The triage of squamous cell abnormalities of cervical cytology by human papilloma virus screening

Objective: The aim of the study was to determine the presence of human papilloma virus (HPV) infection in cervical swabs by the use of the Digene Hybrid Capture assay in a cohort of patients with squamous cell abnormalities found in cervical cytologic screening.

Materials and methods: Thirty-four (0.3%) of 1,100 patients who came for their routine cervical cytologic screening and diagnosed as having squamous cell abnormalities were enrolled in the study. Colposcopy-directed biopsy was obtained from all study patients. HPV DNA was sought in cervical swab specimens placed in Digene transport medium by the use of the Digene Hybrid Capture assay. The findings of cervical cytology, colposcopy-directed biopsy and HPV screening were compared.

Results: In a total of 34 women who were diagnosed as having squamous cell abnormalities in their routine cervical cytologic screening, 15 women had atypical squamous cell lesions of undetermined significancy (ASCUS), 16 women had low-grade cervical intraepithelial lesions (LGSIL), and three women had high-grade cervical intraepithelial lesions (HGSIL). Five (15%) of these women tested positive for HPV screening in cervical swabs where four women had infection with high-risk and one woman had infection with low-risk subtypes. None of the patients with koilocytotic changes of the squamous cells in the class of LGSIL histopathologically tested positive for HPV screening. In addition, one patient diagnosed as having invasive cervical carcinoma histopathologically tested negative for HPV screening. Atypical vascularization was seen colposcopically in this 37-year-old woman who had ASCUS cytologically.

Conclusion: HPV screening seems to have value in the triage of patients with ASCUS with no clear advantage to colposcopy-directed biopsy. The routine performance of HPV screening for the triage of patients with squamous cell abnormalities has no advantage over colposcopy-directed biopsy.

HPV; Squamous cell abnormality; Colposcopy; Cervical cytology; ASCUS; LGSIL; HGSIL

[1] Anon. Human papillomaviruses, vol 64. Lyon. International Agency for Research on Cancer, 1995.

[2] Ozsaran A.A., Atest T., Dikmen Y., Zeytinoglu A., Terek C., Erhan Y. et al.: "Evaluation of the risk of cervical intraepithelial neoplasia and human papilloma virus infection in renal transplant patients receiving immunosuppressive therapy". Eur. J. Gynaecol. Oncol., 1999, 20, 127.

[3] Walboomers J.M., Jacobs M.V., Manos M.M.: "Human papillomavirus is a necessary cause of invasive cancer worldwide". J. Pathol., 1999, 189, 12.

[4] Herrington C.S.: "Do HPV-negative carcinomas exist?". J. Pathol., 1999, 189, 1.

[5] Schiffman M.H., Brinton L.: "The epideniology of cervical carcinogenesis". Cancer, 1995, 76, 1888.

[6] Tate J.E., Resnick M., Sheets E.E., Crum C.P.: "Absence of papillomavirus DNA in normal tissue adjacent to most cervical intraepithelial neoplasms". Obstet. Gynecol., 1996, 88, 257.

[7] Remmink A.J., Walboomers J.M., Helmerhorst T.J.M., Voorhost F.J., Rozendaal L., Risse E.K. et al.: "The presence of persistent high-risk HPV genotypes in dysplastic cervical lesions is associated with progressive disease: natural history up to 36 months". Int. J. Cancer, 1995, 61, 306.

[8] National Cancer Institute Workshop.: "The 1988 Bethesda system for reporting cervical/vaginal cytological diagnoses". JAMA, 1989, 262, 931.

[9] Bauer H.M., Ting Y., Greer C.E., Chambers J.C., Tashiro CJ., Chimera J., Reingold A., Manos M.M.: "Genital human papilloma virus infection in female university students as determined by a P CR-based method". JAMA, 1991, 265, 472.

[10] Lorincz A.T., Reid R., Jenson A.B., Greenberg M.D., Lancester W., Kurman R.J.: "Human papilloma virus infection of the cervix. Relative risk associations of 15 common anogenital types". Obstet. Gynecol., 1992, 79, 328.

[11] Kinney W.K., Manos M.M., Hurley L.B., Ransley J.E.: "W here's the high-grade cervical neoplasia? The importance of the minimally abnormal P apanicolaou diagnoses". Obstet. Gynecol., 1998, 91, 973.

[12] Rebello G., Hallam N., Smart G., Farquharson D., McCafferty J.: "Human papillomavirus testing and the management of women with miIdly abnormal cervical smears: an observational study". Br. Med. J., 200 I, 322, 893.

[13] Cuzick J., Sasieni P., Davies P., Adams J., Normand C., Frater A.: "A systematic review of the role of human papillomavirus testing within a cervical screening programme". Health Technol. Assess., 1999, 3, 14.

[14] Woodman C.B.J., Collins S., Winter H., Bailey A., Ellis J., Pnor P.: "Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study". Lancet, 2001, 357, 1831.

[15] Crabtree D., Unkraut A., Cozens D., Smith T., Lucas C., P ennmgton D. et al.: "Role for HPV testing in ASCUS: A cytologic-histologic correlation". Diagn. Cytopathol., 2002, 27, 382.

[16] Altuglu I., Terek M.C., Ozacar T., Ozsaran A.A., Bilgic; A.:'The prevalence of human papilloma virus DNA in women with mucopurulent endocervicitis". Eur. J. Gynaecol. Oneal., 2002, 23, 166.

[17] Kulasingam S.L., Hughes J.P., Kiviat N.B., Mao C., Weiss N.S., Kuypers J.M., Koutsky L.A.: "Evaluation of human papiloma virus testing in primary serening for cervical abnonnalities: comparison of sensitivity, specificity, and frequency of referral" JAMA, 2002, 288, 1749.