HPV is the major causative agent for cervical cancer. Study on the risk of cervical cancer associated with different hr-HPV genotypes would be useful for disease management and new vaccine strategy. With limited reports available, the present study aimed to investigate the pattern of HPV genotypes coinfections and risk of cervical carcinoma associated with them in Indian population. 15 HPV genotypes were detected by E6/E7 multiplex nested type-specific PCR in the HPV-positive cervical samples of 172 cervical cancer cases and 174 subjects with normal cytology. Association between the genotypes and cervical cancer was estimated by calculating the Odds ratio and 95% confidence interval. Risk of cervical carcinoma was associated with multiple genotypes excluding HPV16 (OR:5.87; 95% CI-1.28-26-29; p = .02), multiple genotypes excluding HPV18 (OR = 2.5; 95% CI = 1.09–6.05; p = .03), multiple genotypes of α9 species(OR = 5.3 95% CI = 1.14–24.03; p = .007), and multiple genotypes of α7 species (OR = 2.5; 95% CI = .49–13.45; p = .2). Genotypes not targeted by quadrivalent vaccine types (OR = 2.94 95% CI = 1.48–5.80; p = .001) conferred 2.94 fold higher risk of cervical carcinoma. Cases those coinfected with phylogenetically related genotypes (OR = 2.29; 95% CI(.69–7.59) p = .17) were at 2.9 fold higher risk of invasive cervical carcinoma than those infected with other genotypes although it is not statistically significant. Whereas phylogenetically unrelated genotypes coinfection is negatively associated with cervical carcinoma (OR = .44 95% CI (.244-.8) p = .007) and it is statistically significant.Genotypes not targeted by 9-valent vaccines (OR = .40; 95% CI = .19-.85; p = .017) associated with lesser risk of cervical carcinoma as compared to other genotypes. Subjects infected with any HPV genotype/genotypes excluding HPV16 in association with HPV 18 (OR = 4.1; 95% CI = 1.81–9.25 P = < .001) were at 4.1 fold higher risk of developing invasive cervical carcinoma.In conclusion, the risk of development of cervical cancer is genotype specific and might be associated with type-specific interactions between the genotypes in multiple infections.

BackgroundConsidering the limited cross protection offered by the current HPV vaccines, understanding the HPV genotype distribution among the different population is essential in predicting the efficacy of current vaccine and devising new vaccine strategy. The present work aimed at investigating the HPV genotypes distribution among women with and without cervical carcinoma in Odisha, Eastern India.MethodsA total of 607 participants have been enrolled between January 2014 and June 2016. L1-PCR, sequencing, and E6/E7 nested multiplex type- specific PCR were performed for HPV detection and genotyping. Cytological distribution of 440 cases includes invasive cervical carcinoma or ICC (n = 210), inflammatory smear (n = 162), normal cytology (n = 68). Statistical analyses were performed by using SPSS version 20.0 software and MediCal version 14.10.2(7). A p-value of ≤ 0.05 was considered statistically significant.ResultsThe overall prevalence of HPV infection was (359/595) 60.33%. Prevalence of HPV infection was 93.80% (197/210) in invasive cervical cancer (ICC) cases, 54.32% (88/162) in inflammatory smear and 19.11% (13/68) in normal cervical cytology. The most prevalent genotype was HPV16 (87.28%) followed by HPV18 (24.56%) and HPV 51(3.46%). The overall prevalence of single type was 76.58% and highest (78.9%) among ICC cases. The most frequent genotype combination after HPV16 + 18(9.4%) was HPV16 + 66 + 68(2.7%) which was frequently observed in inflammatory cytology. Age > 45years, parity ≥3, low socio-economic condition, rural residential area and post menopause state were significantly associated with HPV infection. Multiple infections did not have a significant association with any of the clinicopathological variables (stage, LN metastasis, cell type) except tumor size ≥ 2cm in ICC cases. The impact of 2v, 4v, and 9v vaccines in preventing cervical cancer in Odisha were 89.99, 91.65, and 92.16% respectively.ConclusionThis data would help planning an appropriate strategy for disease monitoring and provides baseline data for post-vaccination surveillance in the region. The nonavalent vaccine would be significant in preventing cervical carcinoma in Odisha. Hence an effective vaccination program based on regional HPV epidemiological profile along with the cervical cancer screening is necessary to reduce the cervical cancer burden in India.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2136-4) contains supplementary material, which is available to authorized users.

In India, there are marked variations in resources for cervical cancer screening. For the first time, resourcestratified screening guidelines have been developed that will be suitable for low middle-income countries with similar diversities. The current article describes the process and outcomes of these resource stratified guidelines for screening and treatment of preinvasive lesions of cervix. Evidence from literature was collated and various guidelines were reviewed by an expert panel. Based on the level of evidence, guidelines were developed for screening by human papillomavirus (HPV) testing, cytology and visual inspection after application of acetic acid (VIA), and management of screen positive lesions in different resource settings. Expert opinion was used for certain country-specific situations. The healthcare system was stratified into two resource settingsgood or limited. The mode of screening and treatment for each was described. HPV testing is the preferred method for cervical cancer screening. VIA by trained providers is especially suitable for low resource settings until an affordable HPV test becomes available. Healthcare providers can choose the most appropriate screening and treatment modality. A single visit approach is encouraged and treatment may be offered based on colposcopy diagnosis ('see and treat') or even on the basis of HPV test or VIA results ('screen and treat'), if compliance cannot be ensured. The Federation of Obsterician and Gynaecologists of India Good Clinical Practice Recommendations (FOGSI) GCPR are appropriately designed for countries with varied resource situations to ensure an acceptable cervical cancer prevention strategy.The three main modalities of screening in use are HPV testing, cytology and visual inspection with 202

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Background: Breast imaging-reporting and data system (BI-RADS) is intended for standardizing mammography reporting. Objectives: We aimed to evaluate the diagnostic precision of the BI-RADS assessment scoring system using histopathological findings as the reference standard. We also aimed to assess the positive predictive value (PPV) of different morphological descriptors for malignancy. Materials and Methods: This retrospective record-based analytical study was conducted in the Department of Radiodiagnosis of Acharya Harihar Post Graduate Institute of Cancer, Cuttack, Odisha, a tertiary cancer center in eastern India. We included patients attending the breast cancer unit with various breast complaints who were subjected to mammographic imaging and histopathological examination. The primary outcomes were the sensitivity, PPV, negative predictive value (NPV), and diagnostic accuracy (DA) of the BI-RADS scores for the pathological reports; secondary objective was the evaluation of the mammographic morphological characteristics. Mammography was interpreted using the BI-RADS 5th edition guidelines, without prior knowledge of the biopsy report. A BI-RADS final assessment score between 1 and 5 was assigned, where 1 indicated a normal study, 2 benign, 3 possibly benign requiring follow up, 4 suspicious requiring biopsy, and 5 indicating likely malignant requiring biopsy and further actions. Results: Between February 2020 and December 2020, we included 247 patients. All the category 5 lesions were malignant, while 76.5% of category 4 lesions were malignant. PPVs of BI-RADS categories 4a, 4b, and 4c were 38%, 90%, and 94%, respectively. Mammography had a sensitivity, specificity, PPV, NPV, and DA of 98.7%, 47.6%, 87.5%, 90.9%, and 87.9%, respectively. Morphological features that were significantly associated with malignancy were spiculated margins (P = 0.003, PPV = 100%), microlobulated margins (P = 0.005, PPV = 96.5%), irregular shape (P = 0.002, PPV = 89.6%), microcalcification (P = 0.005, PPV = 92.8%), skin thickening (P < 0.0001, PPV = 100%), and architectural distortion (P = 0.003, PPV = 96.7%). Conclusion: Digital mammography is a sensitive tool for the evaluation of breast lumps, but BI-RADS final assessment score is subjective as it depends on the interpreter's expertise.