Performance and Diagnostic Accuracy of a Urine-Based Human Papillomavirus Assay in a Referral Population

Background: Human papillomavirus (HPV) testing from clinician-collected cervical and self-collected cervico-vaginal samples is more sensitive for detecting CIN2+/CIN3+ than cytology-based screening, stimulating interest in HPV testing from urine. The objective was to determine the performance of the Trovagene HPV test for the detection of CIN2+ from urine and PreservCyt cervical samples.Methods: Women referred for colposcopy at St Mary's Hospital (London, United Kingdom), following abnormal cytology, were recruited to this diagnostic accuracy study by convenience sampling (September 2011 to April 2013). A total of 501 paired urine and cervical samples were collected. Primary outcomes were sensitivity for CIN2+/CIN3+ and specificity for Collapse

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MESH Headings

• Adult
• Aged
• Cervix Uteri/pathology
• Colposcopy
• DNA, Viral/isolation & purification
• Early Detection of Cancer/methods
• Feasibility Studies
• Female
• Humans
• Mass Screening/methods
• Middle Aged
• Papillomaviridae/isolation & purification
• Papillomavirus Infections/diagnosis
• Papillomavirus Infections/pathology
• Papillomavirus Infections/urine
• Papillomavirus Infections/virology
• Prospective Studies
• RNA, Viral/isolation & purification
• Referral and Consultation
• Sensitivity and Specificity
• Specimen Handling
• United Kingdom
• Urinalysis/methods
• Uterine Cervical Neoplasms/diagnosis
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/urine
• Uterine Cervical Neoplasms/virology
• Vaginal Smears
• Uterine Cervical Dysplasia/diagnosis
• Uterine Cervical Dysplasia/pathology
• Uterine Cervical Dysplasia/urine
• Uterine Cervical Dysplasia/virology

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Grants

• 16891 Cancer Research UK
• C569/A16891 Cancer Research UK

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Affiliation(s)

Jack Cuzick Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
Louise Cadman Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
Amar S Ahmad Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
Linda Ho Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
George Terry Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
Michelle Kleeman Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
Deirdre Lyons Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
Janet Austin Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
Mark H Stoler Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
Cecile Rose T Vibat Trovagene Inc., San Diego, California
Janel Dockter Trovagene Inc., San Diego, California
David Robbins Trovagene Inc., San Diego, California Genomind Inc. King of Prussia, Pennsylvania
Paul R Billings Trovagene Inc., San Diego, California
Mark G Erlander Trovagene Inc., San Diego, California

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Rapid HPLC method for the determination of vitamin A and E and cotinine concentration in human serum in women with CIN and cervical cancer

OBJECTIVE

The aim of this study was to elaborate on the analytical method for quantitative determination of retinol and alpha-tocopherol in serum of women diagnosed with CIN and cervical cancer. The basic problem in the analysis of the vitamins content in biological material is their low physiological concentration level and instability. Liquid chromatography with diode array detector (DAD) was applied.

MATERIAL AND METHODS

The material consisted of serum and urine collected from 12 women diagnosed with cervical intraepithelial neoplasia (CIN) and 16 diagnosed with cervical cancer. The method was evaluated for the following parameters: linearity, recovery, sensitivity, precision, accuracy, selectivity, stability, limit of quantification (LOQ) and limit of detection (LOD).

RESULTS

Results showed good linearity (r2> or =0.99) in the range 0.1 microg/ml-10 mg/ml for retinol and 0.25 microg/ml-15 microg/ml for alpha-tocopherol. The Lower Limit of Detection was 0.15 microg/ml for vitamin E and 0.05 microg/ml for vitamin A. The within-run R.S.Ds were below 5.2% at all concentration levels and the between-run R.S.Ds were below 10.0% at all concentration levels.

CONCLUSIONS

The advantage of this method is that it measures both compounds in a more rapid, reproducible and accurate manner when compared to the previous HPLC studies. The compounds (vitamin A and E and internal standards) are measured in the same sample at the same time. Quantitative determination of cotinine may reveal active smokers and subjects exposed to environmental tobacco smoke, which is independent measurable carcinogenetic co-factor. The following study is a part of a project determining non-viral causative agents in cervical carcinogenesis.

Quantitative determination of 3,3'-diindolylmethane in urine of individuals receiving indole-3-carbinol

Indole-3-carbinol (I3C) or, more correctly, its acid condensation products act as chemoprotective agents via several mechanisms. It induces the expression of cytochrome P-450 1A1, which shifts the estrogen metabolic pathway in favor of C-2 hydroxylation and away from the formation of 16 alpha-hydroxyestrone, a suspected endogenous carcinogen. Increased 16 alpha-hydroxylation of estrogen is associated with greater risk of cancer of the cervix, breast, endometrium, and larynx. The production of 4-hydroxyestrone is also inhibited by I3C. I3C can induce a G1 cell cycle arrest in human MCF-7 breast cancer cells. It can suppress aberrant crypt foci. I3C significantly inhibits the cell adhesion, spreading, and invasion associated with an upregulation of PTEN (a tumor suppressor gene) and E-cadherin (a regulator of cell-cell adhesion) expression in T47-D human breast cancer cells. Thus I3C exhibits anticancer activities by suppressing breast tumor cell growth and metastatic spread. A gas chromatography-mass spectrometry method for the quantitation of diindolylmethane, the principal acid condensation product of I3C, has been developed for use in determining compliance in subjects who have been treated with I3C. The method utilizes a 1-ml urine sample. We have used this method to correlate I3C ingestion with regression of cervical intraepithelial neoplasia in a population of women at risk for cervical cancer. The assay provides an objective marker of consumption using a noninvasive biological fluid and illustrates that diindolylmethane may be used as a marker of compliance in I3C dietary intervention studies.

Beta-core fragment of human chorionic gonadotropin in cervical intraepithelial neoplasia (CIN)

A low molecular weight glycoprotein immunologically identical with the beta-core fragment of hCG (beta C-hCG) has been described in invasive tumors of the genital tract, particularly carcinoma of the cervix. A previous report has also suggested increased urinary concentrations in subjects with cervical intraepithelial neoplasia (CIN). This prospective study of 107 patients with CIN was conducted to determine concentrations of beta C-hCG in the urine compared to a reference population without CIN. All subjects underwent a cervical smear and colposcopy, with biopsy when indicated. Between 11 and 18% of patients had urinary concentrations of beta C-hCG greater than the upper limit of the reference group and these results were confirmed when corrected for urinary creatinine concentration. A substantial number of subjects (19%) also had a positive result in a C-terminal immunoassay. It is concluded that preinvasive carcinoma of the cervix may secrete hCG or beta C-hCG in the earliest stages although measurement of beta C-hCG is unlikely to prove to be a valuable diagnostic marker in CIN.

Effects of interferon-alpha on macrophage activation in patients with ovarian carcinoma and cervical dysplasia

Patients with progressive ovarian carcinoma and patients with dysplasia of the uterine cervix were studied in order to compare clinical efficacy, hematological toxicity and effects on macrophage activation of administered interferon-alpha for both patient groups. One of three patients with ovarian carcinoma showed a minor response. Four of six patients with cervical dysplasia had slight improvements of PAP-smears. Moderate hematological toxicity was observed in the former patient group while side effects were much more pronounced in the latter patients group. However, changes of hematological parameters were not statistically different. Interestingly, the administered interferon-alpha caused the same activation of macrophages in both patients groups as indicated by raised neopterin levels. This activation does not result in clinical improvement but appears to play a role for the hematological toxicity observed during therapy of patients with ovarian carcinoma. It has been suggested that suppression of hematopoiesis is mediated by interferon-gamma. The present neopterin data propose that this lymphokine is continuously produced through influence of the tumor and enhanced by interferon-alpha.

Urinary cyclic nucleotides and the cytopathology of human uterine cervical dysplasias

Blinded urinary assays for cyclic guanosine 3':5'-monophosphate (cGMP) and cyclic adenosine 3':5'-monophosphate (cAMP) were performed on 49 subjects with documented abnormal cervical cytology and 21 control subjects with normal cytology. A significant difference in the mean cGMP:cAMP ratios between the case and control groups was found. A significantly greater proportion of women with cytological abnormalities had a cGMP:cAMP ratio above the 0.2 level (p less than 0.001). Cases treated surgically for severe dysplasia or carcinoma in situ of the cervix revealed a significant postsurgical fall in the cGMP:cAMP ratios (p less than 0.025). The possibility of utilizing urinary ratios of cyclic nucleotides as an objective index in the detection, monitoring of progression, and therapy of preneoplastic cervical lesions is discussed.