HPV test results and histological follow-up results of patients with LSIL Cervical Cytology from the Largest CAP-certified laboratory in China

Correlation of High-Risk HPV Genotypes with Pap Test Findings: A Retrospective Study in Eastern Province, Saudi Arabia

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.

Low-grade squamous intraepithelial lesion on Papanicolaou test: follow-up rates and stratification of risk for high-grade squamous intraepithelial lesion

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.

Risikobewertung von Zytologiebefunden im Zervixkarzinom-Screening

Zielstellung

Das CIN2+-/CIN3+(zervikale intraepitheliale Neoplasie)-Risiko plattenepithelialer zytologischer Befunde (Gruppe II‑p, IIID1, III‑p, IIID2 der Münchner Nomenklatur [MN] III) soll bewertet und mit Empfehlungen für das Patienten-Management korreliert werden.

Material und Methoden

Alle 4321 Frauen mit einer Gruppe II‑p, IIID1, III‑p, IIID2, IVa‑p, IVb-p und V‑p von Januar 2014 bis Dezember 2016 wurden in einer Praxis für Pathologie erfasst. Zytologische Vorbefunde, alle zytologischen und histologischen Folgebefunde bis Juli 2019 wurden dokumentiert. Für die Erstbefunde wurde pro Befundgruppe mittels Kaplan-Meier-Schätzung das Risiko für CIN2+/CIN3+ ermittelt. Das Risiko bei persistierenden Befunden und der Einfluss des Alters wurden untersucht.

Ergebnisse

Für die Erstbefunde der Gruppen II‑p, IIID1, III‑p und IIID2 beträgt das Risiko für CIN2+ nach 12, 24 und 60 Monaten 1,0/3,3/11,8; 3,1/9,4/22,7; 33,4/38,4/55,5 bzw. 35,1/46,2/64,4 (%). Das Risiko für CIN3+ beträgt für die gleichen Zeiträume 0,6/2,7/9,7; 1,9/5,2/14,3; 28,8/32,4/44,0 bzw. 28,5/36,7/52,4 (%). Bei persistierenden Befunden derselben Gruppe steigt das Risiko für CIN2+ und CIN3+ signifikant vom ersten zum zweiten II-p‑, IIID1-, III-p- und IIID2-Befund. Bei den Gruppen II‑p, IIID1 und IIID2 finden sich keine signifikanten Altersunterschiede, bei III-p-Befunden ist das Risiko für Frauen <30 und <35 signifikant größer als für ältere Frauen.

Schlussfolgerung

Die MN III mit 3‑gliedriger Dysplasiegraduierung klassifiziert die zytologischen Befunde risikoorientiert. Ihre Befundgruppen eignen sich als Basis für ein risikoadaptiertes Management, um insbesondere Überdiagnostik und -therapie zu vermeiden.

Rising Mortality Rate of Cervical Cancer in Younger Women in Urban China

BACKGROUND

In recent decades, much effort has been made in China to reduce the burden of cervical cancer.

OBJECTIVE

Our study's purpose was to examine trends of cervical cancer mortality in each 5-year age group for urban and rural Chinese women, respectively.

DESIGNS

Retrospective analysis of cervical cancer mortality from 1987 to 2015 from the World Health Organization Cancer Mortality Database and China Health Statistical Yearbooks.

PARTICIPANTS

Chinese women.

MAIN MEASURES

Trends were examined using annual percent change (APC) and average annual percent change (AAPC) via Joinpoint regression models for each 5-year age group in urban and rural areas, respectively.

RESULTS

In urban China, mortality rate of cervical cancer increased significantly among urban women aged 25-54 years (AAPC 2.12~5.49%), in contrast to a decline trend among urban women older than 60 years (AAPC - 3.61~- 5.35%). In rural China, cervical cancer rates declined in all age groups, but the magnitude was smaller in women aged 30-54 years (AAPC - 0.59~- 2.20%) compared to women older than 55 years (AAPC - 3.06~- 4.33%).

CONCLUSION

Mortality rate of cervical cancer is rising at an alarming rate in younger women in urban China. Timely intervention is required for these vulnerable populations.

Potential influence of p16 immunohistochemical staining on the diagnosis of squamous cell lesions in cervical biopsy specimens: observation from cytologic-histologic correlation

BACKGROUND

The p16 immunohistochemical (IHC) marker has been used increasingly as an adjunct to morphologic assessment of cervical biopsies in which the differential diagnoses include high-grade squamous intraepithelial lesion (HSIL) and its mimics. The objective of this study was to assess the potential influence of p16 IHC staining on the evaluation of cervical biopsy as observed through cytologic-histologic correlation (CHC).

METHODS

Cervical biopsy samples that had cytologic diagnoses of either low-grade squamous intraepithelial lesion (LSIL) or HSIL and also had histologic follow-up were retrieved from the department database. CHC and the use of p16 IHC from 2 periods (group 1, 2008; group 2, 2014-2016) were compared and analyzed.

RESULTS

Histology on 452 samples from patients who had prior LSIL cytology in group 1 yielded 126 benign (27.9%), 272 LSIL (60.2%), and 54 HSIL (11.9%) diagnoses. By comparison, 491 samples from the patients in group 2 yielded 106 benign (21.6%), 277 LSIL (56.4%), and 108 HSIL (22.0%) diagnoses. The difference in CHC discrepancies between the 2 groups was significant (P = .0001), mainly because of the increased diagnosis of HSIL in group 2. Although p16 IHC was not applied to any sample from group 1, it was performed on 141 of 491 samples (28.7%) from group 2. Further follow-up of patients who had histologic HSIL revealed that residual HSIL was identified significantly more often in those who did not have p16 IHC applied in the preceding cervical biopsy than in those did (P = .0004). A similar comparison was performed between 113 patients from group 1 and 152 patients from group 2 who had a prior diagnosis of HSIL cytology, and the difference was statistically insignificant.

CONCLUSIONS

The use of p16 IHC on cervical biopsies in patients who had a prior cytologic diagnosis of LSIL may lead to greater detection and upgrading of HSIL, thereby compounding the discrepancy in CHC.