FISH analysis significantly improved the specificity and positive predictive value of HPV DNA testing in differentiating CIN2+ from CIN2 cytological samples. In conclusion, p16 IHC, p16/Ki-67 DS and hTERC FISH amplification are all valid adjunctive biomarkers which significantly increase the sensitivity and specificity of cervical dysplasia diagnosis, especially when combined with HPV DNA testing. However, considering the global socioeconomic background, we can postulate that p16 and p16/ Ki-67 IHC can be used as a next step after positive cytology for ASC-US or LSIL specimens in low-income countries, instead of HPV DNA testing. Alternatively, if HPV DNA testing is covered by insurance, p16 or p16/Ki-67 DS and HPV DNA co-testing can be performed. In middle- and high-income countries, hTERC amplification can be performed as an adjunctive test to HPV DNA testing in women with ASC-US and LSIL.
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Valasoulis G, Pouliakis A, Michail G, Daponte AI, Galazios G, Panayiotides IG, Daponte A. The Influence of Sexual Behavior and Demographic Characteristics in the Expression of HPV-Related Biomarkers in a Colposcopy Population of Reproductive Age Greek Women. BIOLOGY 2021; 10:biology10080713. [PMID: 34439947 PMCID: PMC8389230 DOI: 10.3390/biology10080713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022]
Abstract
Simple Summary This observational study aimed to investigate the possible influence of sexual behavior and demographic characteristics in the expression of HPV-related biomarkers in a colposcopy population. Lifestyle factors that impacted HPV DNA positivity in a statistically significant manner were younger age at first sexual intercourse, a history of more than four sexual partners as well as a partner change during the last year before HPV DNA assessment. Although ambitious, the development and validation of lifestyle scoring systems that combine molecular and epidemiological patient data to effectively predict underlying cervical pathology will represent a milestone in the quest of cervical cancer prevention. Abstract Despite the significant scientific evolution in primary and secondary cervical cancer prevention in the battle started by George Papanicolaou in the previous century, global cervical cancer mortality rates remain disappointing. The widespread implementation of HPV-related molecular markers has paved the way to tremendous developments in cervical cancer screening, with the transition from cytological approach to the more accurate and cost-effective HPV testing modalities. However, the academic audience and different health systems have not yet adopted a universal approach in screening strategies, and even artificial intelligence modalities have been utilized from the multidisciplinary scientific armamentarium. Combination algorithms, scoring systems as well as artificial intelligent models have been so far proposed for cervical screening and management. The impact of sexual lifestyle inherently possesses a key role in the prevalence of HPV-related biomarkers. This study aimed to investigate any possible influence of sexual behavior and demographic characteristics in the expression of HPV-related biomarkers in a colposcopy population from October 2016 to June 2017, and corroborated the determining role of age at fist intercourse; the older the age, the lower the probability for DNA positivity. Multivariate analysis illustrated additionally that a number of sexual partners exceeding 4.2 was crucial, with women with ≤5 partners being approximately four times less likely to harbor a positive HPV DNA test (p < 0.0001). Similarly, a reported partner change during the last year before HPV DNA assessment contributed to 2.5 times higher odds for DNA positivity (p = 0.0006). From this perspective, the further development and validation of scoring systems quantifying lifestyle factors that could reflect cervical precancer risk seems paramount.
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Affiliation(s)
- George Valasoulis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (A.-I.D.); (A.D.)
- Hellenic National Public Health Organization—ECDC, 15123 Athens, Greece
- Correspondence: ; Tel.: +30-6946-308-060
| | - Abraham Pouliakis
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.P.); (I.G.P.)
| | - Georgios Michail
- Department of Obstetrics & Gynaecology, University Hospital of Patras, 26504 Patras, Greece;
| | - Athina-Ioanna Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (A.-I.D.); (A.D.)
| | - Georgios Galazios
- Department of Obstetrics & Gynaecology, University Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece;
| | - Ioannis G. Panayiotides
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.P.); (I.G.P.)
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (A.-I.D.); (A.D.)
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Valasoulis G, Pouliakis A, Michail G, Kottaridi C, Spathis A, Kyrgiou M, Paraskevaidis E, Daponte A. Alterations of HPV-Related Biomarkers after Prophylactic HPV Vaccination. A Prospective Pilot Observational Study in Greek Women. Cancers (Basel) 2020; 12:cancers12051164. [PMID: 32380733 PMCID: PMC7281708 DOI: 10.3390/cancers12051164] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/26/2020] [Accepted: 05/02/2020] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to investigate the hypothesis that HPV vaccination administered in patients with low-grade (LG) cytology shortly after an initial colposcopic assessment could prospectively alter HPV-related biomarkers. This was a prospective pilot observational study involving women attending a colposcopy clinic for evaluation of abnormal LG cytology that were advised to undergo HPV vaccination and proceeded accordingly. These women were compared with a matched unvaccinated group. Women requiring cervical biopsies or CIN treatment were excluded. Intervention: A full three-dose HPV vaccination was undertaken with either the 2-valent or the 4-valent anti-HPV VLP vaccine. LBC samples were obtained prior and after the completion of the vaccination regimen and tested for HPV DNA genotyping (CLART-2 HPV test) and E6 and E7 mRNA (NASBA technique). Results: Alterations of HPV-related biomarkers at a colposcopy reassessment appointment 12 months later. Analysis: The p-values, relative risk (RR), absolute relative risk (ARR), number needed to treat (NNT) and 95% confidence intervals for each biomarker in each group were assessed. Results: A total of 309 women were included in the analysis. One hundred fifty-two women received the vaccine. HPV vaccination reduced in a statistically significant manner (p < 0.05) HPV DNA positivity rates for genotypes 16, 18, and 31, RR = 1.6 (95% CI: 1.1 to 2.3), RR = 1.7 (95% CI: 1.1 to 2.8), and RR = 1.8 (95% CI: 1.0 to 2.9), in women who only tested DNA-positive for HPV16, 18, and 31 genotypes, respectively, prior to vaccination. A less pronounced, statistically insignificant reduction was shown for women who tested positive for both HPV DNA and mRNA E6 and E7 expression for HPV16, 18, and 33 subtypes. Statistically significant reduction in HPV mRNA positivity was solely documented for genotype 31 (p = 0.0411). Conclusions: HPV vaccination appears to significantly affect the rates of HPV16, 18, and 31 DNA-positive infections in the population testing HPV DNA-positive for the aforementioned genotypes. The above findings deserve verification in larger cohorts.
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Affiliation(s)
- George Valasoulis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece;
- Hellenic National Public Health Organization-ECDC, Marousi, 15123 Athens, Greece
- Correspondence: ; Tel.: +30-6946-308-060
| | - Abraham Pouliakis
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece; (A.P.); (C.K.); (A.S.)
| | - George Michail
- Department of Obstetrics & Gynaecology, University Hospital of Patras, Rio, 26504 Patras, Greece;
| | - Christine Kottaridi
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece; (A.P.); (C.K.); (A.S.)
| | - Aris Spathis
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece; (A.P.); (C.K.); (A.S.)
| | - Maria Kyrgiou
- West London Gynaecological Cancer Center, Department of Obstetrics & Gynaecology, Queen Charlotte’s and Chelsea Hospital, Hammersmith Hospital, London W120HS, UK;
| | - Evangelos Paraskevaidis
- Department of Obstetrics & Gynaecology, University Hospital of Ioannina, Neochoropoulo, 45500 Ioannina, Greece;
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece;
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Macedo ACL, Gonçalves JCN, Bavaresco DV, Grande AJ, Chiaramonte Silva N, Rosa MI. Accuracy of mRNA HPV Tests for Triage of Precursor Lesions and Cervical Cancer: A Systematic Review and Meta-Analysis. JOURNAL OF ONCOLOGY 2019; 2019:6935030. [PMID: 31281360 PMCID: PMC6594270 DOI: 10.1155/2019/6935030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 05/26/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This systematic review evaluates the accuracy of the mRNA HPV biomarker in cervical smears to identify cervical intraepithelial neoplasia (CIN) 2 or 3 and cervical cancer. DATA SOURCE Eligible studies were identified by performing a search of electronic databases on Medline via Pubmed, Lilacs, Cochrane Library, Embase, and Grey literature for papers published between January 1990 and June 2018. STUDY ELIGIBILITY CRITERIA As no randomized studies were identified, this review focuses on observational studies in which the mRNA HPV diagnostic test was compared to a histopathology reference standard. We analyzed studies that included women screened for cervical cancer using mRNA HPV. STUDY APPRAISAL AND SYNTHESIS METHODS After screening, 61 studies including 29,674 patients met the inclusion criteria and were analyzed. Dichotomization was performed by defining CIN2 or worse (CIN2+) versus CIN1, HPV infection, and normal (CIN 1-). The analysis was discriminated by the following tests: Aptima, PreTect HPV Profeer, NucliSens EasyQ HPV, OncoTect, and Quantivirus. RESULTS Analyzing by technique, Aptima, with 28 studies, exhibited superior performance, showing for the outcomes CIN2+ and CIN3+ an AUC of 0.88 (0.82-0.95) and 0.91 (0.84-0.99), a pooled sensitivity of 92.8% (95%CI 91.9-93.7) and 95.6% (95%CI 94.5-96.5), and a pooled specificity of 60.5% (95%CI 59.8-61.3) and 61.9% (95%CI 61.1-62.7), respectively. CONCLUSION This study supports the current hypothesis that the mRNA HPV assay is an adequate tool for secondary cervical cancer screening.
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Affiliation(s)
- Ana Cristina L. Macedo
- Translational Biomedicine Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - João Carlos N. Gonçalves
- Translational Biomedicine Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Daniela Vicente Bavaresco
- Translational Biomedicine Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Antonio José Grande
- Laboratory of Evidence in Health, Medicine and Health Sciences, University of State of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Napoleão Chiaramonte Silva
- Translational Biomedicine Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Maria Inês Rosa
- Translational Biomedicine Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
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Mitra A, Tzafetas M, Lyons D, Fotopoulou C, Paraskevaidis E, Kyrgiou M. Cervical intraepithelial neoplasia: screening and management. Br J Hosp Med (Lond) 2016; 77:C118-23. [DOI: 10.12968/hmed.2016.77.8.c118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Mitra
- Academic Clinical Fellow in the Institute of Reproduction and Developmental Biology, Department of Surgery & Cancer, Imperial College, London
| | - M Tzafetas
- Clinical Research Fellow at Institute of Reproductive and Developmental Biology, Imperial College, London
| | - D Lyons
- Consultant in the Department of Obstetrics and Gynaecology, Imperial Healthcare NHS Trust, London
| | - C Fotopoulou
- Consultant in gynaecological oncology, Imperial College Healthcare NHS trust
| | - E Paraskevaidis
- Professor in the Department of Obstetrics and Gynaecology, University of Ioannina, Ioannina, Greece
| | - M Kyrgiou
- Senior Clinical Lecturer in the Institute of Reproduction and Developmental Biology, Department of Surgery & Cancer, Imperial College, London
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9
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Kyrgiou M, Pouliakis A, Panayiotides JG, Margari N, Bountris P, Valasoulis G, Paraskevaidi M, Bilirakis E, Nasioutziki M, Loufopoulos A, Haritou M, Koutsouris DD, Karakitsos P, Paraskevaidis E. Personalised management of women with cervical abnormalities using a clinical decision support scoring system. Gynecol Oncol 2016; 141:29-35. [DOI: 10.1016/j.ygyno.2015.12.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/04/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
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Mo LZ, Song HL, Wang JL, He Q, Qiu ZC, Li F. Pap Smear Combined with HPV Testing: A Reasonable Tool for Women with High-grade Cervical Intraepithelial Neoplasia Treated by LEEP. Asian Pac J Cancer Prev 2016; 16:4297-302. [PMID: 26028089 DOI: 10.7314/apjcp.2015.16.10.4297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate HPV testing by Hybrid Capture II (HCII) in conjunction with cytology in detecting the residual/recurrence disease after treatment of high-grade cervical intraepithelial neoplasia (CIN II-III) with loop electrosurgical excision procedure (LEEP). MATERIALS AND METHODS A retrospective review of 158 patients with histologically confirmed CIN II-III who underwent LEEP between January 2011 and October 2012 was conducted. Post-treatment control was scheduled at the 3rd, 6th, 12th and 18th month. All patients were followed up by Pap smear and HR-HPV genotype and viral load testing. RESULTS Pre-treatment, HR-HPV DNA, was detected in all specimens of the patients. At follow-up, 25 patients were diagnosed as the residual/recurrent disease during the FU visit, among whom, 16 patients with positive margin: 13 patients (52%) with HR-HPV DNA+/cytology+, 2 patients (8%) with HR-HPV DNA+/cytology-, 1 patient (4%) with cytology+/ HR-HPV DNA-; 9 patients with clean margin--5 patients (55.6%) with HR-HPV DNA+/cytology+; 2 patients (22.2%) with HR- HPV DNA+/cytology-, 2 patients (22.2%) with cytology+/HR-HPV DNA-. None of them persisting HR-HPV DNA-/cytology- with positive or negative margin was identified as the residual/recurrent disease. The majority of residual/recurrent disease was detected at the 12th and 18th month FU, and there was almost no difference in the sensitivity and negative predictive value (NPV) between at the 3rd month and the 6th month FU visits. 14 residual/recurrence disease (14/46:30.4%) had pre-treatment high viral load (>5,000 RUL/PC) and 11 (11/112, 9.8%) with pre-treatment low viral load, P<0.05. CONCLUSIONS (1) The persistence HR-HPV DNA is the root cause of the residual/recurrent disease for the women treated for high-grade CIN; the pre-treatment viral load and margin can be seen as the predictor. (2) The FU visit beginning at the 6th month post-treatment and lasting at least 24 months with the combination of cytology and HPV testing. (3) Patients with high pre-treatment HPV load, which is considered as one risk of developing the residual/recurrent disease, should be paid more attention (especially above 500 RUL/PC) to by clinicians.
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Affiliation(s)
- Ling-Zhao Mo
- Department of Gynecological Oncology, Tumor Hospital Affiliated to Guangxi Medical University, Nanning, Guangxi, China E-mail :
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Garcia Ramos AM, Garcia Ramos ES, Dos Reis HLB, de Rezende RB. Quality evaluation of cone biopsy specimens obtained by large loop excision of the transformation zone. J Clin Med Res 2015; 7:220-4. [PMID: 25699117 PMCID: PMC4330013 DOI: 10.14740/jocmr1951w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/30/2022] Open
Abstract
Background Large loop excision of the transformation zone (LLETZ) has been used for the diagnosis and treatment of precancerous cervical lesions, and it is the first choice of treatment in the majority of cervical pathology services. The aim of this study was to evaluate the presence of thermal artifacts, the need for serial sections, the percentage of clear and involved resection margins and the relationship between endocervical gland involvement and the severity of the lesion in samples resected using LLETZ. Methods A retrospective study was performed at Santa Casa de Misericordia School of Science (HSCMV), Vitoria, Espirito Santo, Brazil with a sample of 52 histopathology slides from patients submitted to conization because of abnormal cytology findings and a biopsy result of cervical intraepithelial neoplasia (CIN) 2, CIN 3 and adenocarcinoma in situ. Statistical analysis was performed using Student’s t-test. Results Serial sections were required to confirm diagnosis in four of 52 cases. Thermal artifacts were present in all cases, with grade I being the most common (94.2% of cases). Clear margins were found in 96.2% of cases. No association was found between glandular involvement and CIN 1 (P > 0.05); however, there was an association with CIN 2 and CIN 3 (P < 0.05). Conclusion The amount of excised tissue was sufficient, thermal artifacts were slight, resection margins were clear in most of cases, and a possible association was found between glandular involvement and the severity of the lesion.
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