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Chen F, Hsu Lin L, Hindi I, Sun W, Shafizadeh N, Szeto O, Brandler TC, Simsir A. HPV Cotesting of Unsatisfactory Papanicolaou Tests: Implications for Follow-up Intervals. Am J Clin Pathol 2023; 160:137-143. [PMID: 37052613 DOI: 10.1093/ajcp/aqad026] [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: 11/11/2022] [Accepted: 02/16/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES The 2019 American Society of Colposcopy and Cervical Pathology management guidelines recommend that patients with an unsatisfactory Papanicolaou (Pap) test (UPT) and negative human papillomavirus (HPV) cotest undergo repeat age-based screening in 2 to 4 months. The rationale is that a negative HPV test in the setting of an UPT may reflect an inadequate sample and therefore should not be interpreted as truly "negative." For patients 25 years and older who are cotested, if HPV is positive for the 16 or 18 genotypes, direct referral for colposcopy is recommended. Our study aimed to determine if a negative HPV cotest result is predictive of the absence of a high-grade squamous intraepithelial lesion (HSIL) and whether these patients may be called back for repeat testing at an interval longer than 2 to 4 months. METHODS Follow-up cervical cytology and biopsy results in women with UPT and HPV cotests from January 2017 to December 2021 were collected. Original UPT and HPV cotest results were correlated with the follow-up Pap and biopsy results. RESULTS There were 1,496 (2.28%) UPT cases out of 65,641 total Pap tests. Among the 1,496 UPT cases, 1,010 (67.5%) had HPV cotesting; 676 (45.1%) were followed by repeat Pap or biopsy within 4 months and 850 (56.8%) within 12 months. The total follow-up rate was 81%, with a range of 3 days to 36 months. The HSIL rate in HPV-positive cases was 5.7% (3/53) vs 0.4% (2/539) (P = .006) in HPV-negative cases. In UPT, HPV cotesting showed negative predictive values for low-grade and high-grade squamous intraepithelial lesion detection of 98.5% and 99.6%, respectively, while positive predictive values were 19% and 5.7%. CONCLUSIONS A negative HPV cotest in individuals with UPT predicted the lack of HSIL in our study. Compliance with the recommended follow-up time of 2 to 4 months for women with UPT was low (45.1%). Our study suggests that women with UPT and negative HPV cotest may be safely called back at an interval longer than 4 months.
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Affiliation(s)
- Fei Chen
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Issa Hindi
- Department of Pathology, NYU Langone Health, New York, NY, US
| | - Wei Sun
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Oliver Szeto
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Aylin Simsir
- Department of Pathology, NYU Langone Health, New York, NY, US
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Grincevičienė Š, Vaitkienė D, Kanopienė D, Vansevičiūtė R, Tykvart J, Sukovas A, Celiešiūtė J, Ivanauskaitė Didžiokienė E, Čižauskas A, Laurinavičienė A, Král V, Hlavačková A, Zemanová J, Stravinskienė D, Sližienė A, Petrošiūtė A, Petrauskas V, Balsytė R, Grincevičius J, Navratil V, Jahn U, Konvalinka J, Žvirblienė A, Matulis D, Matulienė J. Factors, associated with elevated concentration of soluble carbonic anhydrase IX in plasma of women with cervical dysplasia. Sci Rep 2022; 12:15397. [PMID: 36100684 PMCID: PMC9470728 DOI: 10.1038/s41598-022-19492-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
Precancerous lesions of human cervix uteri have a tendency for regression or progression. In cervical intraepithelial neoplasia grade 2 (CINII) case there is an uncertainty if a lesion will progress or regress. The carbonic anhydrase IX (CAIX) enzyme is overexpressed in cervical cancer which is more sensitive to radiotherapy. CAIX is associated with poor prognosis in solid hypoxic tumors. The aim of this study was to determine factors related to elevated soluble CAIX (s-CAIX) in high-grade intraepithelial lesion (HSIL) cases. Methods. Patients diagnosed with HSIL (N = 77) were included into the research group whereas without HSIL (N = 72)—the control group. Concentration of the soluble CAIX (s-CAIX) in plasma was determined by the DIANA ligand-antibody-based method. C. trachomatis was detected from cervical samples by PCR. Primary outcomes were risk factors elevating s-CAIX level in HSIL group. Non-parametric statistical analysis methods were used to calculate correlations. Results. The s-CAIX level in patients with HSIL was elevated among older participants (rs = 0.27, p = 0.04) and with C. trachomatis infection (p = 0.028). Among heavy smokers with HSIL, the concentration of s-CAIX was higher in older women (rs = 0.52, p = 0.005), but was not related to the age of heavy smokers’ controls (τ = 0.18 p = 0.40). Conclusion. The concentration of s-CAIX was higher among older, heavy smoking and diagnosed with C. trachomatis patients. All these factors increased the risk for HSIL progression.
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Landy R, Hollingworth T, Waller J, Marlow LA, Rigney J, Round T, Sasieni PD, Lim AW. Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women. Br J Gen Pract 2022; 72:e538-e545. [PMID: 35667684 PMCID: PMC9183459 DOI: 10.3399/bjgp.2021.0708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cervical cancer incidence and mortality are high in women aged ≥65 years, despite the disease being preventable by screening. Speculum-based screening can become more uncomfortable after the menopause. AIM To examine test performance and acceptability of human papillomavirus (HPV) testing on clinician-collected vaginal samples without a speculum (non-speculum). DESIGN AND SETTING Cross-sectional study in 11 GP practices and four colposcopy clinics in London, UK, between August 2017 and January 2019. METHOD Non-speculum and conventional (speculum) samples were collected from women aged ≥50 years attending for a colposcopy (following a speculum HPV-positive screening result) or women aged ≥35 years (with confirmed cervical intraepithelial neoplasia (CIN) 2+), and women aged 50-64 years attending routine screening. Sensitivity to CIN2+ was assessed among women with confirmed CIN2+ (colposcopy). Specificity to HPV relative to speculum sampling and overall concordance was assessed among women with negative cytology (routine screening). RESULTS The sensitivity of non-speculum sampling for detecting CIN2+ was 83.3% (95% confidence interval [CI] = 60.8 to 94.2) (n = 15/18). There was complete concordance among women with positive CIN2+ who had a speculum sample ≤91 days prior to the non-speculum sample (n = 12). Among 204 women with negative cytology, the specificity to HPV was 96.4% (95% CI = 92.7 to 98.5), with 96.6% concordant results (κ 72.4%). Seventy-one percent (n = 120/170) of women preferred a non-speculum sample for their next screen. CONCLUSION HPV testing on non-speculum clinician-taken samples is a viable approach that warrants further exploration in larger studies. Overall test performance was broadly comparable with that of self-sampling.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, US
| | | | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Laura Av Marlow
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jane Rigney
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Peter D Sasieni
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Anita Ww Lim
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Comparison of the Hybrid Capture II Method with a PCR-Based Screening Method Using a Carboxyfluorescein-Labeled Primer for Detecting Human Papillomavirus in Cervicovaginal Liquid-Based Cytology. JOURNAL OF MOLECULAR PATHOLOGY 2020. [DOI: 10.3390/jmp1010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Human papillomaviruses (HPVs) are DNA viruses, of which over 120 types have been identified. The main screening methods for HPV-DNA include the hybrid capture II (HC-II) and polymerase chain reaction (PCR) assays. Liquid-based cytology (LBC) is a high-quality technique developed to improve the diagnostic reliability of traditional Papanicolaou tests (Pap tests). However, relatively few studies have compared the efficacy of PCR and HC-II assays using cervicovaginal LBC specimens. In this study, we conducted a comparative analysis with results derived from the HC-II assay to assess whether a PCR-based assay using a novel carboxyfluorescein (FAM)-labeled primer could be applied to cervicovaginal LBC specimens. Methods and Results: We analyzed 59 specimens diagnosed as atypical squamous cells of undetermined significance (ASCUS) by Pap tests. After extracting DNA from cervicovaginal LBC specimens, we performed PCR using a FAM-labeled consensus primer, and then conducted fragment analysis to confirm the results. The value of the kappa statistic measuring the agreement between the PCR and HC-II results was 0.8557, or “almost perfect agreement.” Conclusion: Our novel HPV-PCR assay can be successfully applied to cervicovaginal LBC specimens for the detection of HPV subtypes.
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Abdulaziz AMA, Liu L, Sun Y, You X, Cui B, Han S, Zhang Y. Clinicopathologic significance and treatment of ASC-US in cervical cytology. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:307-316. [PMID: 32211114 PMCID: PMC7061793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/31/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND In China, cervical cancer is one of the most common gynecologic malignancies. Cervical cytology is an essential method for screening cervical cancer and cervical intraepithelial neoplasia (CIN), and the most common cytological abnormality result is atypical squamous cells of undetermined significance (ASC-US). Therefore, how to effectively deal with ASC-US cytology has become the focus of scholars. OBJECTIVE We aim to analyze the final histopathologic results, clinicopathologic significance and current rationale of ASC-US cytology. METHODS All patients with first ASC-US cytological reports who attended our gynecological outpatient clinic in Qilu Hospital of Shandong University during January 2010 to December 2015 were recruited to this study. The data were derived from clinical records and evaluated retrospectively. The results of age, High-Risk HPV (DNA) testing, colposcopy, and pathological outcomes were obtained. Directed biopsy was performed if there were any suspicious cervical lesions under colposcopy, while four quadrant biopsy and/or ECC were performed if no suspicious lesions were noted in colposcopies. RESULTS A total of 1246 patients diagnosed with ASC-US were involved in the final statistical analysis. Mean age of patients was 41.6 years and the age range between 40-49 years represented 38.52% of all ASC-US women in this study. All patients were evaluated for HPV (DNA) and positive percent for High-Risk HPV was (67.1%). According to the final histopathologic outcomes after ASC-US cytology, 15.6% and 1.1% of patients had ≥ CIN2+ and invasive carcinoma respectively. Patients with invasive carcinoma were associated with HPV16+ and HPV18+. The detection rate of ≥ CIN2+ among the ASC-US/High-Risk HPV+ group was (53.9%) with a negative-predictive-value (NPV) of 100%. Our findings showed that the final pathologic results of ≥ CIN2+ were consistent with colposcopy with a coincidence rate of (77%), and colposcopical impression sensitivity and specificity for ≥ CIN2+ was (91.1% and 96.1%) respectively. CONCLUSION women with ASC-US have a wide range of final pathologic results, and it can be the initial warning of high-grade CIN or cervical cancer. In China, HPV (DNA) testing triage is a useful shunting measure for ASC-US patients, and an immediate colposcopy is a consequential strategy for dealing with ASC-US cytology to increase the detection rate of high-grade cervical lesions or invasive cancer.
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Affiliation(s)
| | - Lu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Jinan 250012, Shandong, P. R. China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Jinan 250012, Shandong, P. R. China
| | - Xuewu You
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Jinan 250012, Shandong, P. R. China
| | - Baoxia Cui
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Jinan 250012, Shandong, P. R. China
| | - Sai Han
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Jinan 250012, Shandong, P. R. China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Jinan 250012, Shandong, P. R. China
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Wang YY, Kong LH, Liu Y, Wang S, Fan QB, Zhu L, Lang JH. Retrospective analysis of cervical cancer and precancerous lesions in patients with atypical squamous cells of undetermined significance in China. Medicine (Baltimore) 2019; 98:e18239. [PMID: 31804350 PMCID: PMC6919524 DOI: 10.1097/md.0000000000018239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Atypical squamous cells of undetermined significance (ASCUS) are the most common cytological abnormality of all smear test. No study has demonstrated the prevalence of cervical cancer or its precursor in Chinese patients with ASCUS. This study aims to investigate the prevalence of cervical intraepithelial neoplasia 1 or worse (CIN1+) and CIN3 or worse (CIN3+) in patients with ASCUS in China to provide insight into appropriate management for Chinese health care.In a retrospective cross-sectional study, patients who underwent liquid-based thin layer cytology and human papillomavirus (HPV) co-testing at the Peking Union Medical College Hospital between January 2014 and January 2017, and had ASCUS results on liquid-based thin layer cytology test and underwent follow-up and colposcopic biopsy were included. Age, HPV DNA test, and pathological outcomes were assessed.One hundred forty-four patients with ASCUS and positive HPV test results were included. In the 3-year follow-up, 23 (16.0%) patients had CIN1, 28 (19.4%) had CIN2, and 17 (11.8%) had CIN3 or carcinoma in situ. The risk of CIN3+ was significantly higher in those older than 60 years (42.8%, P = .005), whereas the CIN1+ prevalence displayed no significant difference between age groups. Both hybrid Capture II (HC II) value and cytopathological description of HPV infection showed no statistically significant correlation with CIN1+ or CIN3+.Patients with HPV-positive ASCUS who were older than 60 years had a significantly higher risk of CIN3+, and clinicians should pay more attention to them. Both HC II value and cytopathological description of HPV infection showed no significant correlation with CIN1+ or CIN3+.
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Affiliation(s)
| | - Ling-Hua Kong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing-Bo Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Stanczuk G, Baxter G, Currie H, Lawrence J, Cuschieri K, Wilson A, Arbyn M. Clinical validation of hrHPV testing on vaginal and urine self-samples in primary cervical screening (cross-sectional results from the Papillomavirus Dumfries and Galloway-PaVDaG study). BMJ Open 2016; 6:e010660. [PMID: 27113237 PMCID: PMC4854001 DOI: 10.1136/bmjopen-2015-010660] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Papillomavirus Dumfries and Galloway (PaVDaG) assessed the performance of a high-risk human papillomavirus (hrHPV) PCR-based assay to detect high-grade cervical intraepithelial neoplasia (CIN2+) in self-collected vaginal and urine samples. SETTING Women attending routine cervical screening in primary care. PARTICIPANTS 5318 women aged 20-60 years provided self-collected random urine and vaginal samples for hrHPV testing and a clinician-collected liquid-based cytology (LBC) sample for cytology and hrHPV testing. INTERVENTIONS HrHPV testing. All samples were tested for hrHPV using the PCR-based cobas 4800 assay. Colposcopy was offered to women with high-grade or repeated borderline/low-grade cytological abnormalities; also to those who were LBC negative but hrHPV 16/18 positive. PRIMARY AND SECONDARY OUTCOME MEASURES The self-tests' absolute sensitivity and specificity for CIN2+ were assessed on all biospecimens; also, their relative sensitivity and specificity compared with clinician-taken samples. Interlaboratory and intralaboratory performance of the hrHPV assay in self-collected samples was also established. RESULTS HrHPV prevalence was 14.7%, 16.6% and 11.6% in cervical, vaginal and urine samples, respectively. Sensitivity for detecting CIN2+ was 97.7% (95% to 100%), 94.6% (90.7% to 98.5%) and 63.1% (54.6% to 71.7%) for cervical, vaginal and urine hrHPV detection, respectively. The corresponding specificities were 87.3% (86.4% to 88.2%), 85.4% (84.4% to 86.3%) and 89.8% (89.0% to 90.7%). There was a 38% (24% to 57%) higher HPV detection rate in vaginal self-samples from women over 50 years compared with those ≤29 years. Relative sensitivity and specificity of hrHPV positivity for the detection of CIN2+ in vaginal versus cervical samples were 0.97 (0.94 to 1.00) and 0.98 (0.97 to 0.99); urine versus cervical comparisons were 0.53 (0.42 to 0.67) and 1.03 (1.02 to 1.04). The intralaboratory and interlaboratory agreement for hrHPV positivity in self-samples was high (κ values 0.98 (0.96 to 0.99) and 0.94 (0.92 to 0.97) for vaginal samples and 0.95 (0.93 to 0.98) and 0.90 (0.87 to 0.94) for urine samples). CONCLUSIONS The sensitivity of self-collected vaginal samples for the detection of CIN2+ was similar to that of cervical samples and justifies consideration of this sample for primary screening.
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Affiliation(s)
- Grazyna Stanczuk
- Research and Development Support Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
- Global Health Academy, University of Edinburgh, Edinburgh, UK
| | - Gwendoline Baxter
- Research and Development Support Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Heather Currie
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - James Lawrence
- Research and Development Support Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Allan Wilson
- Department of Pathology, Monklands Hospital, Airdrie, UK
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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