hr-HPV testing in the follow-up of women with cytological abnormalities and negative colposcopy

Abstract

Background:The follow-up after abnormal Pap smear and negative colposcopy is not clearly defined. This study aimed at investigating the role of hr-HPV testing in the management of abnormal Pap test and negative colposcopy for Cervical Intraepithelial Neoplasia grade 2 or worse (CIN2+).Methods:The study enroled 1029 women with abnormal screening cytology (years 2006–2010) and negative colposcopy for CIN2+, which subsequently performed a hr-HPV test. Incident CIN2+ lesions were identified through linkage with cancer registry, hospital discharge records, neoplastic pathology reports and the archive of screening programme (2006–2011).Results:During the follow-up, the cohort developed 133 CIN2+ lesions; only one among hr-HPV-negative women. The probability of developing CIN2+ on follow-up time was 0.44% (95% confidence interval (CI) 0.1–3.1) and 41.8% (95% CI 31.8–53.5) for hr-HPV-negative women and hr-HPV-positive women, respectively. A woman with a positive hr-HPV test had about 105 times higher probability of developing a CIN2+ lesion than a woman with a negative hr-HPV test (hazard ratio (HR)=104.5, 95% CI 14.5–755.1), adjusted for index Pap test result, age and cervix squamocolumnar junction visualisation.Conclusion:Our results confirm that hr-HPV testing is able to select the real group of women at risk of developing CIN2+ lesions in the follow-up of abnormal cytology and first negative colposcopy.

Vaginal Microbiota and Cytokine Microenvironment in HPV Clearance/Persistence in Women Surgically Treated for Cervical Intraepithelial Neoplasia: An Observational Prospective Study

“…Overall, consistent with the presence of BV-associated microbiomes, a high concentration of pro-inflammatory cytokines was detected in the vaginal environment of CIN patients, including IL1a, IL1b, IL6, IL8, and TNFa, with the highest values found in the CST-IV profile compared to the others, confirming that BV-like vaginal microbiomes are associated with increased local inflammation (Campisciano et al, 2018;De Seta et al, 2019;Torcia, 2019).…”

“…HPV status was determined by Cobas 4800 HPV Test (Roche Diagnostics, Monza, Italy), allowing detection of 18,31,33,35,39,45,51,52,56,58,59,66,68. Patients were followed according to the Regional Protocol for CC prevention (Carozzi et al, 2015) and LEEP by monopolar energy diathermic loop was used for lesion removal. The protocol includes PAPtest, colposcopy and hrHPV-test before LEEP and follow-up control at 6 months after lesion removal.…”

The prevalence and distribution of human papillomavirus in 4267 Turkish women with or without cervical lesions: A hospital‐based study

“…However, most of the studies showed that HPV prevalence decreases with increasing age with a peak prevalence in younger women 28 . Carozzi et al reported in their study from Italy, that HR‐HPV positivity was higher in patients younger than 35 years of age (62.9%) than patients older than 35 (54.7%) 29 . In the study of Hashim et al, HR‐HPV positivity rates in two age groups (34–43, 44–69) were close, however, the older age group had a slightly higher number 30 .…”

Viral and Cellular Biomarkers in the Diagnosis of Cervical Intraepithelial Neoplasia and Cancer

“…Nowadays, numerous assays have been developed to detect nucleic acids of oncogenic and nononcogenic HPVs in cervical samples. The main advantage of using HPV testing is the high sensitivity, with a consequent high negative predictive value, since the absence of carcinogenic HPV indicates an extremely low risk of cervical intraepithelial neoplasia grade 3 (CIN3) or cancer [ 20 – 22 ], and the longer protection compared with cytology, since the risk of CIN3 and cancer remains very low up to 5 years after a negative HPV test [ 23 ]. The only concern is the low specificity of the HPV assays due to the fact that they cannot discriminate between transient and persistent HPV infections.…”