PCR detection of human papillomavirus of the mucosa: comparison between MY09/11 and GP5+/6+ primer sets

BACKGROUND AND OBJECTIVES

Human papillomaviruses (HPV) are the causal agent for the development of carcinomas in the cervix uteri and further pathological changes of the skin including mucosa, particularly warts, condylomas and dysplasias. Therefore, we investigated the efficacy of different consensus primers pairs for HPV detection by PCR using brushed samples from the oral cavity in comparison with samples from the cervix uteri.

STUDY DESIGN

In the present study, we used two well-established sets of PCR primers in different combinations for the detection of HPV DNA in 106 non-invasive brush biopsy samples of the oral mucosa and 56 samples from the cervix uteri. Direct sequencing of PCR products in all cases determined HPV genotype and specificity.

RESULTS

Overall, HPV was detected in 69 of 106 oral mucosa samples. HPV specific amplicons were obtained in 35.8% (N = 38) when using GP5+/6+ primers. The positivity rate was increased to 65.1% in a GP5+/6+ auto-nested PCR approach. In contrast, MY9/11 PCR and nested PCR with MY9/11 outer followed by GP5+/6+ inner primers yielded 2.2% and 16.1%, respectively. In gynaecological samples, PCR results were similar independent of the primer combination used. Thus, DNA quality and DNA content could be additional factors influencing the rate of positivity.

CONCLUSION

For oral mucosa samples, auto-nested GP5+/6+ PCR is in our hands the most suitable approach for epidemiological studies because of its high sensitivity, high reliability and reproducibility as well as its relatively simple laboratory procedure.

Predictive value of DNA cytometry in CIN 1 and 2. Image analysis of 193 cases

OBJECTIVE

To investigate DNA image cytometry for predicting the prognosis of cervical intraepithelial neoplasia (CIN).

STUDY DESIGN

Smears from 151 women affected by CIN 1 or 2 on cytology with minimal follow-up of three years were included. Sixty-seven showed progression, with histologically confirmed carcinoma in situ or invasive cancer. Eighty-four cases showed regression of the disease, which was cytologically, histologically and colposcopically confirmed. Papanicolaou-stained smears were destained, and the Feulgen reaction was performed with consecutive image DNA cytometry of suspicious cells using an image analysis system (Cires, Zeiss, Germany). The DNA index of the greatest stemline and the number of single aneuploid cells, using 9c exceeding events, were computed.

RESULTS

In the group with progression, an aneuploid DNA stemline was found in 25 smears (26.9%). In 64 cases (66.7%) more than one aneuploid event was detected. The total number of aneuploid cases in this group was 76 (81%). In the group without progression, the number of aneuploid stemlines was 2 (2%). Single aneuploid cells could be found in five cases (5%). The overall number of aneuploid cases in that group was five. The sensitivity was 74.3%, positive predictive value 85.2% and negative predictive value 77%.

CONCLUSION

Aneuploidy is a marker for prospective malignancy in cervical Papanicolaou smears. DNA image cytometry, as an additional method, can be used to predict outcome in patients with CIN 1 and 2 of the cervix. DNA cytometry is not a screening method but can add further information for a treatment decision in doubtful cases.

[Therapy outcome in stage III (FIGO) ovarian carcinomas at the Leipzig University Gynecologic Clinic 1976-1982 and 1985-1991]

This retrospective study compares treatment results (median survival time, 5-year survival rate) of 153 patients diagnosed with FIGO stage III ovarian cancer treated between 1976 to 1982 (n = 73) and 1985 to 1991 (n = 80) respectively. Between 1976 to 1982, the median survival time was 12.3 months, while it increased up to 17.0 months during the period of 1985-1991. The 5-year survival rate increased from 14.0% to 28.0%. This improvement may be due to a more radical surgical approach and the use of platinum-based first-line chemotherapy. However, the difference between the two groups was not statistically significant.

[Histopathologic correlates of false-positive cytologic findings in the uterine cervix]

Between 1984 and 1992, we reinvestigated 170 cases of cervical smears obtained in conization or hysterectomy which had produced false positive cytologic findings. We looked for morphological changes that could explain the cytologic findings. Such changes were found in half of the cases. These cases included 54 (63.6%) specimens with marked cellular polymorphism as a result of inflammation, tissue regeneration, or atrophy. In 51.9% of the cases showed histologic signs of possible HPV infection. The initial findings required reclassification in 12.9% of the cases, and in fifteen cases (17.6%) the biopsy matched the cytologic findings, without being validated by the final findings. We observed histologic phenomena corresponding to the cytologic findings in 30.8% of the cases in group IIID (n = 26) using Papanicolaou's classification system. In groups IV a (n = 72), IV b (n = 44), and V (n = 28), we found a histologic explanation in 54.2%, 47.7%, and 60.7% of the cases, respectively. In most cases we observed polymorphic cellular changes primarily associated with HPV.

False positive cervical smears: a cytometric and histological study

The evidence of exfoliative cytology of the cervix uteri depends on various factors. The rate of false positive cervical smears is on average 8.8%. We have reviewed 170 false positive routinely Papanicolaou-stained cervical smears and the corresponding histological specimens. The aim was to look for non-neoplasic changes explaining the cytological over-interpretation. In addition, nuclear Feulgen-DNA measurements of the smears were made to look for changes in DNA pattern. In 50% of all cases, a cause was found for the false positive cytological diagnosis by means of histological reexamination: non-neoplastic nuclear and cellular polymorphia, severe purulent-erosive inflammation, a higher reclassification or a positive presurgical biopsy. In 51.9% of these cases, there were signs of an infection with human papilloma virus (HPV). In cases without histological explanation of the cytological findings, DNA measurements were made on the suspicious cells. By means of single cell algorithm (5c/9c exceeding events), a general rate of 62.7% of aneuploid specimens was detected. The number of aneuploid single cells ranged between 5 and 63 per slide. Of these cases, 23.1% showed signs of HPV infection. As a result of the study, the number of real 'false positive' cytological diagnoses decreased from 170 to 97 as a result of histological reexamination and DNA measurement. In doubtful cases, DNA measurement of suspicious smears should be made.

[Cytodiagnostic studies of the laryngeal mucosa in chronic laryngitis]

Cytological diagnostic aids in chronic inflammation of the larynx have been rarely employed so far. A study was conducted to prove whether there is any possibility of larnygeal cytological diagnosis and whether there are any premalignant changes. In view of the results obtained by gynaecological exfoliative cytology, attention was focussed on the metaplastic cells. The frequent incidence of metaplasias was highly significant, whereas dysplasias occurred only in chronic laryngitis besides in tumours. One trend occupying higher cytological diagnostic groups in the Papanicolaou pattern was seen in chronic laryngitis. In our opinion, cytological diagnosis in laryngeal investigation is an aid in the followup control in chronic laryngitis, which is a repeatable procedure without unduly stressing the tissue. Recording of cellular changes in chronic laryngitis can enable a prospective appreciation of morphological changes, which can be useful as diagnostic tool for examining suspicious findings.

[Colposcopy and early changes of cervical carcinoma (author's transl)]

Cytology and colposcopy are well recognized methods in the early diagnosis of pre-malignant and early invasive changes of the uterine cervix. Since 1971 the University Department for Women in Leipzig has a cytology clinic. The results of repeat smears before biopsies and the follow-up examinations on 202 cone biopsies are reviewed. The incidence of negative findings decreases with increasing atypia of the squamous epithelium. The highest incidence of false negative smears was 73.3% in mild and moderate dysplasias. The more pronounced the atypia the smaller is the number of inadequate pap smears. In cases with negative cytology and colposcopic atypia the colposcopic findings must be clarified. Only the combination of colposcopy and cytology leads to optimal early diagnosis of cervical intra-epitheal neoplasia and invasive carcinoma of the cervix. The false positive cytosmears in the screening are discussed and a treatment with estrogens prior to repeat examination is recommended. Diagnostic problems arise from a discrepancy in the colposcopic and cytologic findings. Discrepancies depend on the colposcopic experience of the examiner. Improvement of the colposcopic diagnosis is obtained by directed colposcopic biopsy.