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Liu Q, Zhang T, Chen L, Zhou X, Zhang X, Zheng W, Niu S, Zhou F. Correlation of immediate prevalence of cervical precancers and cancers with HPV genotype and age in women with ASC-US/hrHPV+: a retrospective analysis of 2292 cases. J Clin Pathol 2024; 77:338-342. [PMID: 36653168 DOI: 10.1136/jcp-2022-208580] [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] [Received: 09/05/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
AIMS To stratify the risk of cervical precancers (high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS)) and cancers (squamous cell carcinoma (SCC) and adenocarcinoma) based on distinct high-risk human papillomavirus (hrHPV) genotypes as well as age groups among women with atypical squamous cells of undetermined significance (ASC-US) and hrHPV+results. METHODS In total, 2292 cases of ASC-US/hrHPV+ with immediate follow-up biopsy results were included in the study for prevalence analysis. RESULTS Overall, 12.2% women with ASC-US /hrHPV+ had HSIL+ while 0.22% had AIS+ lesions. The HPV-16+ group (31.6%) showed significantly higher prevalence of HSIL+ squamous lesions than other genotype groups (p<0.0001). The prevalence of SCC is significantly higher in HPV-16+ (1.8%) or HPV-18/45+ (1.1%) group than women in other genotype groups (0.1%) (p<0.0001). The HPV-18/45+ group (1.7%) showed significantly higher prevalence of AIS+ glandular lesions than other genotype groups (p=0.003). In addition, SCC prevalence was significantly higher in age over 50 group than that in age under 50 group (1.2% vs 0.2%, p=0.012). CONCLUSION Women with ASC-US/hrHPV+ are at significant risk of cervical precancers and cancers; notably, HPV-16+ group has a higher risk of HSIL squamous lesions and SCC while HPV-18/45+ group has a higher risk of AIS+ glandular lesions. In addition, the older patient group (>50 years) has a significantly higher risk of SCC. Therefore, HPV genotyping as well as patient age need to be considered in the clinical management of patient.
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Affiliation(s)
- Qin Liu
- Department of Pathology, Zhejiang University School of Medicine Women'sHospital, Hangzhou, Zhejiang, China
| | - Tao Zhang
- Department of Gynecology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang, China
| | - Liqing Chen
- Department of Gynecology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, Zhejiang, China
| | - Xin Zhou
- Department of Pathology, Zhejiang University School of Medicine Women'sHospital, Hangzhou, Zhejiang, China
| | - Xiaofei Zhang
- Department of Pathology, Zhejiang University School of Medicine Women'sHospital, Hangzhou, Zhejiang, China
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pathology, Parkland Hospital, Dallas, Texas, USA
| | - Shuang Niu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pathology, Parkland Hospital, Dallas, Texas, USA
| | - Feng Zhou
- Department of Pathology, Zhejiang University School of Medicine Women'sHospital, Hangzhou, Zhejiang, China
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Wang X, Zhang H, Chen L, Xu J, Qu P. A novel method for colposcopic shunting in HPV-positive women: Quantitative detection of HPV E7 oncoprotein. Heliyon 2024; 10:e25238. [PMID: 38420415 PMCID: PMC10900405 DOI: 10.1016/j.heliyon.2024.e25238] [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: 07/30/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
The objective of the study was to evaluate the clinical application potential of quantitatively detecting human papillomavirus (HPV) E7 oncoprotein in HPV-positive women, with the goal of detecting potential high-grade cervical squamous intraepithelial lesions (HSIL) and cervical cancer improving the accuracy of colposcopic shunting in these patients.HPV-positive women (N = 611) were selected for quantitatively detecting HPV E7 protein levels by magnetic particle-based chemiluminescence immunoassay before colposcopy. Receiver operating characteristic (ROC) curve analysis was performed (n = 400) to determine diagnostic detection thresholds for HPV E7 oncoprotein. ThinPrep cytology test (TCT) and Aptima HPV E6/E7 mRNA analysis were also performed (n = 211). The diagnostic performance of these three diagnostic methods in detecting HSIL and cervical cancer was compared with the gold standard of pathological diagnosis. The area under the ROC curve was 0.724. The diagnostic detection threshold of HPV E7 oncoprotein was ≥10.88 ng/mL. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and Youden index of HPV E7 oncoprotein for the identification of HSIL and cervical cancer were 78.7 %, 77.9 %, 72.2 %, 83.3 %, and 56.6 %, respectively, which were higher than those of TCT and HPV E6/E7 mRNA.The results indicate that quantitative detection of HPV E7 oncoprotein can effectively shunt HPV-positive women and reduce unnecessary colposcopy and biopsy. It can detect potential HSIL and cervical cancer in a timely manner and prevent high-risk patients from missing diagnosis.
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Affiliation(s)
- Xinmei Wang
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Hongyuan Zhang
- Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Leiyi Chen
- Department of Outpatient office, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Juan Xu
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
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Liu Y, Jin X, Gong Y, Ma Y, Du B, Yang L, Wang Y, Zhu W. Do women with high-risk HPV E6/E7 mRNA test positivity and NILM cytology need colposcopy? Infect Agent Cancer 2023; 18:54. [PMID: 37773080 PMCID: PMC10542237 DOI: 10.1186/s13027-023-00531-w] [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: 03/08/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE This study aimed to assess the value of an HPV E6/E7 mRNA assay and HPV 16 18/45 genotype assay combined with age stratification for triaging women negative for intraepithelial lesions or malignancy (NILM) cytology. METHODS From January 2017 to December 2021, a total of 162,309 eligible women underwent cervical cancer screening at the Affiliated Hospital of Jining Medical University, China. Excluding those with negative HPV E6/E7 mRNA, abnormal and unsatisfactory cytology, and those who failed to undergo colposcopy, 6,845 women were ultimately included in our study. We analysed the triage guidance for different subtypes of HPV in the presence of NILM cytology. RESULTS Among 162,309 women, 19,834 (12.2%) were positive for HPV E6/E7 mRNA. Of the 6,845 women included in the study, 1,941 (28.4%), 561 (8.2%), 55 (0.8%) and 4,288 (62.6%) tested positive for HPV 16, HPV 18/45, HPV16/18/45 or other HR-HPV genotypes, respectively. The proportions of LSIL+ (including LSIL, HSIL and ICC) and HSIL+ (including HSIL and ICC) pathological results in the HPV 16/18/45 + group were 57% and 34.1%, respectively, higher than 36.3% and 11% in the other HR-HPV + group (χ2 = 653.214, P < 0.001). The percentages of LSIL + and HSIL + in the HPV16 + group (61.3% and 42.8%, respectively) and HPV16+/18/45 + group (76.3% and 41.9%, respectively) were much higher than those in the HPV18 + group (40.6% and 13.1%, respectively) (P < 0.001). However, there was no significant difference in the percentage of histopathological results between the HPV16 + group and HPV16+/18/45 + groups (P > 0.05). The above results were consistent after stratification according to age. CONCLUSION The rate of histopathological abnormalities was still high for the other HR-HPV subtypes with NILM cytology, although the rate of histopathological abnormalities was much higher for the HPV 16/18/45 positive subtypes. Therefore, colposcopy should be performed in women with HPV E6/E7 mRNA positivity and NILM cytology, regardless of age and HPV genotype.
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Grants
- M-2022242 Shandong Provincial Traditional Chinese Medicine Science and Technology Development Project
- M-2022242 Shandong Provincial Traditional Chinese Medicine Science and Technology Development Project
- 2020YXNS026,2021YXNS085,2022YXNS007 the Key R&D Program of Jining
- 2020YXNS026,2021YXNS085,2022YXNS007 the Key R&D Program of Jining
- 2020YXNS026,2021YXNS085,2022YXNS007 the Key R&D Program of Jining
- 2020YXNS026,2021YXNS085,2022YXNS007 the Key R&D Program of Jining
- JYHL2018FMS07,JYHL2022FMS01 Research Fund for Academician Lin He New Medicine
- JYHL2018FMS07,JYHL2022FMS01 Research Fund for Academician Lin He New Medicine
- 81502255 the National Natural Science Foundation of China
- the Key R&D Program of Jining
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Affiliation(s)
- Ying Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Xiu Jin
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Yingying Gong
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Yingying Ma
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Beibei Du
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Linqing Yang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Yunfei Wang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China.
| | - Weipei Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Fu Y, Li Y, Li X, Wang X, Lü W. Risk stratification for cervical precancer and cancer by DH3-HPV partial genotyping and cytology in women attending cervical screening: A retrospective cohort study. J Med Virol 2023; 95:e28482. [PMID: 36609841 DOI: 10.1002/jmv.28482] [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: 08/14/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023]
Abstract
To evaluate the effect of DH3-human papillomavirus (HPV) partial genotyping for risk stratification in cervical cancer screening, we conducted a post hoc analysis within a retrospective cohort of 7263 Chinese women aged 21-71 years who participated in population-based screening. The residual cytological samples at baseline were retested with DH3-HPV and Hybrid Capture 2 (HC2) assay after 3-year follow-up. Risk values with 95% confidence intervals (CIs) of cervical intraepithelial neoplasia (CIN) grade 3/2 or worse (CIN3+/CIN2+) were estimated based on HPV and cytology results. The report complies with the STROBE statement. Across every cytological result, risk estimates obtained from DH3-HPV and HC2 were similar or almost identical. By DH3-HPV partial genotyping, risks of CIN3+/CIN2+ were invariably higher for HPV16/18 than other high-risk HPV (hrHPV). Among women with normal cytology, immediate CIN3+ risks were 8.16% (95% CI = 4.19%-15.28%) for HPV16/18 positive and 0.48% (95% CI = 0.13%-1.73%) for other hrHPV positive. Among women with any abnormal cytology, immediate CIN3+ risks were 33.33% (95% CI = 22.24%-46.64%) for HPV16/18, and 13.33% (95% CI = 8.37%-20.56%) for other hrHPV. Among 5840 women completed 3-year follow-up, the cumulative CIN3+ risk was 25.56% (95% CI = 18.91%-33.59%) for HPV16/18 and 8.22% (95% CI = 6.02%-11.13%) for other hrHPV. Women with an HPV-negative result with DH3-HPV or HC2 test had very low cumulative 3-year CIN3+ risk (0.06%, 95% CI = 0.02%-0.17%), which was about one-tenth of women with normal cytology at baseline (0.62%, 95% CI = 0.45%-0.86%). Similar patterns were observed for the endpoint of CIN2+. These findings suggest that partial genotyping of DH3-HPV performs well in risk stratification, which can better balance the benefits and harms of cervical cancer screening.
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Affiliation(s)
- Yunfeng Fu
- Medical Centre for Cervical Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Li
- Medical Centre for Cervical Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Li
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyu Wang
- Department of Gynecology and Obstetrics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiguo Lü
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Zhuang L, Weng X, Wang L, Xie X, Zhong L, Liu D, Xiu Y. Performance of the Human Papillomavirus E6/E7 mRNA Assay in the Primary Screening of Cervical Cancer: Opportunistic Screening in Fujian, China. Int J Womens Health 2022; 14:1519-1530. [PMID: 36317009 PMCID: PMC9617522 DOI: 10.2147/ijwh.s383431] [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: 07/22/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose A high-risk human papillomavirus E6/E7 mRNA (HR-HPV mRNA) assay is widely used in cervical cancer screening in China. However, it is still unclear whether stand-alone HR-HPV mRNA testing is sufficient for primary screening. The purpose of this study was to investigate the feasibility of a stand-alone HR-HPV mRNA assay for primary screening of cervical cancer. Methods Women aged 21 and older were recruited in Fujian Province, China, from January 2020 to January 2022. Cervical exfoliated cells were collected for cervical cytology and HR-HPV mRNA assays, and women with positive results on either assay were referred for colposcopy. The screening effectiveness of the assay was calculated based on the cervical histology. When comparing the efficacy of the different screening strategies, only women aged 25 and older were included. Results A total of 9927 women were recruited. This study identified 217 cases of high-grade squamous intraepithelial disease or worse (HSIL+). The overall age-specific HR-HPV infection rate showed a U-shaped distribution. The sensitivity of the HR-HPV mRNA assay to identify CIN2+ and CIN3+ was 97.2% and 97.9%, respectively, which was significantly higher than that of cytology (82.9% and 88.6%, P<0.001 and 0.002). The sensitivity of the HR-HPV mRNA primary screening strategy to identify CIN2+ and CIN3+ was 92.2% and 94.3%, respectively, which was similar to the co-testing strategy (P=0.336 and 0.394) and higher than the cytology primary screening (P=0.002 and 0.048). In addition, the HR-HPV primary screening strategy had a lower referral rate for colposcopy than cytology primary screening (5.4% vs 6.6%, P<0.001), and the screening cost was lower than co-testing ($29,594.3 per 1000 screened women vs $55,140 per 1000 screened women, P<0.001). Conclusion In conclusion, the detection of CIN2+/CIN3+ by HR-HPV mRNA is both specific and sensitive. It may be suitable for primary screening of cervical cancer in China.
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Affiliation(s)
- Lijuan Zhuang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Xiulan Weng
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Lihua Wang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Xiaoyan Xie
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Liying Zhong
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Dabin Liu
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yingling Xiu
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China,Correspondence: Yingling Xiu; Dabin Liu, Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Fuzhou, People’s Republic of China, Tel +86-13860610354; +86-13489997701, Fax +86-591-87551247, Email ; ;
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Zhang J, Yang D, Cui X, Liu G, Cui Z, Wang C, Piao H. Performance of human papillomavirus E6/E7 mRNA assay for primary cervical cancer screening and triage: Population-based screening in China. Front Cell Infect Microbiol 2022; 12:935071. [PMID: 36105144 PMCID: PMC9465014 DOI: 10.3389/fcimb.2022.935071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023] Open
Abstract
ObjectiveCervical cancer screening is very important in the prevention and treatment of cervical cancer. In China, the cervical screening strategy needs to be improved. To explore a suitable cervical screening strategy in China, we evaluated the performance of the human papillomavirus (HPV) E6/E7 mRNA (Aptima HPV (AHPV)) assay in primary screening and different triage strategies for women undergoing routine cervical screening.MethodsA total of 10,002 women aged 35 to 65 years of age were recruited in Liaoning Province and Qingdao City, China. Specimens were tested by liquid-based cytology (LBC) and the AHPV assay, and women who tested positive on any test were referred for colposcopy. Genotyping was performed on all high-risk HPV (HR-HPV)-positive samples. Test characteristics were calculated based on histological review.ResultsWe identified 109 women with high-grade squamous intraepithelial lesion or worse (HSIL+), including six with cervical cancer. The sensitivity of AHPV was clearly higher than that of LBC (92.7 [95% CI: 87.2, 97.2] vs. 67.9 [95% CI: 59.6, 76.1], p < 0.001). The specificity of AHPV was 93.0 (95% CI: 92.5, 93.5), which was lower than that of LBC (95.2 [95% CI: 94.8, 95.6], p < 0.001). There was no statistical difference between the positive predictive value of AHPV and LBC (13.5 [95% CI: 11.2, 16.2] vs. 14.3 [95% CI: 11.4, 17.6], p = 0.695). The difference of area under the curve (AUC) values between the AHPV test (0.928 [95% CI: 0.904, 0.953]) and LBC test (0.815 [95% CI: 0.771, 0.860]) in detecting HSIL+ was statistically significant (p < 0.001). Finally, among the three triage strategies, both the sensitivity (73.4 [95% CI: 65.1, 81.7]) and AUC (0.851 [95% CI: 0.809, 0.892]) of AHPV genotyping with reflex LBC triage were the greatest.ConclusionIn summary, the AHPV assay is both specific and sensitive for detecting HSIL+ and may be suitable for use in primary cervical cancer screening in China. AHPV genotyping with reflex LBC triage may be a feasible triage strategy.
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Affiliation(s)
- Jing Zhang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Di Yang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Xiaoli Cui
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Guangcong Liu
- Department of Epidemiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Zhumei Cui
- Department of Gynecology, Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
- *Correspondence: Haozhe Piao, ; Chunyan Wang, ; Zhumei Cui,
| | - Chunyan Wang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
- *Correspondence: Haozhe Piao, ; Chunyan Wang, ; Zhumei Cui,
| | - Haozhe Piao
- Department of Neurosurgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
- *Correspondence: Haozhe Piao, ; Chunyan Wang, ; Zhumei Cui,
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7
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Accuracy and effectiveness of HPV mRNA testing in cervical cancer screening: a systematic review and meta-analysis. Lancet Oncol 2022; 23:950-960. [DOI: 10.1016/s1470-2045(22)00294-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 12/13/2022]
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8
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Giorgi Rossi P, Ronco G, Mancuso P, Carozzi F, Allia E, Bisanzi S, Gillio-Tos A, De Marco L, Rizzolo R, Gustinucci D, Del Mistro A, Frayle H, Confortini M, Iossa A, Cesarini E, Bulletti S, Passamonti B, Gori S, Toniolo L, Barca A, Bonvicini L, Venturelli F, Benevolo M. Performance of HPV E6/E7 mRNA Assay as Primary Screening Test. Results from the NTCC2 Trial. Int J Cancer 2022; 151:1047-1058. [PMID: 35579975 DOI: 10.1002/ijc.34120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/17/2022] [Accepted: 04/23/2022] [Indexed: 11/11/2022]
Abstract
As the primary screening test, E6/E7 mRNA has shown similar sensitivity for CIN3+ and lower positivity rate than the HPV DNA test. Nevertheless, the overall mRNA positivity is too high for immediate colposcopy, making a triage test necessary. The aim was to estimate the mRNA performance as a primary test with different triage strategies. All HPV DNA-positives were tested for mRNA, cytology and p16/ki67. A sample of HPV DNA-negatives were also tested for mRNA to estimate test specificity. We included all CIN3+ histologically diagnosed within 24 months since recruitment. Of the 41127 participants, 7.7% were HPV DNA-positive, of which 66.4% were mRNA-positive. Among the HPV DNA-negatives, 10/1108 (0.9%) were mRNA-positive. Overall, 97 CIN3+ were found. If mRNA was used as the primary test, it would miss about 3% of all CIN3+ with a 22% reduction of positivity compared to HPV DNA. The weighted specificity estimate for <CIN2 was 94.5% (95% CI=93.9%-94.9%) and sensitivity for CIN3+ was 96.9% (95% CI=91.3%-99.1%). If all the weighted estimated 6.0% mRNA-positive women had been referred to colposcopy, PPV for CIN3+ would have been 4.2%. Cytology or p16/ki67 triage would decrease immediate referral to 1.7% and 2.0%, increasing PPV to 11.2% and 11.7%, respectively; total colposcopy referral would be 4.0% and 3.9%, respectively. As the primary screening test, the mRNA assay showed a positivity rate lower than that of HPV DNA, with a small number of CIN3+ missed. Triage with cytology or p16/ki67 would only marginally decrease overall colposcopy referral.
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Affiliation(s)
- Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention (CPO), Turin, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesca Carozzi
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Elena Allia
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Simonetta Bisanzi
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Anna Gillio-Tos
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Laura De Marco
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy.,Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | | | | | | | - Helena Frayle
- Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Massimo Confortini
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Anna Iossa
- ISPRO Oncological Network, Prevention and Research Institute, Screening Unit, Florence, Italy
| | - Elena Cesarini
- Laboratorio Unico di Screening USL Umbria1, Perugia, Italy
| | | | | | - Silvia Gori
- Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | | | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Maria Benevolo
- IRCCS - Regina Elena National Cancer Institute, Rome, Italy
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9
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Bogdanova A, Andrawos C, Constantinou C. Cervical cancer, geographical inequalities, prevention and barriers in resource depleted countries (Review). Oncol Lett 2022; 23:113. [PMID: 35251344 PMCID: PMC8850967 DOI: 10.3892/ol.2022.13233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Anna Bogdanova
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, CY‑1700 Nicosia, Republic of Cyprus
| | - Charles Andrawos
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, CY‑1700 Nicosia, Republic of Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, CY‑1700 Nicosia, Republic of Cyprus
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10
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Wang J, Dong J, Zhou Y, Wang K, Pan M, Deng Z, Wang P, Du Y, Lu W. Performance of human papillomavirus (HPV) mRNA testing and HPV 16 and 18/45 genotyping combined with age stratification in the triaging of women with ASC-US cytology. Gynecol Oncol 2022; 164:607-614. [PMID: 34996586 DOI: 10.1016/j.ygyno.2021.12.033] [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: 10/08/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to assess the clinical performance of an HPV E6/E7 mRNA assay (Aptima HPV, AHPV) and AHPV 16 18/45 genotype assay (AHPV-GT) combined with age stratification for triaging women with atypical squamous cells of undetermined significance (ASC-US) cytology. METHODS In total, 3052 women >21 years old with ASC-US cytology underwent AHPV testing, and AHPV-positive samples were reflex-tested with the AHPV-GT test. All women were referred for colposcopy and then biopsy if indicated. The AHPV and AHPV-GT test performances and risk estimates by hrHPV status with age stratification were calculated. RESULTS Overall, 1599 women (52.4%) tested AHPV positive; of these women, 225 (7.4%), 101 (3.3%) and 1273 (41.7%) tested HPV 16+, HPV 18/45+ and other hrHPV-genotype-positive. When identifying CIN3+, the AHPV test had a 93.2% sensitivity and achieved a higher NPV (99.7% vs. 98.5%, P < 0.001) but a lower PPV (4.3% vs. 10.4%, P < 0.001) than the AHPV-GT test. The immediate risks of CIN3+ in AHPV+, other hrHPV+, and AHPV-GT+ women were 4.3%, 2.7%, and 10.4%, respectively. In the 21-24-year-old group, the immediate risks were 1.6%, 2.0% and 0.0%, which were below the 4.0% threshold for immediate colposcopy. The immediate colposcopy referral rate for AHPV-positive/ASC-US women 25 years or older was reduced from 51.7% to 10.5% by the AHPV-GT risk stratification method. CONCLUSIONS AHPV testing with age stratification is effective for triaging women with ASC-US cytology. AHPV-GT testing may be a proper risk stratification method for women with AHPV-positive ASC-US cytology.
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Affiliation(s)
- Jiajian Wang
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Jie Dong
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Yinjian Zhou
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Kaiyi Wang
- Department of Cervical Disease, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Min Pan
- Department of Cervical Disease, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Zaixing Deng
- Department of Pathology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Pengfei Wang
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Ying Du
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
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11
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Liu Q, Zhou X, Zhang X, Strickland AL, Zheng W, Chen H, Zhou F. HPV Genotype Specific and Age Stratified Immediate Prevalence of Cervical Precancers and Cancers in Women with NILM/hrHPV+: A Single Center Retrospective Study of 26,228 Cases. Cancer Manag Res 2021; 13:6869-6877. [PMID: 34512026 PMCID: PMC8421554 DOI: 10.2147/cmar.s328279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/30/2021] [Indexed: 01/16/2023] Open
Abstract
Purpose To investigate the prevalence of precancers [high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS)] and cancers [squamous cell carcinoma (SCC) and adenocarcinoma (ADC)] in various high-risk human papillomavirus (hrHPV) genotypes or age groups among women with negative for intraepithelial lesion or malignancy (NILM) and hrHPV-positive pap results. Materials and Methods In total, 26,228 women with NILM/hrHPV+ were included in the study. Among them, 5893 had immediate follow-up biopsy results available and were selected for further prevalence analysis. Results About 7.6% and 0.7% women with NILM/hrHPV+ had HSIL and AIS, respectively. The prevalence of HSIL+ squamous lesions is significantly higher in HPV-16+ group than that in other genotype groups (p < 0.0001). The prevalence of AIS+ glandular lesions is significantly higher in HPV-18/45+ groups than women in other genotype groups (p < 0.0001). In addition, the prevalence of HSIL+ lesions was significantly higher in age 25-39 years group than that in age 40-65 years group and >65 years group (p < 0.0001). Overall, the prevalence of HSIL+ in younger women was significantly higher than that in older women when using a cutoff age of 40 years (9.3% vs 5.9%, p < 0.0001) or 50 years (8.6% vs 4.9%, p < 0.0001). No significant difference in AIS+ prevalence was found among different age groups (p = 0.611). Interestingly, the prevalence of SCC and ADC in older women (≥40 years, 0.3% and 0.3%, respectively) was significantly higher than that in younger women (<40 years, 0% and 0.07%) (p = 0.001 for SCC; p = 0.02 for ADC). Conclusion The significant risk of cervical precancers and cancers still exists in women with NILM/hrHPV+, notably the older patient group had a lower risk of cervical precancer, but higher risk of cancer. Therefore, HPV genotyping can be an effective supplemental tool to cytology, and patient age also needs to be considered in the clinical management of patient.
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Affiliation(s)
- Qin Liu
- Department of Pathology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, People's Republic of China
| | - Xin Zhou
- Department of Pathology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, People's Republic of China
| | - Xiaofei Zhang
- Department of Pathology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, People's Republic of China
| | - Amanda Louise Strickland
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75235, USA
| | - Hao Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75235, USA
| | - Feng Zhou
- Department of Pathology, Zhejiang University School of Medicine Women's Hospital, Hangzhou, 310006, People's Republic of China
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12
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Ibáñez R, Mareque M, Granados R, Andía D, García-Rojo M, Quílez JC, Oyagüez I. Comparative cost analysis of cervical cancer screening programme based on molecular detection of HPV in Spain. BMC WOMENS HEALTH 2021; 21:178. [PMID: 33902553 PMCID: PMC8074415 DOI: 10.1186/s12905-021-01310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/15/2021] [Indexed: 12/24/2022]
Abstract
Background HPV cervical cancer screening (CCS) must use validated HPV tests based on the molecular detection of either viral mRNA (Aptima HPV Assay—AHPV) or DNA. AHPV has demonstrated the same cross-sectional and longitudinal sensitivity for the detection of HSIL/CIN2+ lesions but with greater specificity than HPV-DNA tests. The study aimed to estimate the total costs of a CCS with a primary HPV test based on the detection of mRNA compared to DNA in women aged 35–65 years for the National Health System. Methods A decision-tree-based model to estimate the cost of the CCS until the first colposcopy was designed based on Spanish CCS guidelines. The total cost (€, 2019) for CCS with AHPV or DNA tests (HC2 and Cobas) was calculated, including HPV test, liquid-based cytology (LBC) and colposcopy, for a population of 7,263,529 women aged 35–65 years (assuming 70% coverage). Clinical inputs derived from a literature review were validated by a multidisciplinary expert panel. Data from head-to-head studies between different HPV tests were selected. Results The use of AHPV showed reduction of 290,541 (− 35%) and 355,913 (− 40%) LBC compared to HC2 or Cobas, respectively. Furthermore, AHPV avoided 151,699 (− 47%) colposcopies versus HC2 and 151,165 (− 47%) versus Cobas. The total cost of CCS was € 282,747,877 with AHPV, € 322,587,588 with HC2 and € 324,614,490 with Cobas. Therefore, AHPV savings € − 39,839,711 versus HC2 and € − 41,866,613 versus Cobas. Conclusions Assuming that 70% of women from 35 to 65 years attend the CCS programme, the cost of screening up to the first colposcopy using AHPV would provide cost savings of up to € 41.9 million versus DNA tests in Spain. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01310-8.
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Affiliation(s)
- R Ibáñez
- Institut Català d'Oncologia (ICO), Cancer Epidemiology Research Program, Barcelona, Spain
| | - M Mareque
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Madrid, Spain.
| | - R Granados
- Pathology Department. Hospital, Universitario de Getafe, Madrid, Spain
| | - D Andía
- Gynecology and Obstetrics. Hospital Universitario Basurto, Bilbao, Spain
| | - M García-Rojo
- Pathology Department, Hospital, Universitario Puerta del Mar, Cádiz, Spain
| | - J C Quílez
- Gynecology and Obstetrics. Hospital Universitario Basurto, Bilbao, Spain
| | - I Oyagüez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Madrid, Spain
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13
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Bhatia R, Boada EA, Bonde J, Quint W, Christiansen IK, Xu L, Ejegod DM, Moncur S, Cuschieri K, Arbyn M. Evaluation of HarmoniaHPV test for detection of clinically significant Human Papillomavirus infection using the VALGENT framework. J Virol Methods 2021; 294:114161. [PMID: 33895238 DOI: 10.1016/j.jviromet.2021.114161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/29/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
AIM The VALidation of HPV GENotyping Tests (VALGENT) is a framework for comparison and validation of HPV tests with genotyping capabilities. In this study, the clinical performance of a single tube HPV test -HarmoniaHPV- was assessed in SurePath™ samples and compared to a clinically validated reference test, the GP5+/6+ Enzyme ImmunoAssay (GP5+/6 + EIA). METHODS HarmoniaHPV test is a real-time, PCR based, limited genotyping HPV test which detects 14 high-risk HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68 with HPV16, and HPV 18 reported individually. Clinical performance was assessed using 998 unselected, cervical screening samples enriched with 297 cytologically abnormal specimens (100 atypical squamous cells of unspecified significance, 100 low-grade squamous intraepithelial lesions, 97 high-grade squamous intraepithelial lesions). Cases were defined as women diagnosed with histologically confirmed cervical intraepithelial neoplasia 2 or more (≥CIN2, N = 122). RESULTS Using the manufacturer recommended (un-adjusted) cut-offs, HarmoniaHPV had non-inferior sensitivity for detection of ≥ CIN2 but showed inferior specificity. A cut-off optimisation exercise was therefore carried out and optimised cut-offs for each individual channel rendered a sensitivity and specificity of HarmoniaHPV that was non-inferior to GP5+/6 + EIA. Analytically, the test showed excellent intra- and inter-laboratory reproducibility, which improved further with the use of the optimised cut-offs. CONCLUSION HarmoniaHPV when operated with optimised cut-offs fulfils the international clinical criteria for use in cervical cancer screening on SurePath samples. The optimised cut-offs warrant additional testing and independent validation.
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Affiliation(s)
- Ramya Bhatia
- HPV Research Group, University of Edinburgh, EH16 4TJ, Edinburgh, Scotland, United Kingdom; Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, EH16 4SA, Edinburgh, Scotland, United Kingdom.
| | - Elia Alcañiz Boada
- HPV Research Group, University of Edinburgh, EH16 4TJ, Edinburgh, Scotland, United Kingdom
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegårds Alle 30, 2650, Hvidovre, Denmark
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Irene Kraus Christiansen
- Norwegian HPV Reference Laboratory, Department of Microbiology and Infection Control, Akershus University Hospital, 1478, Lørenskog, Norway
| | - Lan Xu
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Juliette Wytsmanstreet 14, B1050, Brussels, Belgium
| | - Ditte Møller Ejegod
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegårds Alle 30, 2650, Hvidovre, Denmark
| | - Sharon Moncur
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, EH16 4SA, Edinburgh, Scotland, United Kingdom
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, EH16 4SA, Edinburgh, Scotland, United Kingdom
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Juliette Wytsmanstreet 14, B1050, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
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14
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Li A, Li J, Austin RM, Wang T, Ashman D, Zhang H, Matsko J, Zhao C. Aptima HPV messenger RNA testing and histopathologic follow-up in women with HSIL cytology: A study emphasizing additional review of HPV-negative cases. Cancer Cytopathol 2021; 129:622-631. [PMID: 33764649 DOI: 10.1002/cncy.22421] [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: 01/18/2021] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND High-risk human papillomavirus (hrHPV) messenger RNA (mRNA) testing, the Food and Drug Administration-approved testing platform since 2013, has been increasing as a cervical screening alternative to hrHPV DNA testing methods. This study reports the largest routine clinical follow-up study reported to date of hrHPV mRNA cotesting and histopathologic follow-up results for women with high-grade squamous intraepithelial lesion (HSIL) cytology results. METHODS HSIL Papanicolaou test results for women cotested with Aptima hrHPV mRNA testing between June 2015 and November 2020 were analyzed along with recorded histopathologic follow-up results within 6 months of screening. RESULTS Aptima hrHPV mRNA-positive results were reported for 95.2% of the cotested HSIL cytology cases (905 of 951). Histopathologic cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was diagnosed on follow-up in 538 of 701 hrHPV mRNA-positive cases (76.8%) and in 15 of 36 hrHPV mRNA-negative cases (41.7%). Additional reviews of the hrHPV mRNA-negative HSIL cases showed variable interpretations, and confirmatory blinded-review interpretations of HSIL or atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion were more likely in cases with histopathologic CIN2+ (77.5% [93 of 120]) than those with cervical intraepithelial neoplasia grade 1 or negative findings (63.1% [101 of 160]; P < .01). CONCLUSIONS This large routine-clinical-practice study confirms the previously reported high sensitivity of hrHPV mRNA testing for the detection of high-grade cervical dysplasia and cervical cancers. The blinded-review findings indicate that additional cytology review may be helpful for confirming an interpretation of HSIL in daily practice, especially for hrHPV-negative HSIL cases.
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Affiliation(s)
- Aofei Li
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan Li
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Jinan Maternity and Child Care Hospital, Jinan, China
| | - R Marshall Austin
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tiannan Wang
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Pathology, University of Southern California, Los Angeles, California
| | - Dayne Ashman
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Huina Zhang
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Jonee Matsko
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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15
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Giorgi Rossi P, Carozzi F, Ronco G, Allia E, Bisanzi S, Gillio-Tos A, De Marco L, Rizzolo R, Gustinucci D, Del Mistro A, Frayle H, Confortini M, Iossa A, Cesarini E, Bulletti S, Passamonti B, Gori S, Toniolo L, Barca A, Bonvicini L, Mancuso P, Venturelli F, Benevolo M. p16/ki67 and E6/E7 mRNA Accuracy and Prognostic Value in Triaging HPV DNA-Positive Women. J Natl Cancer Inst 2021; 113:292-300. [PMID: 32745170 PMCID: PMC7936054 DOI: 10.1093/jnci/djaa105] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/12/2020] [Accepted: 07/23/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study presents cross-sectional accuracy of E6 and E7 (E6/E7) mRNA detection and p16/ki67 dual staining, alone or in combination with cytology and human papillomavirus (HPV)16/18 genotyping, as a triage test in HPV DNA-positive women and their impact on cervical intraepithelial neoplasia (CIN2+) overdiagnosis. METHODS Women aged 25-64 years were recruited. HPV DNA-positive women were triaged with cytology and tested for E6/E7 mRNA and p16/ki67. Cytology positive women were referred to colposcopy, and negatives were randomly assigned to immediate colposcopy or to 1-year HPV retesting. Lesions found within 24 months since recruitment were included. All P values were 2-sided. RESULTS 40 509 women were recruited, and 3147 (7.8%) tested HPV DNA positive; 174 CIN2+ were found: sensitivity was 61.0% (95% confidence interval [CI] = 53.6 to 68.0), 94.4% (95% CI = 89.1 to 97.3), and 75.2% (95% CI = 68.1 to 81.6) for cytology, E6/E7 mRNA, and p16/ki67, respectively. Immediate referral was 25.6%, 66.8%, and 28.3%, respectively. Overall referral was 65.3%, 78.3%, and 63.3%, respectively. Cytology or p16/ki67, when combined with HPV16/18 typing, reached higher sensitivity with a small impact on referral. Among the 2306 HPV DNA-positive and cytology-negative women, relative CIN2+ detection in those randomly assigned at 1-year retesting vs immediate colposcopy suggests a -28% CIN2+ regression (95% CI = -57% to +20%); regression was higher in E6/E7 mRNA-negatives (Pinteraction = .29). HPV clearance at 1 year in E6/E7 mRNA and in p16/ki67 negative women was about 2 times higher than in positive women (Pinteraction < .001 for both). CONCLUSIONS p16/ki67 showed good performance as a triage test. E6/E7 mRNA showed the highest sensitivity, at the price of too high a positivity rate to be efficient for triage. However, when negative, it showed a good prognostic value for clearance and CIN2+ regression.
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Affiliation(s)
- Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Carozzi
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Guglielmo Ronco
- International Agency for Research on Cancer, Lyon, France
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Elena Allia
- Center for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Simonetta Bisanzi
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Anna Gillio-Tos
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Laura De Marco
- Center for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Raffaella Rizzolo
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Daniela Gustinucci
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | | | | | - Massimo Confortini
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Anna Iossa
- ISPRO Oncological Network, Prevention and Research Institute, Screening Unit, Florence, Italy
| | - Elena Cesarini
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Simonetta Bulletti
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Basilio Passamonti
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Silvia Gori
- Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Laura Toniolo
- Azienda Unità Locale Socio Sanitaria 6, Este, Padua, Italy
| | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Benevolo
- IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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16
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Mousavi AS, Pouryasin A, Yarandi F, Pirzadeh L, Alipour A, Khodadad S, Pouryasin M. Assessment of Cervical Cancer Molecular-Based Screening Tools; HPV-DNA Detection versus E6/E7 mRNA Testing; First Report of a Prospective Cohort Study among Iranian Women. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1734-1742. [PMID: 33643949 PMCID: PMC7898099 DOI: 10.18502/ijph.v49i9.4093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Human papillomavirus (HPV) has been found as the most considerable causes of cervical cancer. Recently, several molecular methods have been introduced to increase the accuracy of the screening programs and decrease the mortality rate. Among these methods, mRNA-based methods have more advantages as they assess the expression level of HPV E6 and E7 oncogenic mRNAs. This study aimed to evaluate the results of HPV RNA- and DNA-based methods among Iranian women population with normal cytology results. Methods: Overall, 4640 women were enrolled referred to the Gynecology Oncology Ward of Vali-e-Asr Hospital, private and academic clinics, Tehran, Iran from Jan 2016 to Apr 2018. To assess the HPV-DNA infection INNO-LiPA® HPV Genotyping Extra-II kit was used. For HPV-RNA assessment, Aptima HPV Assay and in house HPV-RNA genotyping methods were applied. Results: The positivity rates of HPV infection according to DNA- and RNA-based methods were 18.0% and 11.2%, respectively (P<0.001). The positive predictive value, negative predictive value, specificity and sensitivity of DNA-based method in contrast with RNA-based method were 59.2% (56.6–61.6), 99.4% (99.0–99.6), 91.7% (90.8–92.6) and 95.2% (93.0–96.9) respectively. Conclusion: At the present study for prognosis of cervical cancer, RNA-based method seemed to be more specific in contrast to DNA-based method. Patient follow up and further studies will be conducted in order to clarify the clinical sensitivity and specificity of the two methods.
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Affiliation(s)
- Azam-Sadat Mousavi
- Department of Gynecology-Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.,National Association of Iranian Gynecologists and Obstetricians, Tehran, Iran.,Iranian Society for Colposcopy and Cervical Pathology, Tehran, Iran
| | - Ali Pouryasin
- Department of Molecular Diagnosis, Armin Pathobiology Laboratory, Tehran, Iran.,Department of Genetics, Arsanjan Branch, Islamic Azad University, Arsanjan, Iran
| | - Fariba Yarandi
- National Association of Iranian Gynecologists and Obstetricians, Tehran, Iran.,Iranian Society for Colposcopy and Cervical Pathology, Tehran, Iran.,Department of Gynecology-Oncology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Pirzadeh
- Department of Gynecology-Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.,National Association of Iranian Gynecologists and Obstetricians, Tehran, Iran.,Iranian Society for Colposcopy and Cervical Pathology, Tehran, Iran
| | - Abbas Alipour
- Thalassemia Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shakiba Khodadad
- National Association of Iranian Gynecologists and Obstetricians, Tehran, Iran.,Department of Gynecology-Oncology, Erfan Hospital, Tehran, Iran
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17
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Zorzi M, Del Mistro A, Giorgi Rossi P, Laurino L, Battagello J, Lorio M, Soldà M, Martinotti Gabellotti E, Maran M, Dal Cin A, Fiore A, Rugge M, Maggino T. Risk of CIN2 or more severe lesions after negative HPV-mRNA E6/E7 overexpression assay and after negative HPV-DNA test: Concurrent cohorts with a 5-year follow-up. Int J Cancer 2020; 146:3114-3123. [PMID: 31583683 DOI: 10.1002/ijc.32695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 11/05/2022]
Abstract
Aim of this study was to compare the 5-year risk of cervical intraepithelial neoplasia grade 2+ (CIN2+)/CIN3+ and the performance parameters at 3-year rescreening of a negative E6/E7 mRNA-human papillomavirus (HPV) test with those of a HPV-DNA-negative test. We studied a cohort of HPV-negative women tested with the Aptima HPV-mRNA Assay ("HPV-mRNA cohort") versus a cohort of HPV negatives tested with the Hybrid Capture 2 (HC2) DNA test living in neighboring areas. Both cohorts were rescreened after 3 years by a HPV-DNA test (HC2 or Cobas 4800 HPV test). HPV test positivity, referral to colposcopy and detection of CIN2+ at 3-year rescreening were computed. The Veneto Cancer Registry was checked to search for invasive cancers and CIN3 diagnosed up to 5 years from the negative baseline test. Some 22,338 HPV-mRNA and 68,695 HPV-DNA-negative women were invited to 3-year rescreening, and, respectively, 16,641 (74.5%) and 54,630 (79.6%) complied with the invitation. The proportion of HPV-positive tests, referral to colposcopy and detection of CIN2+ in the HPV-mRNA and HPV-DNA cohorts were, respectively. 4.0 and 3.9% (ratio 1.08; 95% confidence interval [CI] 0.99-1.17), 2.6 and 2.5% (ratio 1.06, 95% CI 0.95-1.18) and 1.4 and 1.7‰ (ratio 0.85, 95% CI 0.54-1.33). The relative 5-year cumulative risk of cancer and of CIN2+ in the HPV-mRNA and HPV-DNA cohorts were 4.5 and 8.7/100,000 (ratio 0.51; 95%CI 0.01-4.22) and 1.1 and 1.5/1,000 (ratio 0.74; 95%CI 0.45-1.16), respectively. A negative HPV-mRNA test confers a risk of invasive cervical carcinoma and of CIN2+ at 5 years comparable to that of a negative HPV-DNA test.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Annarosa Del Mistro
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Licia Laurino
- Pathology Unit, Dell'Angelo General Hospital, Venice, Italy
| | | | - Melania Lorio
- Department of Prevention, Local Health Authority 3 Serenissima, Venice, Italy
| | - Marika Soldà
- Department of Obstetrics and Gynaecology, Dell'Angelo General Hospital, Venice, Italy
| | | | - Michela Maran
- Pathology Unit, Dell'Angelo General Hospital, Venice, Italy
| | | | | | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padua, Italy.,Deparment of Diagnostic Medical Sciences and Special Therapies, University of Padova, Padua, Italy
| | - Tiziano Maggino
- Department of Obstetrics and Gynaecology, Dell'Angelo General Hospital, Venice, Italy
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Weston G, Dombrowski C, Harvey MJ, Iftner T, Kyrgiou M, Founta C, Adams EJ. Use of the Aptima mRNA high-risk human papillomavirus (HR-HPV) assay compared to a DNA HR-HPV assay in the English cervical screening programme: a decision tree model based economic evaluation. BMJ Open 2020; 10:e031303. [PMID: 32152154 PMCID: PMC7064071 DOI: 10.1136/bmjopen-2019-031303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the impact of using the Aptima messenger RNA (mRNA) high-risk human papilloma virus (HR-HPV) assay versus a DNA HR-HPV assay in a primary HPV cervical screening programme. DESIGN One hypothetical cohort followed for 3 years through HPV primary cervical screening. SETTING England. PARTICIPANTS A hypothetical cohort of women aged 25-65 years tested in the National Health Service (NHS) Cervical Screening Programme (CSP) for first call or routine recall testing. METHODS A decision tree parameterised with data from the CSP (2017/18) and the HORIZON study. Uncertainty analyses were conducted using data from the FOCAL and GAST studies, other DNA HPV tests in addition to one-way and probabilistic sensitivity and scenarios analyses, to test the robustness of results. INTERVENTIONS Aptima mRNA HR-HPV assay and a DNA HR-HPV assay (cobas 4800 HPV assay). MAIN OUTCOME MEASURES Primary: total colposcopies and total costs for the cohort. Secondary: total HPV and cytology tests, number lost to follow-up. RESULTS At baseline for a population of 2.25 million women, an estimated £15.4 million (95% credibility intervals (CI) £6.5 to 24.1 million) could be saved and 28 009 (95% CI 27 499 to 28 527) unnecessary colposcopies averted if Aptima mRNA assays are used instead of a DNA assay, with 90 605 fewer unnecessary HR-HPV and 253 477 cytology tests performed. These savings are due to a lower number of HPV positive samples in the mRNA arm. When data from other primary HPV screening trials were compared, results indicated that using the Aptima mRNA assay generated cost savings and reduced testing in every scenario. CONCLUSION Using the Aptima mRNA assay versus a DNA assay would almost certainly yield cost savings and reduce unnecessary testing and procedures, benefiting the NHS and women in the CSP.
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Affiliation(s)
| | | | | | - Thomas Iftner
- Department of Medical Virology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Kyrgiou
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Imperial College London, London, UK
- Queen Charlotte's and Chelsea, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Christina Founta
- Department of Gynaecological Oncology, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, Somerset, UK
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Ernstson A, Urdell A, Forslund O, Borgfeldt C. Cervical cancer prevention among long-term screening non-attendees by vaginal self-collected samples for hr-HPV mRNA detection. Infect Agent Cancer 2020; 15:10. [PMID: 32082413 PMCID: PMC7017526 DOI: 10.1186/s13027-020-00280-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background The efficacy of cervical cancer screening programs is dependent on the participation rate. To increase participation among women not attending cervical cancer screening, self-collected samples for detection of high-risk human papillomavirus (hr-HPV) may be an option. The aims of this study were: to investigate the response rate to sending a self-collected vaginal sample for hr-HPV mRNA detection to long-term non-attendees; the compliance with follow-up among women positive for HPV in the self-sample; the prevalence of cervical dysplasia (high grade squamous intraepithelial lesion (HSIL), atypical squamous cells that cannot exclude HSIL (ASC-H) or adenocarcinoma in situ (AIS)) or cancer among the responders; as well as to explore reasons for not returning a self-sample. Methods A vaginal self-sampling kit was sent to 6023 women aged 30–70 years who had not provided a cervical screening sample for ≥7 years in the Region of Skåne, Sweden in November and December 2017. The self-sample was analyzed by Aptima HPV mRNA assay (Hologic). All vaginal self-samples returned no later than May 31, 2018 were included in the study. Follow-up of the results was registered until January 31, 2019 with a follow-up time varying between eight to 14 months. Women positive for hr-HPV mRNA were invited for a follow-up examination. This examination consisted of a cervical sample for cytological analysis and renewed Aptima HPV mRNA testing. Two hundred thirty-five women who had not returned the self-sample were randomly selected for telephone interviews, in order to explore their reasons. Results The response rate for the self-collected vaginal hr-HPV sample was 13.2% [(797/6023), 95% CI 12.4–14.1%] and 9.9% [(79/796), 95% CI 7.9–12.2%] were positive for hr-HPV mRNA. The prevalence of severe dysplasia or cancer in the whole group of responders was 1.3% [(10/796), 95% CI 0.6–2.3%], with a cervical cancer prevalence of 0.4% [(3/796), 95% CI 0.1–1.1%]. Only 27 women participated in the telephone interviews, no particular reason for not returning self-samples was observed. Conclusions Self-collected vaginal hr-HPV samples increased participation in the cervical cancer screening among long-term non-attendees. The prevalence of cervical cancer was almost seven times higher for long-term non-attendees than in the organized screening population.
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Affiliation(s)
- Avalon Ernstson
- Department of Obstetrics & Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Annika Urdell
- Department of Obstetrics & Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ola Forslund
- 2Department of Medical Microbiology, Laboratory Medicine Region Skåne, Lund University, Lund, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics & Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
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20
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Alinity m HR HPV Assay Fulfills Criteria for Human Papillomavirus Test Requirements in Cervical Cancer Screening Settings. J Clin Microbiol 2019; 58:JCM.01120-19. [PMID: 31666369 DOI: 10.1128/jcm.01120-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/20/2019] [Indexed: 12/24/2022] Open
Abstract
The Alinity m HR HPV assay (Alinity) is a novel human papillomavirus (HPV) assay that individually identifies genotypes HPV16, HPV18, and HPV45 while reporting on 11 other high-risk HPV (hrHPV) genotypes in two aggregates: HPV31/33/52/58 and HPV35/39/51/56/59/66/68. The clinical performance of Alinity for screening for cervical cancer was evaluated in population-based settings. For women aged ≥30 years, the clinical sensitivity (n = 68) and specificity (n = 3,077) for the detection of cervical intraepithelial neoplasia grade 2+ (CIN2+) of Alinity were 100.0% and 92.4%, respectively, and were not inferior to those of the Qiagen Digene Hybrid Capture 2 high-risk HPV DNA assay (hc2) (P = 0.0006 and P < 0.0001, respectively). The intralaboratory reproducibility and interlaboratory agreement of Alinity were 96.7% (kappa, 0.92) and 98.7% (kappa, 0.97), respectively. In the group ≥30 years of age, women who were baseline hrHPV negative had a lower risk for CIN2+ at 3 years using Alinity (0.04%) than those with a normal baseline cytology (0.65%) and had a risk comparable to that determined by the Abbott RealTime High Risk HPV assay (0.04%), hc2 (0.08%), or the Roche Cobas 4800 HPV assay (0.04%). High-risk HPV16/18 infection was associated with a significantly higher baseline and 3-year CIN2+ and CIN3+ risk than the absence of HPV16/18 or the presence of hrHPVs at the baseline (all P values were <0.05). The baseline CIN2+ risk was 8.8% for those with HPV31/33/52/58 infection and 2.5% for those with HPV35/39/51/56/59/66/68 infection, while the 3-year CIN2+ risk was 17.0% and 4.9%, respectively (relative risk, 3.4 [P = 0.03] and 3.5 [P = 0.003], respectively), suggesting that extended genotyping by Alinity may be valuable in improving patient risk stratification. Alinity fulfills international consensus guideline criteria for primary cervical cancer screening and can be considered clinically validated, demonstrating safety comparable to that of other clinically validated HPV tests.
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Salazar KL, Duhon DJ, Olsen R, Thrall M. A review of the FDA-approved molecular testing platforms for human papillomavirus. J Am Soc Cytopathol 2019; 8:284-292. [PMID: 31320315 DOI: 10.1016/j.jasc.2019.06.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The advent of US Food and Drug Administration (FDA)-approved molecular testing for human papillomavirus (HPV) has resulted in a dramatic shift from cytological testing alone to a combination of cytology and molecular testing for primary HPV screening. HPV testing has quickly become an essential component of daily practice in most laboratories and clinical practices. Although the principle of HPV testing is now familiar, it is important to understand the mechanisms behind these platforms in order to properly interpret the results and understand the limits of each method. HPV tests are more automated and reproducible than cytology, but are by no means perfect. None of these platforms will identify every HSIL/CIN2+ or cancer. This fact must be kept in mind when correlating the results of HPV testing with cytology or biopsy findings. The goal of this paper is to review the FDA- approved molecular testing platforms for HPV, including methodology, limitations, and specifications. The concordance between the platforms will also be discussed. Package inserts of the 5 FDA- approved molecular testing platforms for HPV, as well as a literature review of the platforms, were reviewed and assimilated into the article. Due to the multiple modalities available for detection of hrHPV, the concordance between these assays becomes important. Prior publications have compared HC2, Cervista, cobas, and Aptima, with most studies comparing to HC2 because it is considered the reference standard. With the newly approved BD platform, concordance studies were reviewed as well.
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Affiliation(s)
- Katrina L Salazar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Daniel J Duhon
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
| | - Randall Olsen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Michael Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
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22
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Balducci G, Carbotta G, Sederino MG, Delvecchio A, Laforgia R, Sallustio P, Lobascio P, Ferrarese F, Minafra M, Fedele S, Palasciano N. Effective management of extensive tissue loss after abdominoperineal resection for Buschke-Loewenstein tumor. G Chir 2019; 38:229-232. [PMID: 29280702 DOI: 10.11138/gchir/2017.38.5.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The giant condyloma acuminatum or Buschke-Loewenstein tumor is a rare, sexually transmitted disease. It is an epithelial tumor characterized by its high potential of malignancy towards developing into a highly invasive squamous cell carcinoma. The present case concerns a drug addicted 40-year-old man who smuggled drugs using his rectum. He had a partially ulcerated mass in the perianal area of about 20 x 10 cm. He reported a progressive growth of this neoplasm during the last 3 years associated with perianal pain, obstructed defecation, bad sitting posture, no fever and weight loss. Our first approach was a left laparoscopic loop colostomy for a fecal diversion and antalgic purpose, and biopsy of the perineal mass. Then, he underwent a complete excision of the perianal neoplasm. The pathologist's positive diagnosis of a well differentiated squamous cell carcinoma, evidently necessitated the radicalization of the surgical procedure of abdominal perineal resection. In consideration of the surgical wound depth and size, a VAC Therapy with Negative Pressure Wound Therapy was applied. The BLT incidence rate has been steadily increasing over the last decade especially among male patients. An aggressive surgical approach is usually to get the best oncologic outcome but the difficult management of the perianal wound is challenging. In our experience VAC therapy has been shown to be an effective tool in promoting the healing of the perineal wound after abdominoperineal resection.
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23
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Lindroth Y, Borgfeldt C, Thorn G, Bodelsson G, Forslund O. Population-based primary HPV mRNA cervical screening compared with cytology screening. Prev Med 2019; 124:61-66. [PMID: 31047910 DOI: 10.1016/j.ypmed.2019.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/10/2019] [Accepted: 04/28/2019] [Indexed: 11/29/2022]
Abstract
Primary HPV screening for cervical cancer by HPV mRNA testing (Aptima) was implemented in January 2017, for women ≥30 through 70 years, in the Region of Skåne, Sweden. HPV positive samples underwent cytology assessment, and women with any degree of abnormal cytology were referred for colposcopy. The aim was to audit the primary HPV screening program, by comparing the cytology results to those of corresponding women (aged ≥30 through 65 years) screened with conventional cytology during 2016. Overall, HPV was detected among 7.0% (4433/63,055) of the women ≥30-70 years in the primary HPV screening program. Among a co-tested (cytology and HPV) subgroup aged 40-42 years (N = 5039), HPV was detected in 100% (28/28) of high-grade squamous intraepithelial lesions (HSIL) and atypical squamous cells of undetermined significance (ASCUS) where HSIL could not be excluded (ASCH) (9/9), and in 80% (4/5) of cases of atypical glandular cells (AGC). Among women ≥30-65 years, the proportion ASCUS or worse (ASCUS+) was similar with cytology (3.52% [2016]) and primary HPV screening (3.70% [2017]). Only the proportion of ASC-H changed by the use of primary HPV screening, from 0.13% (2016) to 0.23% (2017) (p < 0.001). The colposcopy referral rate increased by 54% (3.70 vs 2.41%), when primary HPV screening was introduced. In conclusion, the implemented primary HPV screening approach demonstrated similar prevalence of ASCUS+ cytology as conventional screening. In addition, primary HPV screening decreased cytology assessments by 86% in our screening population of women 30 through 70 years taken into account the co-tested women.
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Affiliation(s)
- Ylva Lindroth
- Department of Laboratory Medicine, Medical Microbiology, Lund University, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynaecology at Skåne University Hospital, Lund University, Sweden
| | - Gunilla Thorn
- Department of Laboratory Medicine, Clinical Genetics and Pathology, Lund, Sweden
| | - Gunilla Bodelsson
- Department of Laboratory Medicine, Clinical Genetics and Pathology, Lund, Sweden
| | - Ola Forslund
- Department of Laboratory Medicine, Medical Microbiology, Lund University, Sweden.
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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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Wang J, Du Y, Dong J, Zhou Y, Wang P, Zhang X, Chen Y, He P. Clinical significance of genotyping for human papillomavirus (HPV) 16 18/45 combined with cytology in cervical exfoliated cells in HPV oncogenic mRNA-positive women. Gynecol Oncol 2019; 153:34-40. [PMID: 30630629 DOI: 10.1016/j.ygyno.2018.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/24/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study aimed to assess human papilloma virus (HPV) 16 18/45 typing test results combined with cytology for cervical exfoliated cells from women who screened positive in an HPV E6/E7 mRNA assay (Aptima HPV, AHPV). METHODS In total, 3257 AHPV-positive women aged 25-65 years were underwent AHPV 16 18/45 Genotype assay (AHPV-GT) testing with cytology. Women were referred for colposcopy and further biopsy if indicated. Different triaging strategies were compared. RESULTS Overall, 624 women (19.2%) tested AHPV-GT positive. When identifying CIN2+, compared with cytology, AHPV-GT achieved a similar AUC (0.72 vs. 0.69, P = 0.158) but a higher specificity (85.1% vs. 79.3%, P < 0.001) and positive predictive value (PPV) (29.6% vs. 23.2%, P < 0.001). When identifying CIN2+, compared with cytology, the cotesting strategy (cytology combined with AHPV-GT) increased the AUC from 0.69 to 0.76 (P < 0.001), with a higher sensitivity (84.6% vs. 59.5%, P < 0.001), higher NPV (97.6% vs. 94.9%, P < 0.001) and similar PPV (21.6% vs. 23.2%, P = 0.054). When identifying CIN2+, the results of combination strategy (AHPV-GT genotyping plus reflex cytology in women positive for the 11 other hrHPV genotypes) were consistent with those of the cotesting strategy. Similar results were achieved when identifying CIN3 + . CONCLUSIONS The AHPV-GT test may be a promising triage approach with high specificity in women receiving AHPV-positive primary screening tests. Although a combination strategy and cotesting strategy detected the same CIN2+ and CIN3+ cases, the former required significantly fewer screening tests.
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Affiliation(s)
- Jiajian Wang
- Department of Gynecology, Huzhou Maternity&Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Ying Du
- Department of Gynecology, Huzhou Maternity&Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Jie Dong
- Department of Gynecology, Huzhou Maternity&Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Yuanping Zhou
- Department of Gynecology, Huzhou Maternity&Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Pengfei Wang
- Department of Gynecology, Huzhou Maternity&Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Xiaoxing Zhang
- Department of Gynecology, Huzhou Maternity&Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Yingying Chen
- Department of Gynecology, Huzhou Maternity&Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Pingya He
- Department of Gynecology, Huzhou Maternity&Child Health Care Hospital, Huzhou, Zhejiang Province, China.
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Iftner T, Neis KJ, Castanon A, Landy R, Holz B, Woll-Herrmann A, Iftner A, Staebler A, Wallwiener D, Hann von Weyhern C, Neis F, Haedicke-Jarboui J, Martus P, Brucker S, Henes M, Sasieni P. Longitudinal Clinical Performance of the RNA-Based Aptima Human Papillomavirus (AHPV) Assay in Comparison to the DNA-Based Hybrid Capture 2 HPV Test in Two Consecutive Screening Rounds with a 6-Year Interval in Germany. J Clin Microbiol 2019; 57:e01177-18. [PMID: 30355760 PMCID: PMC6322477 DOI: 10.1128/jcm.01177-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/08/2018] [Indexed: 11/20/2022] Open
Abstract
Longitudinal data on the E6/E7 mRNA-based Aptima human papillomavirus (AHPV) assay exceeding three years in comparison to the gold standard Digene Hybrid Capture 2 (HC2) test are not available. We previously reported the cross-sectional data of the German AHPV Screening Trial (GAST) in which 10,040 women were recruited and tested by liquid-based cytology, the HC2 assay, and the AHPV assay. Four hundred eleven test-positive women were followed for up to six years. In addition, 3,295 triple-negative women were screened after a median time of six years. Overall, 28 high-grade cervical intraepithelial neoplasia (CIN3) cases were detected. The absolute risk of developing high-risk HPV-positive CIN3+ over six years among those women that tested negative at baseline was 2.2 (95% confidence interval [95% CI], 1.0 to 4.9) and 3.1 (95% CI, 1.7 to 5.7) per 1,000 women screened by the HC2 and the AHPV tests; the additional risk for those with AHPV-negative compared with HC2-negative results was 0.9 (95% CI, -0.2 to 2.1) per 1,000. In comparison, the absolute risk following a negative LBC test was 9.3 (95% CI, 2.9 to 30.2). The relative sensitivity of AHPV compared to HC2 was 91.5% for CIN3+, and the negative predictive values were 99.8% (95% CI, 99.5 to 99.9%) for HC2 and 99.7% (95% CI, 99.4 to 99.8%) for AHPV. Our data show that the longitudinal performance of the AHPV test over six years is comparable to the performance of the HC2 test and that the absolute risk of CIN3+ over six years following a negative AHPV result in a screening population is low. (This study is registered at ClinicalTrials.gov under registration number NCT02634190.).
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Affiliation(s)
- Thomas Iftner
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | - Alejandra Castanon
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Rebecca Landy
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | - Barbara Holz
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | - Angelika Iftner
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Annette Staebler
- Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Diethelm Wallwiener
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Claus Hann von Weyhern
- Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Felix Neis
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Juliane Haedicke-Jarboui
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Peter Martus
- Medical Faculty Tübingen, Institute for Clinical Epidemiology and Applied Biometry, Tübingen, Germany
| | - Sara Brucker
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Melanie Henes
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Peter Sasieni
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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Clinical and Analytical Evaluation of the Anyplex II HPV HR Detection Assay within the VALGENT-3 Framework. J Clin Microbiol 2018; 56:JCM.01176-18. [PMID: 30209184 DOI: 10.1128/jcm.01176-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/05/2018] [Indexed: 11/20/2022] Open
Abstract
In 2012, VALidation of human papillomavirus (HPV) GENotyping Tests (VALGENT) was initiated to provide a formalized and uniform study framework for comparison and validation of HPV assays with genotyping capability. In VALGENT-3, the clinical and analytical performance of Anyplex II HPV HR detection (Anyplex) was compared to that of the Hybrid Capture 2 HPV DNA test (hc2) and the cobas 4800 HPV test (cobas). The panel comprises 1,300 stored samples that were obtained from women 25 to 64 years old who participated in the Slovenian cancer screening program, enriched with 300 samples from women with abnormal cervical cytology. The sensitivity and specificity of Anyplex were noninferior to those of hc2, with a relative sensitivity of 1.01 (95% confidence interval [CI], 0.97 to 1.04) for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and 1.01 (95% CI, 0.97 to 1.06) for CIN3+ and relative specificity of 1.02 (95% CI, 1.00 to 1.03) for a CIN grade of ≤1. The clinical sensitivity of Anyplex for CIN2+ and CIN3+ was comparable to that of hc2 (P values for McNemar test [p McN] of 0.655 and 0.564, respectively), but its specificity was significantly higher (p McN = 0.008). The sensitivity and specificity of Anyplex were also noninferior to those of cobas, with relative sensitivity of 1.01 (95% CI, 0.98 to 1.04) for CIN2+ and 1.01 (95% CI, 0.99 to 1.04) for CIN3+ and relative specificity of 1.00 (95% CI, 0.99 to 1.01) (p McN value of >0.05 in all cases). Regardless of the clinical outcome (CIN2+ or CIN3+), age restriction (women ≥30 years old), or comparator test used, Anyplex consistently showed excellent clinical performance and can be considered validated for primary cervical cancer screening.
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Tewari P, White C, Kelly L, Pilkington L, Keegan H, D'Arcy T, Toole SO, Sharp L, O'Leary JJ, Martin CM. Clinical performance of the Cobas 4800 HPV test and the Aptima HPV assay in the management of women referred to colposcopy with minor cytological abnormalities. Diagn Cytopathol 2018; 46:987-992. [DOI: 10.1002/dc.24066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Prerna Tewari
- Department of Histopathology; Trinity College Dublin; Dublin Ireland
- CERVIVA, Department of Molecular Pathology; Coombe Women and Infants University Hospital; Dublin Ireland
| | - Christine White
- Department of Histopathology; Trinity College Dublin; Dublin Ireland
- CERVIVA, Department of Molecular Pathology; Coombe Women and Infants University Hospital; Dublin Ireland
| | - Lynne Kelly
- Department of Histopathology; Trinity College Dublin; Dublin Ireland
| | - Loretto Pilkington
- CERVIVA, Department of Molecular Pathology; Coombe Women and Infants University Hospital; Dublin Ireland
| | - Helen Keegan
- CERVIVA, Department of Molecular Pathology; Coombe Women and Infants University Hospital; Dublin Ireland
| | - Tom D'Arcy
- Department of Obstetrics and Gynaecology; Coombe Women and Infants University Hospital; Dublin Ireland
| | - Sharon O’ Toole
- Department of Histopathology; Trinity College Dublin; Dublin Ireland
- CERVIVA, Department of Molecular Pathology; Coombe Women and Infants University Hospital; Dublin Ireland
| | - Linda Sharp
- Institute of Health and Society; Newcastle University; Newcastle UK
| | - John J O'Leary
- Department of Histopathology; Trinity College Dublin; Dublin Ireland
- CERVIVA, Department of Molecular Pathology; Coombe Women and Infants University Hospital; Dublin Ireland
| | - Cara M Martin
- Department of Histopathology; Trinity College Dublin; Dublin Ireland
- CERVIVA, Department of Molecular Pathology; Coombe Women and Infants University Hospital; Dublin Ireland
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29
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Cook DA, Smith LW, Law JH, Mei W, Gondara L, van Niekerk DJ, Ceballos KM, Jang D, Chernesky M, Franco EL, Ogilvie GS, Coldman AJ, Krajden M. Comparative performance of human papillomavirus messenger RNA versus DNA screening tests at baseline and 48 months in the HPV FOCAL trial. J Clin Virol 2018; 108:32-37. [PMID: 30223252 DOI: 10.1016/j.jcv.2018.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/29/2018] [Accepted: 09/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND HPV FOCAL is a randomized trial comparing high-risk HPV [Hybrid Capture 2 (HC2)] vs. liquid-based cytology (LBC) for primary cervical screening. OBJECTIVE The present study objective was to compare Aptima HPV (AHPV) and HC2 assay performance at the intervention arm baseline and 48 mo. screens in relation to the rates of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+). STUDY DESIGN Women enrolled after December 2010 (n = 3475) were screened at baseline with both AHPV and HC2 (AHPV was blinded). Women with CIN2+ exited the trial; HC2 negative (-) women and those HC2 positive (+) with <CIN2 returned for 48 mo. screening with AHPV, HC2, and LBC. RESULTS At baseline, 7.2% were AHPV + vs. 8.4% for HC2 (p = 0.06). Round 1 AHPV CIN2+ sensitivity (relative to HC2) was 96.0% (95%CI: 86.5-99.0; p = 0.15) and 100% (95%CI: 82.4-100) for CIN3+. AHPV and HC2 specificities (<CIN2) were 94.1% vs. 93.0% respectively (p = 0.05). At 48 mo., 4.8% and 5.2% were AHPV+ and HC2+ respectively (p = 0.41), and both tests had the same CIN2+ and CIN3+ sensitivities (87.5% and 85.0% respectively). AHPV specificity (95.8%) was higher, but not significantly, than HC2 (95.3%; p = 0.38). Of 3226 baseline AHPV- women, 12/2,858 (0.4%) had CIN2+ vs. 13/2821 (0.5%) for the 3184 baseline HC2- women. CONCLUSIONS There was no significant difference in CIN2+ detection for AHPV vs. HC2 at baseline or at 48 mo. Baseline AHPV- and HC2- women had similar CIN2+ rates at 48 mo., demonstrating the safety of a four year screening interval for AHPV- women.
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Affiliation(s)
- Darrel A Cook
- BC Centre for Disease Control, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | | | - Jennifer H Law
- Lower Mainland Pathology & Laboratory Medicine, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Wendy Mei
- Lower Mainland Pathology & Laboratory Medicine, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - Dirk J van Niekerk
- BC Cancer Agency, Vancouver, BC, Canada; Lower Mainland Pathology & Laboratory Medicine, Provincial Health Services Authority, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kathy M Ceballos
- BC Cancer Agency, Vancouver, BC, Canada; Lower Mainland Pathology & Laboratory Medicine, Provincial Health Services Authority, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dan Jang
- McMaster University/St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Max Chernesky
- McMaster University/St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Gina S Ogilvie
- BC Centre for Disease Control, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrew J Coldman
- BC Cancer Agency, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, BC, Canada; Lower Mainland Pathology & Laboratory Medicine, Provincial Health Services Authority, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Quality Improvement to Demonstrate the Lack of Reliability of the Human Papillomavirus mRNA Assay to Identify Women With Latent Human Papillomavirus Infections. Obstet Gynecol 2018; 132:778. [DOI: 10.1097/aog.0000000000002827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Roe CJ, Hanley KZ. Updates in Cervical Cytology: The 90-Year-Long Journey from Battle Creek to Today. Surg Pathol Clin 2018; 11:589-599. [PMID: 30190142 DOI: 10.1016/j.path.2018.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ninety years ago, at the Battle Creek conference, Papanicolaou introduced cervical exfoliative cytology. Since then, the "Pap test" has come a long way. The discovery of a causal relationship between cervical carcinoma and HPV infection opened the door for molecular testing and immunomarkers for HPV. The Clinical Laboratory Improvement Amendments, 1988, established quality assurance and quality control programs to monitor performance of cytology laboratories. The Bethesda System for reporting cervical cytology laid the foundations for cervical cytology education, implementation of management guidelines, and further research on cervical carcinogenesis. HPV vaccine penetration in both genders remains 62% or less.
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Affiliation(s)
- Catherine J Roe
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Krisztina Z Hanley
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
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32
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Fan Y, Shen Z. The clinical value of HPV E6/E7 and STAT3 mRNA detection in cervical cancer screening. Pathol Res Pract 2018; 214:767-775. [DOI: 10.1016/j.prp.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/16/2018] [Accepted: 02/08/2018] [Indexed: 01/10/2023]
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Liu S, Minaguchi T, Lachkar B, Zhang S, Xu C, Tenjimbayashi Y, Shikama A, Tasaka N, Akiyama A, Sakurai M, Nakao S, Ochi H, Onuki M, Matsumoto K, Yoshikawa H, Satoh T. Separate analysis of human papillomavirus E6 and E7 messenger RNAs to predict cervical neoplasia progression. PLoS One 2018; 13:e0193061. [PMID: 29466435 PMCID: PMC5821364 DOI: 10.1371/journal.pone.0193061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/02/2018] [Indexed: 11/29/2022] Open
Abstract
A few studies previously suggested that human papillomavirus (HPV) E6 messenger RNA (mRNA) may exist uniformly in all grades of cervical intraepithelial neoplasia (CIN), whereas the detection rate of E7 mRNA may increase with disease progression from low-grade CIN to invasive carcinoma. The aim of this study was to clarify the different roles of E6 and E7 mRNAs in cervical carcinogenesis. The presence of each E6 and E7 mRNA was analyzed in 171 patients with pathologically-diagnosed CIN or cervical carcinoma. We utilized a RT-PCR assay based on consensus primers which could detect E6 mRNA (full-length E6/E7 transcript) and E7 mRNAs (spliced E6*/E7 transcripts) separately for various HPV types. E7 mRNAs were detected in 6% of CIN1, 12% of CIN2, 24% of CIN3, and 54% of cervical carcinoma. The presence of E7 mRNAs was significantly associated with progression from low-grade CIN to invasive carcinoma in contrast with E6 mRNA or high-risk HPV (HR-HPV) DNA (p = 0.00011, 0.80 and 0.54). The presence of both E6 and E7 mRNAs was significantly associated with HPV16/18 DNA but not with HR-HPV DNA (p = 0.0079 and 0.21), while the presence of E6 mRNA was significantly associated with HR-HPV DNA but not with HPV16/18 DNA (p = 0.036 and 0.089). The presence of both E6 and E7 mRNAs showed high specificity and low sensitivity (100% and 19%) for detecting CIN2+ by contrast with the positivity for HR-HPV DNA showing low specificity and high sensitivity (19% and 89%). The positive predictive value for detecting CIN2+ was even higher by the presence of both E6 and E7 mRNAs than by the positivity for HR-HPV DNA (100% vs. 91%). In 31 patients followed up for CIN1-2, the presence of both E6 and E7 mRNAs showed significant association with the occurrence of upgraded abnormal cytology in contrast with E6 mRNA, HR-HPV DNA, or HPV16/18 DNA (p = 0.034, 0.73, 0.53, and 0.72). Our findings support previous studies according to which E7 mRNA is more closely involved in cervical carcinogenesis than E6 mRNA. Moreover, the separate analysis of E6 and E7 mRNAs may be more useful than HR-HPV DNA test for detecting CIN2+ precisely and predicting disease progression. Further accumulation of evidence is warranted to validate our findings.
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Affiliation(s)
- Shuling Liu
- Doctoral Program in Obstetrics and Gynecology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takeo Minaguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Bouchra Lachkar
- Doctoral Program in Obstetrics and Gynecology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shuang Zhang
- Doctoral Program in Obstetrics and Gynecology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Chenyang Xu
- Doctoral Program in Obstetrics and Gynecology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuri Tenjimbayashi
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ayumi Shikama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobutaka Tasaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Azusa Akiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Manabu Sakurai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sari Nakao
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroyuki Ochi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mamiko Onuki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Koji Matsumoto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Asciutto KC, Ernstson A, Forslund O, Borgfeldt C. Self-sampling with HPV mRNA analyses from vagina and urine compared with cervical samples. J Clin Virol 2018; 101:69-73. [PMID: 29433016 DOI: 10.1016/j.jcv.2018.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/14/2018] [Accepted: 02/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND In order to increase coverage in the organized cervical screening program, self-sampling with HPV analyses has been suggested. OBJECTIVES The aim was to compare human papillomavirus (HPV) mRNA detection in vaginal and urine self-collected samples with clinician-taken cervical samples and the corresponding clinician-taken histological specimens. STUDY DESIGN Self-collected vaginal, urine and clinician-taken cervical samples were analyzed from 209 women with the Aptima mRNA assay (Hologic Inc, MA, USA). Cervical cytology, colposcopy, biopsy and/or the loop electrosurgical excision procedure (LEEP) were performed in every examination. RESULTS The sensitivity of the HPV mRNA test in detecting high-grade squamous intraepithelial lesions (HSIL)/adenocarcinoma in situ (AIS)/cancer cases was as follows: for the vaginal self-samples 85.5% (95% CI; 75.0-92.8), the urinary samples 44.8% (95% CI; 32.6-57.4), and for routine cytology 81.7% (95% CI; 70.7-89.9). For the clinician-taken cervical HPV samples the sensitivity of the HPV mRNA test in detecting HSIL/AIS/cancer was 100.0% (95% CI; 94.9-100.0). The specificity of the HPV mRNA was similar for the clinician-taken cervical HPV samples and the self-samples: 49.0% vs. 48.1%. The urinary HPV samples had a specificity of 61.9% and cytology had a specificity of 93.3%. CONCLUSION The sensitivity of the Aptima HPV mRNA test in detecting HSIL/AIS/cancer from vaginal self-samples was similar to that of routine cytology. The Aptima HPV mRNA vaginal self-sampling analysis may serve as a complement in screening programs.
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Affiliation(s)
| | - Avalon Ernstson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Lund University, Sweden
| | - Ola Forslund
- Department of Clinical Microbiology, Skåne University Hospital, Lund, Lund University, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Lund University, Sweden.
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Granados R, Tellez-Safina H, Solis I, Mateos F, Rodriguez-Barbero JM, Aramburu JA, Huertas MA, Bajo P, Camarmo E, Corrales T, Medina P, Calvo B, Martin E, Anta L, Zamora M, Alcaide T. Cervical cancer screening cotesting with cytology and MRNA HPV E6/E7 yields high rates of CIN2+ lesions in young women. Diagn Cytopathol 2017; 45:1065-1072. [PMID: 28949442 DOI: 10.1002/dc.23821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/01/2017] [Accepted: 09/12/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND European guidelines recommend primary HPV testing for cervical cancer screening. However, the starting age remains to be defined, with an undecided window between 30 and 35 years. This pilot study compares the effectiveness of primary HPV testing to that of cytology for the detection of high-grade (CIN2+) lesions stratified by age. METHODS Cotesting with LBC cytology and APTIMA® HPV (AHPV) was performed in 5053 women aged 25-65 in an opportunistic screening program in Madrid. AHPV-positive cases were referred to colposcopy and genotyped for HPV16 and 18/45 (AHPV-GT). Results were analyzed stratified in four age groups. RESULTS 454 cases (9.0%) were AHPV-positive. Women under 35 had a 30.2% CIN2+ rate, compared to 21.9% and 20.4% for women aged 35-44 or 45-54. There was a significant increase (P < .05) in the rate of CIN2+ in AHPV-GT-positive women when compared to that for other HPV types (AHPV-other), being 43.3% versus 15.7%. AHPV-GT-positive women under 35 had significantly higher rates of CIN2+ lesions than any other age-group. The sensitivity of cytology for cervical CIN2+ in APHV-positive women was 60.6%. All 4 carcinomas, including one AHPV-negative endometrial adenocarcinoma, had abnormal cytology. All cervical CIN2+ lesions biopsied were AHPV-positive. CONCLUSIONS Aptima HPV shows a significantly higher sensitivity for cervical CIN2+ lesions than cytology alone. Unexpectedly, AHPV-positive women under 35 had the highest incidence of CIN2+ lesions, particularly when they are HPV16/18/45-positive. Reconsidering HPV primary screening before the recommended age of 35 is warranted.
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Affiliation(s)
- Rosario Granados
- Department of Pathology, Hospital Universitario de Getafe, Madrid, Spain
| | - Hilda Tellez-Safina
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Isabel Solis
- Department of Gynecology, Hospital Universitario de Getafe, Madrid, Spain
| | - Francisco Mateos
- Department of Gynecology, Hospital Universitario de Getafe, Madrid, Spain
| | | | | | | | - Paloma Bajo
- Department of Pathology, Hospital Universitario de Getafe, Madrid, Spain
| | | | - Teresa Corrales
- Department of Pathology, Hospital Universitario de Getafe, Madrid, Spain
| | - Pedro Medina
- Direccion Asistencial Norte Madrid, Primary Care, Alfonso Rodriguez Castelao 17, Madrid
| | - Beatriz Calvo
- Direccion Asistencial Sur Madrid, Primary Care, Juan de la Cierva s/n, Getafe
| | - Esther Martin
- Direccion Asistencial Sur Madrid, Primary Care, Juan de la Cierva s/n, Getafe
| | - Laura Anta
- Direccion Asistencial Sur Madrid, Primary Care, Juan de la Cierva s/n, Getafe
| | - Manuel Zamora
- Direccion Asistencial Sur Madrid, Primary Care, Juan de la Cierva s/n, Getafe
| | - Teresa Alcaide
- Direccion Asistencial Sur Madrid, Primary Care, Juan de la Cierva s/n, Getafe
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Determinants of Viral Oncogene E6-E7 mRNA Overexpression in a Population-Based Large Sample of Women Infected by High-Risk Human Papillomavirus Types. J Clin Microbiol 2017; 55:1056-1065. [PMID: 28100595 DOI: 10.1128/jcm.01794-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/10/2017] [Indexed: 01/08/2023] Open
Abstract
Cervical cancer screening by human papillomavirus (HPV) DNA testing with cytology triage is more effective than cytology testing. Compared to cytology, the HPV DNA test's higher sensitivity, which allows better protection with longer intervals, makes it necessary to triage the women with a positive result to compensate its lower specificity. We are conducting a large randomized clinical trial (New Technologies for Cervical Cancer 2 [NTCC2]) within organized population-based screening programs in Italy using HPV DNA as the primary screening test to evaluate, by the Aptima HPV assay (Hologic), the use of HPV E6-E7 mRNA in a triage test in comparison to cytology. By the end of June 2016, data were available for 35,877 of 38,535 enrolled women, 2,651 (7.4%) of whom were HPV DNA positive. Among the samples obtained, 2,453 samples were tested also by Aptima, and 1,649 (67.2%) gave a positive result. The proportion of mRNA positivity was slightly higher among samples tested for HPV DNA by the Cobas 4800 HPV assay (Roche) than by the Hybrid Capture 2 (HC2) assay (Qiagen). In our setting, the observed E6-E7 mRNA positivity rate, if used as a triage test, would bring a rate of immediate referral to colposcopy of about 4 to 5%. This value is higher than that observed with cytology triage for both immediate and delayed referrals to colposcopy. By showing only a very high sensitivity and thus allowing a longer interval for HPV DNA-positive/HPV mRNA-negative women, a triage by this test might be more efficient than by cytology.
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Cook DA, Smith LW, Law J, Mei W, van Niekerk DJ, Ceballos K, Gondara L, Franco EL, Coldman AJ, Ogilvie GS, Jang D, Chernesky M, Krajden M. Aptima HPV Assay versus Hybrid Capture ® 2 HPV test for primary cervical cancer screening in the HPV FOCAL trial. J Clin Virol 2016; 87:23-29. [PMID: 27988420 DOI: 10.1016/j.jcv.2016.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/26/2016] [Accepted: 12/09/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cervical cancer screening programs are switching from Pap screening to high-risk HPV testing. OBJECTIVES To compare the Aptima HPV Assay (AHPV) with the Hybrid Capture® 2 High-Risk HPV DNA Test® (HC2) for primary cervical screening. STUDY DESIGN HPV FOCAL is a randomized trial comparing HC2 to liquid-based cytology (LBC) for screening women aged 25-65. AHPV and HC2 were compared at the baseline screen (n=3473). Genotyping was by the Aptima HPV 16 18/45 Genotype Assay. We assessed HPV genotyping and reflex LBC for colposcopy triage. RESULTS AHPV/HC2 agreement was 96.5% (kappa 0.76); positive agreement was 77.4%. The AHPV positive rate was 7.2% vs. 8.4% for HC2 (p=0.06). Based on HC2 screening, round 1 CIN2 and CIN3+ rates were 9.2/1000 and 5.2/1000 respectively. Using HC2 as the comparator test, AHPV CIN2+ and CIN3+ relative sensitivities were 0.96 and 1.00 (p=1.00) respectively. High-grade reflex LBC and HPV 16 infection were significantly associated with CIN3+. AHPV specificity was 0.94 vs. 0.93 (p=0.05) for HC2. Compared with triage of HC2+ with abnormal cytology or HPV persistence for 12 months, colposcopy referral would be significantly reduced (38.3/1000 vs. 60.8/1000; p<0.001) if AHPV+ women with abnormal LBC and HPV 16/18/45 were referred at baseline. CIN2+ and CIN3+ detection rates were not significantly different for the two strategies. CONCLUSIONS AHPV vs. HC2 screening had equivalent CIN2+ and CIN3+ detection. Triage of AHPV+ by abnormal reflex LBC and the presence of HPV 16/18/45 would result in a significantly lower colposcopy referral rate with similar CIN2+ and CIN3+ detection rates as the overall HC2+ referral algorithm.
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Affiliation(s)
- Darrel A Cook
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada; BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Laurie W Smith
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada
| | - Jennifer Law
- Lower Mainland Laboratories, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Wendy Mei
- Lower Mainland Laboratories, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Dirk J van Niekerk
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada; Lower Mainland Laboratories, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada; University of British Columbia, Faculty of Medicine, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Kathy Ceballos
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada; Lower Mainland Laboratories, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada; University of British Columbia, Faculty of Medicine, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Lovedeep Gondara
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada
| | - Eduardo L Franco
- McGill University, Division of Cancer Epidemiology, 546 Pine Ave W, Montreal, QC, H2W 1S6, Canada
| | - Andrew J Coldman
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada; University of British Columbia, Faculty of Medicine, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Gina S Ogilvie
- BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada; University of British Columbia, Faculty of Medicine, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Dan Jang
- McMaster University/St. Joseph's Healthcare, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Max Chernesky
- McMaster University/St. Joseph's Healthcare, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Mel Krajden
- BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada; Lower Mainland Laboratories, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada; University of British Columbia, Faculty of Medicine, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
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Wright TC, Stoler MH, Aslam S, Behrens CM. Knowledge of Patients' Human Papillomavirus Status at the Time of Cytologic Review Significantly Affects the Performance of Cervical Cytology in the ATHENA Study. Am J Clin Pathol 2016; 146:391-8. [PMID: 27543984 DOI: 10.1093/ajcp/aqw125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES With human papillomavirus (HPV) testing, patients' HPV status may be known when reviewing cytology specimens. METHODS 41,955 women 25 years or older had cytology and HPV screening. Originally, cytology was reviewed blinded to HPV status. We re-reviewed unblinded to HPV status a subset of 428 cytology slides from women with cervical intraepithelial neoplasia grade 2 + (CIN2+) and 1,287 from women without CIN2+. RESULTS Of the original interpretations of atypical squamous cells of undetermined significance (ASC-US), 33.7% were downgraded to negative after unblinded review, and 8.7% were upgraded to atypical squamous cells, cannot rule out a high-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion. Of the original interpretations of ASC-US, 66.7% were downgraded on unblinded review in HPV-negative women and 30.2% were upgraded in HPV 16+/HPV 18+ women. Unblinding increases the sensitivity for cervical intraepithelial neoplasia grade 3+ of cotesting from 54.1% to 62.4% (P = .0015) and the sensitivity of HPV primary screening from 72.2% to 77.1% (P = .0029). With cotesting, specificity with unblinding is improved, whereas with HPV primary screening, there would be a small decrease in specificity. CONCLUSIONS Unblinded cytology increases overall sensitivity with either cotesting or HPV primary screening; specificity is either slightly improved or is not affected by unblinding.
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Affiliation(s)
- Thomas C Wright
- From the Department of Pathology and Cell Biology, Columbia University, New York, NY
| | - Mark H Stoler
- Department of Pathology, University of Virginia, Charlottesville
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Screening women for cervical cancer carcinoma with a HPV mRNA test: first results from the Venice pilot program. Br J Cancer 2016; 115:525-32. [PMID: 27490801 PMCID: PMC4997543 DOI: 10.1038/bjc.2016.216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/24/2016] [Accepted: 06/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background: HPV DNA-based screening is more effective than a Pap test in preventing cervical cancer, but the test is less specific. New HPV tests have been proposed for primary screening. The HPV mRNA test showed a similar or slightly lower sensitivity than the HPV DNA tests but with a higher specificity. We report the results of an organised HPV mRNA-based screening pilot program in Venice, Italy. Methods: From October 2011 to May 2014, women aged 25–64 years were invited to undergo a HPV mRNA test (Aptima). Those testing positive underwent cytological triage. Women with positive cytology were referred to colposcopy, whereas those with negative cytology were referred to repeat the HPV mRNA test 1 year later. The results of the HPV mRNA test program were compared with both the local historical cytology-based program and with four neighbouring DNA HPV-based pilot projects. Results: Overall, 23 211 women underwent a HPV mRNA test. The age-standardised positivity rate was 7.0%, higher than in HPV DNA programs (6.8% relative rate (RR) 1.11, 95% confidence interval (CI) 1.05–1.17). The total colposcopy referral was 5.1%, double than with cytology (2.6% RR 2.02, 95% CI 1.82–2.25) but similar to the HPV DNA programs (4.8% RR 1.02; 95% CI 0.96–1.08). The cervical intraepithelial neoplasia grade 2+ detection rate with HPV mRNA was greater than in the HPV DNA programs at baseline (RR 1.50; 95% CI 1.19–1.88) and not significantly lower at the 1-year repeat (RR 0.70; 95% CI 0.40–1.16). The overall RR was 1.29 (95% CI 1.05–1.59), which was much higher than with cytology (detection rate 5.5‰ vs 2.1‰ RR 2.50, 95% CI 1.76–3.62). Conclusions: A screening programme based on the HPV mRNA obtained results similar to those observed with the HPV DNA test. In routine screening programmes, even a limited increase in HPV prevalence may conceal the advantage represented by the higher specificity of HPV mRNA.
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Poljak M, Oštrbenk A, Seme K, Šterbenc A, Jančar N, Vrtačnik Bokal E. Three-year longitudinal data on the clinical performance of the Abbott RealTime High Risk HPV test in a cervical cancer screening setting. J Clin Virol 2016; 76 Suppl 1:S29-S39. [DOI: 10.1016/j.jcv.2015.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 01/29/2023]
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Hemper E, Wittau M, Lemke J, Kornmann M, Henne-Bruns D. Management of a giant perineal condylomata acuminata. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 5:Doc07. [PMID: 26814336 PMCID: PMC4724757 DOI: 10.3205/iprs000086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A condylomata acuminata infection is caused by human papillomaviridae (HPV). This sexually transmitted condition most often affects the perineal region. Importantly, infections with types 16 and 18 are associated with an increased risk for anal and cervix cancer. In most cases topical therapy is sufficient for successfully treating condylomata acuminata. Here, we report the case of a 51-year old patient who suffered from a giant perianal located condylomata acuminata which had developed over a period of more than 10 years. Imaging by MRI revealed a possible infiltration of the musculus sphincter ani externus. Because a topical treatment or a radiotherapy was considered unfeasible, a surgical treatment was the only therapeutic option in this unusual case. First, a colostomy was performed and subsequently a resection of the tumor in toto with circular resection of the external portion of the musculus sphincter ani externus was performed. The large skin defect was closed by two gluteus flaps. The rectum wall was reinserted in the remnant of the musculus sphincter ani externus. Postoperatively, parts of the flaps developed necrosis. Therefore, a vacuum sealing therapy was initiated. Subsequently, the remaining skin defects were closed by autologous skin transplantation. Six months later the colostomy could be reversed. To date, one year after first surgery, the patient has still a normal sphincter function and no recurrence of the condylomata acuminata. This case report demonstrates how giant condylomata acuminata can be successfully treated by extended surgical procedures including colostomy and plastic reconstruction of resulting defects upon resection.
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Affiliation(s)
- Evelyn Hemper
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | - Mathias Wittau
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | - Johannes Lemke
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | - Marko Kornmann
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | - Doris Henne-Bruns
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
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Schiffman M, Wentzensen N. A Suggested Approach to Simplify and Improve Cervical Screening in the United States. J Low Genit Tract Dis 2016; 20:1-7. [PMID: 26704326 PMCID: PMC4692178 DOI: 10.1097/lgt.0000000000000170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cervical cancer prevention strategies in the United States have become complicated and even controversial, despite advanced understanding of carcinogenic human papillomavirus (HPV) infection as the necessary causal agent. Twenty years ago, etiologic and methodologic studies had already yielded 2 powerful preventive approaches. There are excellent vaccines to prevent the most carcinogenic types of HPV infection; reduced HPV endemicity will ultimately prevent a large fraction of cervical precancer and cancers. For prevention of cervical cancer in the interim, sensitive HPV tests that target women at risk of cancer, by detection of the DNA/RNA of approximately a dozen carcinogenic HPV types, permit early diagnosis and treatment of precancers.Although HPV vaccines and tests have continued to improve, implementation of these new HPV-based prevention methods has been relatively slow in the United States and in most places worldwide. Increasing vaccination rates is the clearest and most vital long-term priority. But, for decades to come, screening will also be important. To promote useful discussion, this commentary will raise some current critical issues in simplifying and speeding the rational introduction of HPV molecular methods into US cervical screening.
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Affiliation(s)
- Mark Schiffman
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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Haedicke J, Iftner T. A review of the clinical performance of the Aptima HPV assay. J Clin Virol 2015; 76 Suppl 1:S40-S48. [PMID: 26614686 DOI: 10.1016/j.jcv.2015.10.027] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/19/2015] [Accepted: 10/31/2015] [Indexed: 11/20/2022]
Abstract
This comprehensive review compiles published data from 62 original articles comparing different HPV tests and one meta-analysis on the clinical performance of the Aptima HR HPV (AHPV) assay in either screening or referral populations as well as for the purpose of test of cure. A number of publications with technical issues were also considered. Besides a brief introduction in the development of E6/E7 mRNA testing, the review summarizes data on analytical sensitivies and specificities, as well as on clinical sensitivity, specificity, NPV and PPV with histological endpoints CIN2+ and CIN3+, where available. Although most studies were of cross-sectional design, five studies with a longitudinal prospective design or component were identified. In addition to the study design, sample size, age and CIN2/3+ prevalence of the respective cohort are listed. This allows direct comparison of the published data in the respective groups. One major outcome of this review is the remarkably stable similar sensitivities of AHPV and HC2 independent from study design for detection of CIN2/3+ combined with a higher specificity of the AHPV. The second outcome was the longitudinal predictive value derived from registry linkage and other prospective studies that would support the applicability of the AHPV test in primary screening with at least a three year screening interval.
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Affiliation(s)
- Juliane Haedicke
- Division of Experimental Virology, Medical Virology, University Hospital Tübingen, Germany
| | - Thomas Iftner
- Division of Experimental Virology, Medical Virology, University Hospital Tübingen, Germany.
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Which high-risk HPV assays fulfil criteria for use in primary cervical cancer screening? Clin Microbiol Infect 2015; 21:817-26. [DOI: 10.1016/j.cmi.2015.04.015] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 11/22/2022]
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