Prior High-Risk Human Papillomavirus Testing and Papanicolaou Test Results of 70 Invasive Cervical Carcinomas Diagnosed in 2012: Results of a Retrospective Multicenter Study

Abstract

Context.-Persistent high-risk human papillomavirus (hrHPV) infection is essential for the development of cervical cancer and its precursor lesions. High-risk HPV testing has a higher sensitivity than cytology does for detecting cervical epithelial lesions. However, a large study from a single institution showed 31% of patients with invasive cervical cancer had negative baseline hrHPV testing within 5 years preceding the diagnosis.Objective.-To investigate the limitation of hrHPV testing in detecting invasive cervical cancer.Design.-Cases from 2012 with a histologic diagnosis of invasive cervical carcinoma were retrieved from multiple institutions. From those records, prior hrHPV testing and Papanicolaou test results in the 5 years before the cancer diagnosis were recorded.Results.-Seventy patients with cervical carcinoma were included in the study. Negative HPV test result rates were 9% (5 of 53), 23% (6 of 26), and 25% (2 of 8) during the periods of less than 1 year, 1 to 3 years, and 3 to 5 years before the histologic diagnoses, respectively. Negative Papanicolaou testing results in the same time intervals were 3.4% (2 of 59), 33% (10 of 30), and 40% (6 of 15). Although the HPV À rate seemed to be different among different HPV test methods, no statistical significance was detected because of small sample size. Negative hrHPV rates in patients with adenocarcinoma were similar to those in patients with squamous cell carcinoma.Conclusions.-These data expose limitations for the potential use of primary HPV testing. In addition, current screening guidelines recommending cotesting at 5-year intervals should be evaluated further with additional historic data collection because there are women with negative results for both Papanicolaou tests and hrHPV testing within the period of 3 to 5 years before an invasive carcinoma diagnosis.

The clinical performance of computer‐assisted liquid‐based cytology, primary hrHPV screening, and cotesting at a Turkish Tertiary Care Hospital

“…Similarly, Zhao et al 23 reported that 9%-25% of patients with squamous cell carcinoma (SCC) had negative hrHPV test results in the preceding 1-5 years. The data from the Kaiser Permanente study showed that 37% of women with SCC were HPV-negative 5 years before the histological diagnosis of cervical cancer.…”

Cervical Biopsy, Smear Evaluation and Comparison of Human Papilloma Virus Subtypes Result

“…Diğer ülkelerde yapılan çalışmalara bakıldığında ise, HPV6, HPV11 ve HPV31 en sık izlenen tiplerdir (16). Smear preparatlarının Papanikolaou smear ile incelenmesi, servikal kanser insidansını azaltmada başarılı bir yöntem olmakla birlikte; HPV saptanmasının daha sensitif olduğunu ileri süren çalışmalar da mevcuttur (19). Zhao ve ark.…”

“…Zhao ve ark. (19), invaziv servikal kanserli olgularının %31'inin HPV negatif olduğunu belirtmişlerdir. Literatürde buna benzer sonuçlar bulan başka çalışmalar da vardır (20,21).…”

“…Literatürde buna benzer sonuçlar bulan başka çalışmalar da vardır (20,21). HPV enfeksiyonları, skuamöz hücreli karsinom gelişmeden birkaç yıl içinde iyileşebilirler (19). Aslında HPV negatif servikal kanserler de mevcuttur, ama bunlar minimal deviasyon gösteren endoservikal adenokarsinom, gastrik tip, intestinal tip, mesonefrik, şeffaf hücreli tip gibi çok az görülen tiplerdir (19,22).…”

Primary High-Risk Human Papillomavirus Testing for Cervical Cancer Screening in the United States: Is It Time?

“…Some studies have demonstrated that 10% of cervical tissues in US tumor registries do not contain detectible HPV 25 and that 37% of cervical adenocarcinomas around the world are HPV negative. 26 Similarly, studies following up patients for an extended time have shown higher rates of baseline negative HPV results in patients with cervical cancer, 27 a point that questions both the prevalence of HPV positivity in cervical cancers and the length of follow-up time in these studies used to support the interim guidance. If a significant percentage of cervical cancers are not causally related to an HPV infection or do not test HPV positive with current methods, a screening algorithm that keeps HPV-negative women in a general screening pool could miss clinically significant lesions.…”