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Jones TE, Matsko J, Elishaev E, Clark BZ, Carter G, Harinath L, Zhao C. Changes over time in papanicolaou cytology test and HPV test in a large women's academic center laboratory. J Am Soc Cytopathol 2023:S2213-2945(23)00023-6. [PMID: 37142542 DOI: 10.1016/j.jasc.2023.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION In the past 2 decades, cervical cancer screening guidelines in the United States have undergone numerous revisions with recent greater emphasis on primary high-risk human papillomavirus (hrHPV) testing. MATERIALS AND METHODS We examine the trends of Papanicolaou test and hrHPV testing at our large academic center across 4 years (2006, 2011, 2016, and 2021) over a 15-year period. The number of ThinPrep Papanicolaou and hrHPV tests, as well as the triggers for HPV testing, were retrospectively analyzed. RESULTS A total of 308,355 Papanicolaou tests and 117,477 hrHPV tests were reported across the 4 years. The number of Papanicolaou tests performed decreased nearly 3-fold over the study period, with only 43,230 Papanicolaou tests performed in 2021. The HPV test to Papanicolaou test ratio increased: 17% of Papanicolaou tests had an associated HPV test in 2006, whereas 72% of Papanicolaou tests ordered in 2021 had a companion hrHPV. The use of co-testing also increased. Overall, 73% were co-tests and 27% were reflexively ordered in the 4 one-year time periods. Co-tests constituted only 46% of HPV tests in 2006, but this increased to 93% in 2021. The percentage of positive hrHPV results decreased; in 2006, 18.3% of cases were positive, dropping to 8.6% in 2021 due to the marked increase in co-testing. Stratifying by diagnostic category, hrHPV results have remained relatively constant. CONCLUSION With the numerous recent revisions of cervical screening guidelines, screening strategies at our institution reflected these changes in clinical practice. Papanicolaou and HPV co-testing became the most common screening method for women 30 to 65 years of age in our cohort.
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Affiliation(s)
- Terri E Jones
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonee Matsko
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Esther Elishaev
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Beth Z Clark
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gloria Carter
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lakshmi Harinath
- 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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Song F, Du H, Xiao A, Wang C, Huang X, Liu Z, Zhao M, Men H, Wu R. Type-specific Distribution of Cervical hrHPV Infection and the Association with Cytological and Histological Results in a Large Population-based Cervical Cancer Screening Program: Baseline and 3-year Longitudinal Data. J Cancer 2020; 11:6157-6167. [PMID: 32922555 PMCID: PMC7477419 DOI: 10.7150/jca.48357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/16/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: This study aimed to describe the study design, and to analyze the type-specific distribution of cervical high-risk human papillomavirus (hrHPV) infection and its association with cytological and histological results in a large population-based screening program in Buji Street, Shenzhen, China. Methods: A total of 10,186 women aged 21-70 years were co-tested by Cobas4800 HPV assay and liquid-based cytology. Women were referred to colposcopy by virtue of being HPV16/18-positive, Other hrHPV-positive/ cytology ≥ASCUS, or HPV-negative/ cytology ≥LSIL. Three-year histological follow-up data were recorded. Results: The overall prevalence of hrHPV infection was 11.1%; among them, the highest type was Other hrHPV (8.9%), followed by HPV16 (1.6%) and HPV18 (0.6%). Moreover, the prevalence of hrHPV and that of HPV16 increased with cytological severity (Ptrend <0.001). In the baseline phase, 106 women had cervical intraepithelial neoplasia 2/3 (CIN2/3) and six had cervical cancers. During 3-year follow-up, 12 cases of CIN2/3 and no cancers were identified. For HPV16-positive women with normal cytology, the baseline risks of CIN2/3 or worse (CIN2+/CIN3+) were 15.5% (7.0-23.9%) and 4.2% (1.4-8.5%) respectively. For Other hrHPV-positive women with normal cytology, the cumulative 3-year risks of CIN2+/CIN3+ were 3.1% (1.0-5.2%) and 0.7% (0.3-2.1%) respectively. Strikingly, 75.8% (322/425) of abnormal cytology and 50.9% (29/57) HSIL cytology were attributed to Other hrHPV infection in HPV-positive women. Similarly, Other hrHPV infection led to large proportions of CIN2 (62.7%) and CIN3+ (43.9%) over 3-year follow-up. Conclusions: The co-testing modality is a feasible, effective and safe option for cervical cancer screening in urban population. Great importance should also be attached to 'genotypes excluding HPV16/18' and separate detection of each genotype when considering screening and vaccination strategy.
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Affiliation(s)
- Fangbin Song
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Aimin Xiao
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Zhihong Liu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Meifang Zhao
- Buji Street Family Planning Service Center, Buji Street, Longgang District, Shenzhen 518129, PR China
| | - Hongjian Men
- Buji Street Family Planning Service Center, Buji Street, Longgang District, Shenzhen 518129, PR China
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
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Kussaibi H, Al Dossary R, Ahmed A, Muammar A, Aljohani R. Correlation of High-Risk HPV Genotypes with Pap Test Findings: A Retrospective Study in Eastern Province, Saudi Arabia. Acta Cytol 2020; 65:48-55. [PMID: 32784299 DOI: 10.1159/000509669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION High-risk human papillomavirus (HR HPV) is found to be responsible for 4.5% of cancer in general, primarily cervical cancer. We aim here to highlight the prevalence and genotypes of HR HPV and correlate its association with Pap tests' results, which are still not well known in the Eastern Province of Saudi Arabia. METHODS Over 7 years (2013-2019), the results of 164 Saudi women coinvestigated for HR HPV along with Pap tests were collected from the archive of King Fahd University Hospital. Only women who had atypical squamous cells of undetermined significance (ASCUS) on the Pap test and those at elevated risk of infection were cotested for HR HPV; otherwise, the Pap test was the only screening modality for cervical cancer. Data were organized and statistically analyzed using IBM SPSS v26. RESULTS Out of 164 Saudi women, 14.5% (n = 24/164) showed positive results for HR HPV (8 patients had HPV16 and 2 had both HPV16 and HPV18/45, while the remaining 14 had other HR HPV); among them, 41.5% (n = 10/24) had an abnormal Pap test (5 ASCUS and 5 LSIL), while 58.5% (n = 14/24) had a negative Pap test. On the other hand, 21% (n = 35/164) of patients, in the study, had an abnormal Pap test (24 ASCUS, 8 low-grade squamous intraepithelial lesion [LSIL], and 3 atypical glandular cell [AGC]). In 80% (n = 19/24) of ASCUS cases, HR HPV was not detected; however, 20% (n = 5/24) were positive for other HR HPV. Concerning LSIL cases, 62.5% (n = 5/8) were positive for HR HPV (1 case showed HPV16 and HPV18/45, 2 cases showed HPV16, and 2 cases showed other HR HPV), while in the remaining 37.5% (n = 3/8) LSIL cases, HR HPV was negative; similarly, all AGC cases were negative for HR HPV. Statistical analysis showed a significant correlation between HPV status and Pap test findings (p value <0.001). DISCUSSION/CONCLUSION HR HPV frequency and genotype distribution, in this study, might reflect a different regional infection pattern. The high association of HR HPV with negative cytology emphasizes the need to add the HR HPV test to screening modalities of cervix cancer.
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Affiliation(s)
- Haitham Kussaibi
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia,
| | - Reem Al Dossary
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Ayesha Ahmed
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Aroub Muammar
- College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Raghad Aljohani
- College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
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Low-grade squamous intraepithelial lesion on Papanicolaou test: follow-up rates and stratification of risk for high-grade squamous intraepithelial lesion. J Am Soc Cytopathol 2020; 9:258-265. [PMID: 32402830 DOI: 10.1016/j.jasc.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/06/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Low-grade squamous intraepithelial lesion (LSIL) Papanicolaou test is associated with moderate risk of high-grade squamous intraepithelial lesion (HSIL) at colposcopic biopsy. High-risk human papillomavirus (hrHPV) cotesting risk stratifies patients with LSIL Papanicolaou test, with higher rates of HSIL for those hrHPV+. hrHPV genotyping is not considered in current LSIL management algorithms. MATERIALS AND METHODS We performed a 2-year retrospective review of LSIL Papanicolaou tests in patients 25 to 65 years old to assess rates of follow-up and HSIL at biopsy. Patient age, hrHPV cotest and genotype results, prior screening results, and follow-up testing for 3 years were recorded. RESULTS A total of 71.5% (376 of 526) of patients had at least 1 follow-up colposcopic biopsy; 18% had HSIL on follow-up, including 20% of hrHPV+ and 12% of hrHPV-. HSIL at biopsy was most common when HPV16/18 was present (32%) and when multiple subtypes were detected (46%) versus when non-16, non-18 hrHPV alone was present (16%) or hrHPV was negative (12%). Of those hrHPV-, 5 of 22 (23%) with a prior screening abnormality had HSIL versus 1 of 27 (4%) for those without prior abnormalities. Follow-up occurred more commonly for hrHPV+ cotests (82%) than hrHPV- cotests (54%). No differences in follow-up rate based on hrHPV genotyping was seen. CONCLUSIONS The highest HSIL rates were seen when HPV16/18 was present (32%). HSIL rates were similar for those hrHPV- (12%) and non-16, non-18 hrHPV+ (16%). Follow-up was more common for those hrHPV+, but genotype results did not impact follow-up rates. Past screening results may impact risk of HSIL for hrHPV- cases.
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Tao X, Zhang H, Zhang H, Xiao J, Li J, Zhou X, Wang L, Zhao C. Follow‐up with histopathology and HPV testing on LSIL cytology in China’s largest academic woman’s hospital. Cancer Cytopathol 2019; 127:258-266. [PMID: 30892831 DOI: 10.1002/cncy.22119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Xiang Tao
- Department of Pathology Obstetrics and Gynecology Hospital of Fudan University Shanghai China
| | - Huina Zhang
- Department of Pathology University of Rochester Medical Center Rochester New York
| | - Hao Zhang
- Department of Pathology Obstetrics and Gynecology Hospital of Fudan University Shanghai China
| | - Jianan Xiao
- Department of Pathology Obstetrics and Gynecology Hospital of Fudan University Shanghai China
| | - Juan Li
- Department of Pathology Jinan Maternity and Child Care Hospital Shandong China
| | - Xianrong Zhou
- Department of Pathology Obstetrics and Gynecology Hospital of Fudan University Shanghai China
| | - Li Wang
- Department of Pathology Obstetrics and Gynecology Hospital of Fudan University Shanghai China
| | - Chengquan Zhao
- Department of Pathology Obstetrics and Gynecology Hospital of Fudan University Shanghai China
- Department of Pathology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
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Zhang H, Varma KR, Han M, Matsko J, Zhao C. Immediate histopathologic follow-up of cervista and aptima high-risk HPV assays in women with LSIL cytology. Cancer Cytopathol 2018; 126:525-532. [DOI: 10.1002/cncy.22017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Huina Zhang
- Department of Pathology, Magee-Womens Hospital; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Kavita R. Varma
- Department of Pathology, Magee-Womens Hospital; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Min Han
- Department of Pathology, Magee-Womens Hospital; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - 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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Zheng B, Yang H, Li Z, Wei G, You J, Liang X, Zhao C. HPV test results and histological follow-up results of patients with LSIL Cervical Cytology from the Largest CAP-certified laboratory in China. J Cancer 2017; 8:2436-2441. [PMID: 28900480 PMCID: PMC5595072 DOI: 10.7150/jca.19421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/30/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Age-adjusted evaluations have explored the possible utility of (HPV test results in women with LSIL Pap. We investigated HPV test results and histopathologic follow-up results of LSIL patients from China's largest CAP-certified laboratory. METHODS Patients with LSIL between 2011 and 2015 from the Guangzhou Kingmed Diagnostics were retrospectively retrieved and their hrHPV test results and histological follow-up results were collected and analyzed. RESULTS LSIL result was identified in 37,895 cases from 2,206,588 Pap tests (1.7%) including 1,513,265 liquid-based cytology and 693,323 conventional Pap tests. The average of these women was 38.4 years (15-88). The LSIL reporting rate in women <30 years was significantly higher than that in women > 30 years (2.1% vs 1.7%). The age specific reporting LSIL rates declined with increased age. 8,014 of 37,895 (21.2%) women with LSIL cytology also had HC2 HPV test results. 75.8% of women with LSIL Pap tests were hrHPV+ and the HPV+ rates declined with increased age except in patients older than 60 years. Overall histopathologic diagnoses within 6 months after LSIL were identified in 5,987 of 37,895 patients at Guangzhou Kingmed Diagnostics. CIN2/3 was identified in 15.2% patients, CIN1 in 66.9%, negative in 14.9% patients. No invasive carcinoma was found in all patients. Of 8014 patients with LSIL Pap test and HPV testing results, 1727 patients had histological follow-up within 6 months after Pap cytology test and HPV testing. The detection rate of CIN2/3 was significantly higher in patients with positive HPV testing result than that in patients with negative HPV testing result (17.8% vs. 8.1%). Among patients with LSIL/HPV negative tests, CIN2/3 was detected in 1 of 30 (3.3%) women aged 50 years and above, appearing lower than those in women less than 50 years (8.0%, 28/351, P=0.357). CONCLUSION This is the largest histological follow-up study in women with LSIL Pap from China and the data are helpful in establishing a baseline for better understanding the status of cervical screening in China. The 85.1% positive predict value of LSIL Pap cytology for follow-up CIN lesion was within currently recognized benchmark ranges.
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Affiliation(s)
- Baowen Zheng
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Huaitao Yang
- Department of Pathology, University Cincinnati College of Medicine, Cincinnati, OH 45219, USA
| | - Zaibo Li
- Department of Pathology, Wexner Medical Center at Ohio State University, Columbus, OH 43210, USA
| | - Guijian Wei
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Jia You
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Xiaoman Liang
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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