Primary Screening for Cervical Cancer Based on High-Risk Human Papillomavirus (HPV) Detection and HPV 16 and HPV 18 Genotyping, in Comparison to Cytology

Abstract

ObjectivesThe objective of the present study is to assess the performance of a high-risk human papillomavirus (HR-HPV) DNA test with individual HPV-16/HPV-18 genotyping as a method for primary cervical cancer screening compared with liquid-based cytology (LBC) in a population of Greek women taking part in routine cervical cancer screening.MethodsThe study, conducted by the “HEllenic Real life Multicentric cErvical Screening” (HERMES) study group, involved the recruitment of 4,009 women, aged 25–55, who took part in routine cervical screening at nine Gynecology Departments in Greece. At first visit cervical specimens were collected for LBC and HPV testing using the Roche Cobas 4800 system. Women found positive for either cytology or HPV were referred for colposcopy, whereas women negative for both tests will be retested after three years. The study is ongoing and the results of the first screening round are reported herein.ResultsValid results for cytology and HPV testing were obtained for 3,993 women. The overall prevalence of HR-HPV was 12.7%, of HPV-16 2.7% and of HPV-18 1.4%. Of those referred for colposcopy, cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was detected in 41 women (1.07%). At the threshold of CIN2+, cytology [atypical squamous cells of undetermined significance (ASC-US) or worse] and HPV testing showed a sensitivity of 53.7% and 100% respectively, without change between age groups. Cytology and HPV testing showed specificity of 96.8% and 90.3% respectively, which was increased in older women (≥30) in comparison to younger ones (25–29). Genotyping for HPV16/18 had similar accuracy to cytology for the detection of CIN2+ (sensitivity: 58.5%; specificity 97.5%) as well as for triage to colposcopy (sensitivity: 58.5% vs 53.7% for cytology).ConclusionHPV testing has much better sensitivity than cytology to identify high-grade cervical lesions with slightly lower specificity. HPV testing with individual HPV-16/HPV-18 genotyping could represent a more accurate methodology for primary cervical cancer screening in comparison to liquid-based cytology, especially in older women.

Triage strategies in cervical cancer detection in Mexico: methods of the FRIDA Study

“…This extension of screening may help to reduce the burden of cervical disease in women aged 30 to 35 years, compared to cytology screening alone, as suggested in previous studies. 3,35 We furthermore seek to improve upon the current cytologic screening methods. We are using monolayer cytology and an automated process to ensure quality control of the cytological material and eliminate residues (blood, mucus) that hinder reading.…”

The prevelance of human papillomavirus (HPV) genotypes detected by PCR in women with normal and abnormal cervico-vaginal cytology

“…Current epidemiologic data identifies 15 HPV types as high-risk types (16,18,31,33,35,39,45, 51, 52, 56, 58, 59, 68, 73, and 82) and 12 types (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108) as low-risk types [9]. Moreover, infection with two specific high-risk HPVs (HPV-16 and HPV-18) is reported to be linked with 90% of all uterine cervical cancers, and more than half of other anogenital tumors, and a small percentage of head and neck tumors [10].…”

Modernas metodologías diagnosticas para la detección del Virus del Papiloma Humano y prevención del cáncer de cuello uterino

“…Es una técnica que utiliza una fase liquida que permite la hibridación por complementariedad del ADN viral con el ARN sintético de 13 genotipos de VPH-AR (16,18,31,33,35,39,45, 51, 52, 56, 58, 59 y 68) y cinco VPH-BR (6,11,42, 43 y 44). La hibridación es captada por anticuerpos fijados en los pozos de la microplaca, se elimina el exceso de reactivos, se agrega un revelador luminiscente y la emisión de luz es proporcional a la cantidad de ADN, otorgando una medida semicuantitativa de la carga viral 25 .…”

“…Según sus estudios, esta situación se debe a diversos factores como la calidad de la toma y lectura de la citología, el tratamiento, la calidad del tratamiento, el acceso oportuno a la confirmación diagnóstica y no solo a la cobertura de la población como lo ha enfocado la OMS 14,15 . De esta manera, se ha determinado que en Colombia, posiblemente la mayor causa de la mortalidad debido a este tipo de cáncer sea el limitado seguimiento de los casos positivos identificados en la citología cervical, pero también mencionan que debido a la baja sensibilidad de la citología (la cual según sus resultados oscilaba entre 42 y 61%) 13 es difícil otorgar un diagnóstico acertado en las pacientes analizadas; por lo que se hace necesario la implementación de nuevas metodologías al programa que tengan una mayor sensibilidad 13,16 .…”