TITLE:
Clinical evaluation of HPV DNA test combined with liquid-based cytology in the diagnosis of cervical disease
AUTHORS:
Raghvendra Thakur, Jasma Mally, Rajina Shrestha, Xuehua Zheng, Mengli Zhang, Yanjun Wu, Neelima Bajracharya, Guiying Zheng
KEYWORDS:
Human Papillomavirus; Thin-Prep Cytology Test; Hybrid Capture; Cervical Intraepithelial Neoplasia; Bethesda System; Colposcopy Examination
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.3,
May
10,
2013
ABSTRACT: Objectives:
To evaluate the sensitivity and accuracy of the HPV DNA test in conjunction
with thin prep cytology test as a screening method of human papillomavirus
(HPV) infection. To study either the cervical erosion is related to high risk
HPV infection or to determine the mean age distribution that is more prone to
HPV infection. Material and Methods: The study is a retrospective cohort
implemented to determine the real performance of liquid based medium and HPV
DNA testing combined in second clinical hospital of Jilin University Changchun,
China. The study group included total 150 patients from January 1, 2011 to
December 30, 2012. A computerized search identified patients with thin prep
test results and high risk HPV DNA testing during a 2-year period was
recruited. The patients were chosen after proper speculum examination followed
by thin prep cytology (TCT) and HPV DNA test. Cytologic specimens were obtained
with endocervical brush, which was rinsed into the vial of Cytyc. The residual
samples after the cytology report were taken for reflex HPV DNA test. The
manufacture protocol was followed for HPV DNA testing using Hybrid Capture II.
Colposcopic biopsy was performed for the diagnosis purpose, in patients who had
atypical squamous cells of undeter-mined significance (AUS-US), low grade intraepithelial
lesion (LSIL) or high-grade intraepithelial lesion (HSIL) in cytology and with
positive results of highrisk HPV DNA. The diagnostic criteria were based on
the Bethesda System (TBS). Findings: The high risk HPV positive women with
abnormal cytology had a CIN I risk of 73 (86%), whereas 35 (23.3%) high-risk
HPV positive women out of 109 (72.7%) normal cytology who underwent
histological biopsy had CIN I 16 (10.7%). The risk for cervical intraepithelial
neoplasia (CIN) in women with high-risk HPV positive with normal cytology was
higher among women invited for the first time 31 - 40 years of age 12 (8%)
than among older women 1 (0.7%). Out of 44 (29.3%) women who had I degree
erosion with 6 (14%) positive HPV DNA test 38 (86%) had a normal histology
biopsy showing no statically significant between them. Conclusion: The data confirm
that HR-HPV DNA testing is much more sensitive than cytology alone and that HPV
DNA testing helps in identifying women with high risk of serious cervical
disease in an efficient and medically acceptable manner. The other most
significant advantage of this cervical cancer screening method is that women
who are HPV DNA positive can easily and quickly referred for colposcopic
examination (within one year), which could identify the precancerous and cancer
stage. And those who are HPV DNA negative can safely have much longer screening
intervals saving considerable costs. With mean age being 38 ± 10 years, age
older than 30 years should undergo HPV DNA testing with cytology triage in
primary screening. But in woman younger than 30 years using HPV DNA assay, as
an initial screening step can increase the prevalence of abnormal smears and
the positive predictive value of HPV followed by TCT. However, close follow-up
is essential if the initial biopsy is negative because a considerable
number of women may have HPV infection positive in subsequent studies.