The prevelance of human papillomavirus (HPV) genotypes detected by PCR in women with normal and abnormal cervico-vaginal cytology
Abstract
Objectives: Cervical cancer is the second most common type of cancer for women worldwide with a great proportion proved to be related to human papillomavirus (HPV) infection. As infection with HPV is the strongest risk factor for cervical neoplasia, detection of HPV genotypes in cervical and vaginal specimens of women with normal and abnormal cytology seems to be of paramount importance in cervical cancer screening. The objective of the study is to evaluate the prevalence and HPV genotypes among women with normal or abnormal Pap smear tests.
Material and methods: This retrospective study was conducted in a tertiary care university hospital in western Turkey. A total of 201 patients in whom both HPV typing and Pap test was performed between 2012 and 2016 in our obstetrics and gynecology department were enrolled in this study. Clinical and laboratory data were obtained for all participants. Cervical smears of the patients were classified by the Bethesda system and HPV analyses were done using the polymerase chain reaction (PCR) method.
Results: This study included 201 women, 72 of whom had normal and 129 of whom had abnormal Pap smear results. HPV DNA was detected in 91 (45.2%) of the 201 investigated women. Out of 72 patients with normal cervico-vaginal cytology, HPV positivity was detected in 35 (49%) patients, whereas 33 (35%) patients out of 94 with ASCUS , 18 (62%) patients out of 29 with LSIL and 5 (83%) patients out of 6 with HSIL had HPV positivity. Out of 35 HPV positive women that had normal pap test results, 25 (75%) were found to have high risk HPV (HR-HPV) genotypes. In women with ASCUS, LSIL and HSIL, HR-HPV genotype rates were found to be 94%, 89% and 100% respectively. The most common identified HPV types were HPV58, HPV16, HPV31, HPV33, HPV11 and HPV35.
Conclusions: The frequency of HPV infection was found to be higher in our study compared to previous reports. Moreover, although HR-HPV genotypes were also detected in patients with normal cervical cytology, a majority of patients with HR-HPV genotypes were associated with abnormal cervical smear cytology including high rates of atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion.
Keywords: Cervical cancerPap smearsquamous intraepithelial lesion
References
- Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127(12): 2893–2917.
- Catarino R, Petignat P, Dongui G, et al. Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. World J Clin Oncol. 2015; 6(6): 281–290.
- Özmen V, Dağoğlu N, Dede İ, et al. Turkish Ministry of Health, 2nd Turkish Medical General Assembly Clinical Oncology Study Group Report. J Breast Health. 2016; 12(1): 9–17.
- Ghosh S, Seth S, Paul J, et al. Evaluation of Pap smear, high risk HPV DNA testing in detection of cervical neoplasia with colposcopy guided or conventional biopsy as gold standard. Int J Healthcare Biomed Res. 2014; 2(2): 192–197.
- Wardak S. Human Papillomavirus (HPV) and cervical cancer. Med Dosw Mikrobiol. 2016; 68(1): 73–84.
- Zhang L, Bi Q, Deng H, et al. Human papillomavirus infections among women with cervical lesions and cervical cancer in Eastern China: genotype-specific prevalence and attribution. BMC Infect Dis. 2017; 17(1): 107.
- Sasaki Y, Iwanari O, Arakawa I, et al. Cervical Cancer Screening With Human Papillomavirus DNA and Cytology in Japan. Int J Gynecol Cancer. 2017; 27(3): 523–529.
- Fernandez AF, Rosales C, Lopez-Nieva P, et al. The dynamic DNA methylomes of double-stranded DNA viruses associated with human cancer. Genome Res. 2009; 19(3): 438–451.
- Abreu ALP, Souza RP, Gimenes F, et al. A review of methods for detect human Papillomavirus infection. Virol J. 2012; 9: 262.
- Agorastos T, Chatzistamatiou K, Katsamagkas T, et al. HERMES study group. Primary screening for cervical cancer based on high-risk human papillomavirus (HPV) detection and HPV 16 and HPV 18 genotyping, in comparison to cytology. PLoS One. 2015; 10(3): e0119755.
- Solomon D, Davey D, Kurman R, et al. Forum Group Members, Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002; 287(16): 2114–2119.
- Nayar R, Wilbur DC. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes, ed 3. Springer, New York 2015.
- Lin WM, Ashfaq R, Michalopulos EA, et al. Molecular Papanicolaou tests in the twenty-first century: molecular analyses with fluid-based Papanicolaou technology. Am J Obstet Gynecol. 2000; 183(1): 39–45.
- Hesselink AT, Berkhof J, van der Salm ML, et al. Clinical validation of the HPV-risk assay, a novel real-time PCR assay for detection of high-risk human papillomavirus DNA by targeting the E7 region. J Clin Microbiol. 2014; 52(3): 890–896.
- Zou R, Xie W, Wang H, et al. Establishment and Application of a Method for High-Risk Human Papillomavirus Genotyping in Cervical Cancer Tissue. Clin Lab. 2016; 62(6): 1075–1085.
- Tunç SY, Onan MA, Turp AB, et al. Prevalence and types of cervical human papillomavirus among Turkish women and its relationship with demographic factors in a gynecology outpatient clinic. Eur J Gynaecol Oncol. 2016; 37(1): 53–58.
- Dursun P, Senger SS, Arslan H, et al. Human papillomavirus (HPV) prevalence and types among Turkish women at a gynecology outpatient unit. BMC Infect Dis. 2009; 9: 191.
- Tricco AC, Ng CH, Gilca V, et al. Canadian oncogenic human papillomavirus cervical infection prevalence: systematic review and meta-analysis. BMC Infect Dis. 2011; 11: 235.
- Dunne EF, Unger ER, Sternberg M, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007; 297(8): 813–819.
- Almonte M, Albero G, Molano M, et al. Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine. 2008; 26 Suppl 11: L16–L36.
- Deluca GD, Basiletti J, González JV, et al. Human papilloma virus risk factors for infection and genotype distribution in aboriginal women from Northern Argentina. Medicina (B Aires). 2012; 72(6): 461–466.
- McGraw SL, Ferrante JM. Update on prevention and screening of cervical cancer. World J Clin Oncol. 2014; 5(4): 744–752.
- Nour NM. Cervical cancer: a preventable death. Rev Obstet Gynecol. 2009; 2(4): 240–244.
- Açikgöz A, Ergör G. Cervical cancer risk levels in Turkey and compliance to the national cervical cancer screening standard. Asian Pac J Cancer Prev. 2011; 12(4): 923–927.
- Arı M, Döğer FK, Kırdar S, et al. Cervical Biopsy, Smear Evaluation and Comparison of Human Papilloma Virus Subtypes Result. Meandros Med Dent J. 2016; 17(1): 17–21.
- Yavuzer D, Karadayı N, Erdağı A, et al. typing with PCR in cervical cancerous and precancerous lesions. Kartal EAH Med J. 2009; 20(1): 1–6.
- Finan RR, Irani-Hakime N, Tamim H, et al. Detection of human papillomavirus (HPV) genotypes in cervico-vaginal scrapes of women with normal and abnormal cytology. Clin Microbiol Infect. 2001; 7(12): 688–692.
- Antonishyn NA, Horsman GB, Kelln RA, et al. The impact of the distribution of human papillomavirus types and associated high-risk lesions in a colposcopy population for monitoring vaccine efficacy. Arch Pathol Lab Med. 2008; 132(1): 54–60.
- Blossom DB, Beigi RH, Farrell JJ, et al. Human papillomavirus genotypes associated with cervical cytologic abnormalities and HIV infection in Ugandan women. J Med Virol. 2007; 79(6): 758–765.
- Al-Awadhi R, Chehadeh W, Kapila K. Prevalence of human papillomavirus among women with normal cervical cytology in Kuwait. J Med Virol. 2011; 83(3): 453–460.
- Banna NEl, Eyd GAl, Saeed R. High-risk human papillomavirus infection among women with pap smear tests negative for intraepithelial lesions or malignancy. Int J Med Public Health. 2014; 4(1): 102.
- Stenvall H, Wikström I, Backlund I, et al. Accuracy of HPV testing of vaginal smear obtained with a novel self-sampling device. Acta Obstet Gynecol Scand. 2007; 86(1): 16–21.
