HPV Genotype Specific and Age Stratified Immediate Prevalence of Cervical Precancers and Cancers in Women with NILM/hrHPV+: A Single Center Retrospective Study of 26,228 Cases

Abstract

To investigate the prevalence of precancers [high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS)] and cancers [squamous cell carcinoma (SCC) and adenocarcinoma (ADC)] in various high-risk human papillomavirus (hrHPV) genotypes or age groups among women with negative for intraepithelial lesion or malignancy (NILM) and hrHPV-positive pap results. Materials and Methods: In total, 26,228 women with NILM/hrHPV+ were included in the study. Among them, 5893 had immediate follow-up biopsy results available and were selected for further prevalence analysis. Results: About 7.6% and 0.7% women with NILM/hrHPV+ had HSIL and AIS, respectively. The prevalence of HSIL+ squamous lesions is significantly higher in HPV-16+ group than that in other genotype groups (p < 0.0001). The prevalence of AIS+ glandular lesions is significantly higher in HPV-18/45+ groups than women in other genotype groups (p < 0.0001). In addition, the prevalence of HSIL+ lesions was significantly higher in age 25-39 years group than that in age 40-65 years group and >65 years group (p < 0.0001). Overall, the prevalence of HSIL+ in younger women was significantly higher than that in older women when using a cutoff age of 40 years (9.3% vs 5.9%, p < 0.0001) or 50 years (8.6% vs 4.9%, p < 0.0001). No significant difference in AIS+ prevalence was found among different age groups (p = 0.611). Interestingly, the prevalence of SCC and ADC in older women (≥40 years, 0.3% and 0.3%, respectively) was significantly higher than that in younger women (<40 years, 0% and 0.07%) (p = 0.001 for SCC; p = 0.02 for ADC). Conclusion:The significant risk of cervical precancers and cancers still exists in women with NILM/hrHPV+, notably the older patient group had a lower risk of cervical precancer, but higher risk of cancer. Therefore, HPV genotyping can be an effective supplemental tool to cytology, and patient age also needs to be considered in the clinical management of patient.

Correlation of immediate prevalence of cervical precancers and cancers with HPV genotype and age in women with ASC-US/hrHPV+: a retrospective analysis of 2292 cases

“…Our previous study in NILM/hrHPV+ women demonstrated lower risk of cervical precancer but higher risk of cancer in the older patient group 30. In the current study, the prevalence of HSIL+squamous lesions or AIS+ glandular lesions showed no significant difference among different age groups.…”

Correlation of immediate prevalence of cervical squamous cell precancers and cancers with HPV genotype and age in women with LSIL cytology: A retrospective analysis of 1617 cases

“…Our previous study showed that in the NILM/hrHPV-positive population, the older patient group exhibited a lower risk of cervical precancer but a higher risk of cancer. 21 Similarly, in ASC-US/hrHPV-positive women, the prevalence of cervical SCC is significantly higher in older women than in younger women. 22 In the current study, 25-39 age years group showed a significantly higher prevalence of CIN1 ( p = .032).…”

Which is the best management for women with normal cervical cytologic findings despite positivity for non-16/18 high risk human papillomaviruses?

“…Recognizing that women who are NILM but have non-16/18 HR-HPV persistence are still at risk for precancerous lesions; however, the utility of the current strategy is confined to a higher risk in women who have type-specific persistence of non-16/18 genotypes. This is especially true for younger NILM women, who had a significantly higher HSIL prevalence than older women (27). When no precursor lesion is detected at the initial screening, there is no agreement on the duration of follow-up on non-HPV16/18 persistence before referral to colposcopy or treatment.…”

“…Moreover, the prevalence and risk for HSIL decline with increasing age in women who are NILM (1,36). However, when an age cutoff of 40 years was used, the prevalence of HSIL in younger women who were NILM was significantly higher than that in older women, and the group of older women conferred a lower risk for cervical precursor lesions and a higher risk for cancer compared to the group of younger women (27).…”

“…Several longitudinal and cross-sectional studies have reported a relatively high prevalence of HSIL in women who were NILM but positive for HR-HPV. The proportion of HSIL or more advanced lesions ranges from 5.40 to 20.39% ( 16 , 27 – 29 ). Moreover, HSIL was detected in 7.5% (20/265) of women who were NILM but positive for HR-HPV during the follow-up period ( 9 ).…”