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Dai W, Wang T, Chen L, Qiu Z, Chen P, Chen D. Immediate risk of cervical intraepithelial neoplasia and diagnostic value of colposcopy among cytology-negative women with oncogenic HPV: a retrospective study. BMC Womens Health 2024; 24:419. [PMID: 39049047 PMCID: PMC11267838 DOI: 10.1186/s12905-024-03258-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Cervical cancer screening results that are negative for cytology but positive for high-risk human papillomavirus (HR-HPV) are not uncommon. One-year follow-up is suggested for patients with no history of HPV positivity under the most recent American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines (2019). The aim of this study was to evaluate the immediate risk of cervical intraepithelial neoplasia (CIN) among cytology-negative patients positive for HR-HPV. The diagnostic accuracy of colposcopy in these patients was investigated. METHODS A retrospective study was conducted in patients who were cytology negative but HR-HPV positive and referred for colposcopy from January 2022 to August 2023. Patients were compared in terms of the immediate rate of CIN lesions among the HPV16-positive group, the HPV18-positive group and the non-16/18 HR-HPV-positive group. The distribution of CIN2 + lesions according to age was evaluated. The factors associated with the accuracy of colposcopy were evaluated using univariate and multivariate logistic regression. RESULTS Among the 372 patients, 195 had chronic cervicitis, 131 had CIN1, 37 had CIN2/3, and nine had carcinoma. The immediate rates of CIN2 + lesions and CIN3 + lesions in patients who were not HR-HPV16/18-positive were comparable to those in patients who were HPV16/18-positive (P = 0.699). In addition, among patients diagnosed with CIN2 + lesions, 8 (17.39%) patients were women aged < 30 years. When pathological results were used as a reference, the consistency rate of colposcopy was 61.0% (227/372). Multivariate analyses revealed that age and the type of cervical transformation zone were independent factors affecting the accuracy of colposcopy (P < 0.001). CONCLUSIONS In countries with limited resources, immediate colposcopy referral should be recommended for patients who are cytology negative but HR-HPV-positive (including non-16/18 HR-HPV-positive), and cervical cancer screening via cotesting should be suggested for women aged < 30 years. Colposcopy has moderate diagnostic value and can be affected by age and the type of cervical transformation zone.
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Affiliation(s)
- Weichao Dai
- Department of Gynaecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Tongfei Wang
- Department of Gynaecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Lin Chen
- Department of Gynaecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Zhongyuan Qiu
- Department of Gynaecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Peifang Chen
- Department of Gynaecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China
| | - Dezhao Chen
- Department of Gynaecology and Obstetrics, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China.
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Li M, Zhao C, Zhang X, Li J, Zhao Y, Zhang W, Ren L, Wei L. PAX1/JAM3 Methylation and HPV Viral Load in Women with Persistent HPV Infection. Cancers (Basel) 2024; 16:1430. [PMID: 38611108 PMCID: PMC11010937 DOI: 10.3390/cancers16071430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
The relationship of PAX1/JAM3 methylation as well as HPV viral load (VL) with cervical lesions has been reported, but their role in persistent HPV infection without cervical high-grade lesions has not been fully elucidated. A total of 231 females diagnosed with persistent HPV infection and pathologically confirmed absence of high-grade cervical lesions were selected from the Colposcopy Outpatient Clinic of Peking University People's Hospital, from March 2023 to December 2023. They were categorized into two groups based on the duration of HPV infection: the HPV persistent less than 3 years group and the more than 3 years group. PAX1/JAM3 methylation and HPV VL were determined by real-time PCR and BioPerfectus Multiplex Real-Time (BMRT)-HPV reports type-specific VL/10,000 cells, respectively. The average age of individuals with HPV infection lasting more than 3 years was higher compared to those with less than 3 years (48.9 vs. 45.1 years), with a statistically significant difference. Among the participants, 81.8% (189/231) had no previous screening. The methylation levels of JAM3 and PAX1 were significantly higher in individuals with HPV infection persisting for more than 3 years compared to those with less than 3 years, with a statistically significant difference (p < 0.05). There was a significant correlation between PAX1 and JAM3 methylation (p < 0.001), which could be used as cumulative evidence of HPV infection duration before the occurrence of precancerous lesions. The incidence of vaginal intraepithelial lesions was higher in individuals with HPV infection persisting for more than 3 years compared to those with less than 3 years, and HPV VL can be used as an indicative biomarker for concurrent cervical-vaginal lesions, especially for HPV other than 16/18 genotypes.
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Affiliation(s)
| | | | | | | | | | | | | | - Lihui Wei
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11 Xizhimen South Street, Beijing 100044, China; (M.L.); (C.Z.); (X.Z.); (J.L.); (Y.Z.); (W.Z.); (L.R.)
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Srisuttayasathien M, Kantathavorn N, Luasiripanthu T, Petchjorm S, Samrarn J, Ittiamornlert P, Krisorakun W, Vanichtantikul A, Wetcho T, Saeloo S. Correlation between P16/Ki67 in cervical cytology and diagnosis of cervical intraepithelial neoplasia 2-3 in Thai women infected with high-risk types of human papillomavirus. Taiwan J Obstet Gynecol 2024; 63:192-198. [PMID: 38485314 DOI: 10.1016/j.tjog.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES The addition of p16/Ki-67 dual immunostaining to human papilloma virus (HPV) screening tests has been shown to increase the detection rate of high-grade cervical intraepithelial neoplasia. Thus, the aim of this study was to evaluate the accuracy of p16/Ki67 dual staining in the detection of cervical intraepithelial neoplasia 2 (CIN2+) in women with high-risk HPV infection. MATERIALS AND METHODS A cross-sectional study was conducted between August 2017 and August 2019 at the Chulabhorn Hospital in Bangkok, Thailand. Women aged 20-70 years who underwent co-testing and tested positive for high-risk (HR) HPV (N = 215) were invited to participate in the study. P16/Ki67 testing was performed on residual cytological materials. Colposcopic biopsies were performed on all patients, and the results were correlated with positive or negative p16/Ki-67 test results. RESULTS The sensitivity and specificity of p16/Ki-67 dual staining in the detection of CIN2+ in the women with HR HPV infection were 74.4 % and 63.4 %, respectively. Compared with liquid-based cytology (LBC), p16/Ki67 cytology had similar sensitivity (p = 1.000) and specificity (p = 0.561) to LBC for detecting CIN2+. CONCLUSION In this study, p16/Ki67 dual staining in HPV triage demonstrated a test performance similar to that of LBC.
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Affiliation(s)
- Manasawee Srisuttayasathien
- Department of Obstetrics and Gynecology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand.
| | - Nuttavut Kantathavorn
- Department of Obstetrics and Gynecology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand; Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Taksa Luasiripanthu
- Department of Pathology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Supinda Petchjorm
- Department of Pathology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Jidapa Samrarn
- Department of Obstetrics and Gynecology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Pornprom Ittiamornlert
- Department of Obstetrics and Gynecology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Wasanai Krisorakun
- Department of Obstetrics and Gynecology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Asama Vanichtantikul
- Department of Obstetrics and Gynecology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Thanita Wetcho
- Department of Obstetrics and Gynecology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Siriporn Saeloo
- Clinical Research Management Unit, Chulabhorn Learning and Research Centre, Chulabhorn Royal Academy, Bangkok 10210, Thailand
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Wu M, Ma X, Li H, Li B, Wang C, Fan X, Fan A, Xue F. Which is the best management for women with normal cervical cytologic findings despite positivity for non-16/18 high risk human papillomaviruses? Front Public Health 2022; 10:950610. [PMID: 36438260 PMCID: PMC9682294 DOI: 10.3389/fpubh.2022.950610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022] Open
Abstract
Women who test positive for the human papillomavirus (HPV) but have normal cytology constitute the predominant subgroup of patients in the screening population in the post-vaccination era. The distribution of HPV genotypes changed dramatically, which was attributable to an increase in HPV vaccination coverage. These changes have created uncertainty about how to properly manage women with normal cytology, non-HPV16/18 infections, or persistent infections. Current recommendations include retesting and continued surveillance in the absence of HPV16/18 infection. However, these are not always applicable. The ability to implement genotyping or incorporate HPV16/18 with some additional high-risk HPV (HR-HPV) types for triage and management with the aim of identifying type-specific risks in this population could be acceptable. When the next set of guidelines is updated, generating potential triage strategies for detecting high-grade cervical lesions, such as the p16/Ki67 cytology assay and other alternatives that incorporate genotyping with newer tests, should be considered. Current clinical management is shifting to risk-based strategies; however, no specific risk threshold has been established in this population. Importantly, innovative triage testing should be evaluated in combination with primary screening and management. Furthermore, there is an untapped opportunity to coordinate HPV genotyping in combination with colposcopic characteristics to modify risk in this group. Hence, providing a more personalized schedule through the efficient application of risk stratification and improving the detection of pre-cancer and cancer is an option worth exploring.
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Affiliation(s)
- Ming Wu
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaotong Ma
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Huiyang Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Bijun Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Chen Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiangqin Fan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Aiping Fan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,*Correspondence: Fengxia Xue
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Aromseree S, Wongjumpa W, Ekalaksananan T, Temtanakitpaisan A, Kleebkaow P, Srisathaporn S, Tongchai P, Pientong C. P16/Ki-67 Dual Staining in Positive Human Papillomavirus DNA Testing for Predictive Diagnosis of Abnormal Cervical Lesions in Northeastern Thai Women. Asian Pac J Cancer Prev 2022; 23:3405-3411. [PMID: 36308365 PMCID: PMC9924320 DOI: 10.31557/apjcp.2022.23.10.3405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Cervical cancer screening can effectively reduce new cervical cancer cases, including in Thailand. The abnormal results are subsequently referred for colposcopy. To avoid unnecessary colposcopy, an efficient triage is still needed for validation. This study aimed to investigate the overall positivity of cytology-based screening, HPV detection, and p16/Ki-67 dual staining and evaluate different triage strategies for predictive diagnosis of abnormal cervical lesions in northeastern Thailand. METHODS Cervical cells were collected from 191 women who came for cervical screening in the gynecological outpatient department during March 2019-February 2020. Pap smear samples were classified into 6 groups including 17 atypical glandular cells (AGC), 21 atypical squamous cells of undetermined significance (ASC-US), 7 atypical squamous cells - cannot exclude HSIL (ASC-H), 26 low-grade squamous intraepithelial lesions (LSILs), 19 high-grade SILs (HSILs) and 101 no squamous intraepithelial lesion (noSIL). Polymerase chain reaction (PCR) was performed for HPV DNA detection. HPV genotyping was determined by reverse line blot hybridization. P16/Ki-67 dual staining was performed by using CINtec PLUS Cytology kit. Biopsies from abnormal screening were collected for surgical pathology classification. RESULTS High-risk HPV (HR-HPV) infection was 2.97%, 29.41%, 38.10%, 57.14%, 46.15% and 84.21% in noSIL, AGC, ASC-US, ASC-H, LSIL and HSIL cytology respectively. P16/ Ki-67 in noSIL, AGC, ASC-US, ASC-H, LSIL and HSIL was 0.99%, 5.88%, 9.52%, 42.86%, 26.92% and 63.16%, respectively (P-value < 0.001). Among p16/Ki-67 positive cases, 96.15% (25/26) were infected with HPV and 84.62% (22/26) were HR-HPV. The overall positivity of each and co-testing between cytology or HPV DNA testing or p16/Ki-67 dual staining was evaluated. In each cervical lesion, primary HPV DNA testing showed the highest sensitivity, but low specificity. The combined all HPV/HR-HPV with p16/Ki-67 detection increased the specificity of abnormal cervical lesions. CONCLUSION P16/Ki-67 dual stain cytology in HPV-positive women performs well for diagnosis of abnormal cervical lesions and should be considered for management of HPV-positive women to avoid unnecessary colposcopy referrals.
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Affiliation(s)
- Sirinart Aromseree
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. ,HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Weerayut Wongjumpa
- HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Tipaya Ekalaksananan
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. ,HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Amornrat Temtanakitpaisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
| | - Pilaiwan Kleebkaow
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
| | - Sawarot Srisathaporn
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. ,HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Panwad Tongchai
- HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Chamsai Pientong
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. ,HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand. ,For Correspondence:
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Song F, Yan P, Huang X, Wang C, Du H, Qu X, Wu R. Roles of extended human papillomavirus genotyping and multiple infections in early detection of cervical precancer and cancer and HPV vaccination. BMC Cancer 2022; 22:42. [PMID: 34991494 PMCID: PMC8734293 DOI: 10.1186/s12885-021-09126-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background The aim of the study was to investigate the risk of human papillomavirus (HPV) genotyping particularly vaccine genotypes and multiple infections for cervical precancer and cancer, which might contribute to developing genotype-specific screening strategy and assessing potential effects of HPV vaccine. Methods The HPV genotypes were identified using the Seq HPV assay on self-collected samples. Hierarchical ranking of each genotype was performed according to positive predictive value (PPV) for cervical intraepithelial neoplasia 2/3 or worse (CIN2+/CIN3+). Multivariate logistic regression model was used to estimate the odds ratios (ORs) with 95% confidence interval (CI) of CIN2+ according to multiplicity of types and vaccine types. Results A total of 2811 HPV-positive women were analyzed. The five dominant HPV genotypes in high-grade lesions were 16/58/52/33/18. The overall ranking orders were HPV16/33/35/58/31/68/18/ 56/52/66/51/59/45/39 for CIN2+ and HPV16/33/31/58/45/66/52/18/35/56/51/68/59/39 for CIN3+. The risks of single infection versus co-infections with other types lower in the hierarchy having CIN2+ were not statistically significant for HPV16 (multiple infection vs. single infection: OR = 0.8, 95%CI = 0.6-1.1, P = 0.144) or other genotypes (P > 0.0036) after conservative Bonferroni correction. Whether HPV16 was present or not, the risks of single infection versus multiple infection with any number (2, ≥2, or ≥ 3) of types for CIN2+ were not significantly different. In addition, HPV31/33/45/52/58 covered by nonavalent vaccine added 27.5% of CIN2, 23.0% of CIN3, and 12.5% of cancer to the HPV16/18 genotyping. These genotype-groups were at significantly higher risks than genotypes not covered by nonavalent vaccine. Moreover, genotypes covered by nonavalent vaccine contributed to 85.2% of CIN2 lesions, 97.9% of CIN3 and 93.8% of cancers. Conclusions Partial extended genotyping such as HPV33/31/58 but not multiplicity of HPV infections could serve as a promising triage for HPV-positive self-samples. Moreover, incidence rates of cervical cancer and precancer were substantial attributable to HPV genotypes covered by current nonavalent vaccination. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09126-3.
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Affiliation(s)
- Fangbin Song
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China
| | - Peisha Yan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China. .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China.
| | - Xinfeng Qu
- Sanming Project of Medicine in Shenzhen, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China. .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China.
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Cabibi D, Napolitano C, Giannone AG, Micciulla MC, Porcasi R, Lo Coco R, Bosco L, Vinciguerra M, Capra G. Predictive Role of the p16 Immunostaining Pattern in Atypical Cervical Biopsies with Less Common High Risk HPV Genotypes. Diagnostics (Basel) 2021; 11:diagnostics11111947. [PMID: 34829294 PMCID: PMC8619678 DOI: 10.3390/diagnostics11111947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/10/2023] Open
Abstract
P16 immunostaining is considered a useful surrogate of transcriptionally active high-risk (hr) HPV infection. Only strong and widespread “block-like” immunoreactivity is considered specific, whereas weak/focal p16 positive immunostaining is considered not specific, and follow-up and HPV molecular detection is not indicated. The aim of the study was to evaluate the presence of HPV DNA and Ki67 immunostaining in 40 cervical atypical biopsies (CALs) with mild and focal histological features suggestive of HPV infection—20 cases with weak/focal p16 positive immunoreactivity and 20 cases negative for p16 expression. In 16/20 weak/focal p16 positive CALs (80%), the INNO-LiPA HPV genotyping detected hrHPV genotypes (HPV 31, 51, 56, 59, 26, 53, 66, 73, and 82). Co-infection of two or more hrHPV genotypes was often evidenced. HPV16 and 18 genotypes were never detected. Ki67 immunostaining was increased in 10/20 cases (50%). In 19/20 p16 negative CALs, hrHPV infection was absent and Ki67 was not increased. These results suggest that weak/focal p16 immunostaining represents the early stage of transcriptionally active infection, strongly related to the presence of less common hrHPV genotypes, probably with a slower transforming power, but with a potential risk of progression if the infection persists. HPV DNA genotyping and follow-up could be useful in these cases to verify if they are able to evolve into overt dysplastic changes and to improve knowledge of less common hrHPV genotypes.
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Affiliation(s)
- Daniela Cabibi
- Anatomic Pathology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (D.C.); (C.N.); (M.C.M.); (R.P.); (R.L.C.); (G.C.)
| | - Caterina Napolitano
- Anatomic Pathology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (D.C.); (C.N.); (M.C.M.); (R.P.); (R.L.C.); (G.C.)
| | - Antonino Giulio Giannone
- Anatomic Pathology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (D.C.); (C.N.); (M.C.M.); (R.P.); (R.L.C.); (G.C.)
- Correspondence: ; Tel.: +39-0916553725
| | - Maria Carmela Micciulla
- Anatomic Pathology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (D.C.); (C.N.); (M.C.M.); (R.P.); (R.L.C.); (G.C.)
| | - Rossana Porcasi
- Anatomic Pathology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (D.C.); (C.N.); (M.C.M.); (R.P.); (R.L.C.); (G.C.)
| | - Roberta Lo Coco
- Anatomic Pathology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (D.C.); (C.N.); (M.C.M.); (R.P.); (R.L.C.); (G.C.)
| | - Liana Bosco
- Section of Biology and Genetics, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D), University of Palermo, 90127 Palermo, Italy;
- Department of Biological, Chemistry and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, 90127 Palermo, Italy
| | - Manlio Vinciguerra
- International Clinical Research Center, St. Anne’s University Hospital, 656 91 Brno, Czech Republic;
- Division of Medicine, Institute for Liver and Digestive Health, University College London (UCL), London WC1E 6BT, UK
- Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, 9002 Varna, Bulgaria
| | - Giuseppina Capra
- Anatomic Pathology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (D.C.); (C.N.); (M.C.M.); (R.P.); (R.L.C.); (G.C.)
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Song F, Belinson JL, Yan P, Huang X, Wang C, Du H, Qu X, Wu R. Evaluation of p16 INK4a immunocytology and human papillomavirus (HPV) genotyping triage after primary HPV cervical cancer screening on self-samples in China. Gynecol Oncol 2021; 162:322-330. [PMID: 34059349 DOI: 10.1016/j.ygyno.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Self-sampling for human papillomavirus (HPV) testing is an effective option to increase the cervical screening coverage. How to best triage HPV-positive self-samples remains controversial. Here, we evaluated the performance of a novel p16INK4a immunocytology approach (p16) and HPV genotyping in triaging HPV-positive self-samples. METHODS A cohort of 73699 women were screened via SeqHPV assay on self-samples. HPV-positive women who met any sequential positive result of HPV16/18 or VIA or p16 were referred for colposcopy. A triage strategy was considered favorable if the NPV for CIN3+ was ≥98%, combined with an improvement of sensitivity and specificity in comparison to the comparator, being the 'ASC-US+' triage and the guideline strategy (HPV16/18+ or ASC-US+). RESULTS A total of 3510 HPV-positive women were included, 422 (12.0%) CIN2+ and 247 (7.0%) CIN3+ were identified. The positivity of p16 and ASC-US+ were 36.3% and 22.2%, respectively. p16 was more sensitive and less specific than ASC-US+ (P < 0.0001). However, when combined p16 with cytology or genotypes, two triage strategies were superior to the 'ASC-US+' strategy: p16 scored 3+; HPV16/33/58/31+ &p16+. Moreover, four strategies were favorable to the guideline strategy: ASC-US+ or p16+; LSIL+ or p16+; HPV16+ or p16+; HSIL+ or p16+ or HPV16+. These strategies achieved better balance between diseases detection and colposcopy referral. CONCLUSIONS Our findings indicate the promising utility of p16 immunocytology via adjusting the staining score or serving as an ancillary tool to liquid-based cytology or combining with genotyping for the triage of HPV-positive self-samples, which promotes the precise screening of cervical cancer.
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Affiliation(s)
- Fangbin Song
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China
| | - Jerome L Belinson
- Preventive Oncology International, Cleveland Heights, OH, USA; The Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Peisha Yan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China.
| | - Xinfeng Qu
- Sanming Project of Medicine in Shenzhen, Peking University Shenzhen Hospital, Shenzhen 518036, PR China.
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China.
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