Assessment of cervicovaginal smear and HPV DNA co-test for cervical cancer screening: implications for diagnosis and follow-up strategies

Authors

  • Nazma Shaheen Department of Pathology, Sheikh Fozilatunnessa Mujib Memorial KPJ Specialized Hospital, Gazipur, Bangladesh
  • Syeda Sadia Afrin Department of Pathology, Dhaka Medical College, Dhaka Bangladesh
  • Mohammad Rezaul Karim Ripon Oral and Maxillofacial Surgery Department, Military Dental Center, Sylhet, Bangladesh
  • Kamrun Nahar Department of Microbiology and Virology, Sheikh Fozilatunnessa Mujib Memorial KPJ Specialized Hospital, Gazipur, Bangladesh
  • Abu Anis Khan Department of Pathology, Sheikh Fozilatunnessa Mujib Memorial KPJ Specialized Hospital, Gazipur, Bangladesh
  • Sharmin Haque Department of Pathology, Bangladesh Medical College, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20242921

Keywords:

Real-time polymerase chain reaction, Atypical squamous cells of undetermined significance, Human papillomavirus, Cervical intraepithelial neoplasm

Abstract

Background: Cancer of the cervix, despite being a preventable disease, continues to be a significant public health problem in females. In recent years, much new development has taken place in the field of screening, diagnosis and management of cervical intraepithelial neoplasia.

Methods: A total of 980 patients aged between 20 to 60 years were included in the study. All the patients have gone through Pap test, RT-PCR for HPV test and colposcopy biopsy. Then the sensitivity and specificity are calculated. Retrospectively selected Pap specimens with RT-PCR HPV testing results obtained from the Department of Pathology of Sheikh Fozilatunnessa Mujib Memorial KPJ Specialized Hospital, Gazipur, Bangladesh from July 2022 to July 2024 followed by the result is correlated with Colposcopy guided biopsy.

Results: We found 250 cases of human papilloma virus RT-PCR positive, 433 cases of Pap test positive result and 399 cases of positive colposcopy biopsy result. So, The HPV test was demonstrated to be more sensitive (75%) than specific (55%) and was more sensitive than colposcopy for detecting CIN changes (75% vs. 73%).

Conclusion: HPV tests showed a higher sensitivity than colposcopy, but colposcopy results presented higher specificity. Combining HPV testing and colposcopy proved to be the most efficient method for detecting CIN lesions.

References

Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer. 2003;88(1):63-73.

Sankaranarayanan R, Bhatla N, Gravitt PE, Basu P, Esmy PO, Ashrafunnessa KS, et al. Human papillomavirus infection and cervical cancer prevention in India, Bangladesh, Sri Lanka, and Nepal. Vaccine. 2008;26:1-16.

Nanda K, McCrory DC, Myers ER. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med. 2000;132(10):810-9.

Mayrand MH, Duarte-Franco E, Rodrigues I. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16):1579-88.

Cuzick J, Clavel C, Petry KU. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119(5):1095-101.

Nauclear P, Ryd W, Tornberg S. Human Papilloma virus and papanicolaou test to screen for cervical cancer. N Engl J Med. 2007;357(16):1589-97.

Munoz N, Bosh FX, Castellsague X, Sanjose S, Hammoudad D, Shah KV, et al. Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004;111(2):278-85.

Ferris DG, Wright TC, Litaker MS, Richart RM, Lorincz AT, Sun XW, et al. Triage of women with ascus and lsil on pap smear reports: Management by repeat Pap smear, HPV DNA testing, or colposcopy? J Fam Pract. 46(2):125-35.

Ciotti M, Sesti F, Paba P, Benedetto A, Patrizi L, Criscuolo A, et al. Human papillomavirus (HPV) testing in the management of women with abnormal Pap smears. Experience of a colposcopy referral clinic. Eur J Gynaecol Oncol. 2004;25(5):577-84.

Barut MU, Kale A, Kuyumcuoğlu U, Bozkurt M, Ağaçayak E, Özekinci S, et al. Analysis of sensitivity, specificity, and positive and negative predictive values of smear and colposcopy in diagnosis of premalignant and malignant cervical lesions. Med Sci Monit. 2015;21:3860-7.

Schneider A, Hoyer H, Lotz B, Leistritza S, Kühne-Heid R, Nindl I, et al. Screening for high grade cervical intra-epithelial neoplasia and cancer by testing for high-risk HPV, routine cytology or colposcopy. Int J Cancer. 2000;89(6):529-34.

Monsonego J, Zerat L, Catalan F, Coscas Y. Genital human papillomavirus infections: Correlation of cytological, colposcopic and histological features with viral types in women and their male partners. Int J STD AIDS. 1993;4(1):13-20.

Ibánez R, Autonell J, Sarda M, Crespo N, Pique P, Pascual A, et al. Protecting the underscreened women in developed countries: The value of HPV test. BMC Cancer. 2014;14(1):574.

Adamopoulou M, Kalkani E, Charvalos E, Avgoustidis D, Haidopoulos D and Yapijakis C: Comparison of cytology, colposcopy, HPV typing and biomarker analysis in cervical neoplasia. Anticancer Res. 2009;29(8):3401-9.

Pretorius RG, Peterson P, Novak S, Azizi F, Sadeghi M, Lorincz AT. Comparison of two signal-amplification DNA tests for high-risk HPV as an aid to colposcopy. J Reprod Med. 47(4):290-6.

Castle PE, Sideri M, Jeronimo J, Solomon D, Schiffman M. Risk assessment to guide the prevention of cervical cancer. Am J Obstet Gynecol. 2007;197(4):356.

Chrysostomou A, Stylianou D, Constantinidou A and Kostrikis L. Cervical cancer screening programs in Europe: The transition towards HPV vaccination and population-based HPV testing. Viruses. 2018;10(12):729.

Lew JB, Simms K, Smith M, Lewis H, Neal H and Canfell K. Effectiveness modelling and economic evaluation of primary HPV screening for cervical cancer prevention in New Zealand. PLoS One. 2016;11(5):1516-9.

Pista A, Costa C, Saldanha C, Moutinho JAF, Moutinho JM, Arrobas F, Catalao C and Kempers J: Budget impact analysis of cervical cancer screening in portugal: Comparison of cytology and primary HPV screening strategies. BMC Public Health. 2000;19(1):235.

Al-Awadhi R, Chehadeh W, Jaragh M, Al-Shaheen A, Sharma P and Kapila K: Distribution of human papillomavirus among women with abnormal cervical cytology in Kuwait. Diagn Cytopathol. 2013;41(2):107-14.

Bardin A, Vaccarella S, Clifford G, Lissowska J, Rekosz M, Bobkiewicz P, et al. Human papillomavirus infection in women with and without cervical cancer in Warsaw, Poland. Eur J Cancer. 2008;44(4):557-64.

Negri G, Rigo B, Vittadello F, Mian C, Egarter-Vigl E. Abnormal cervicovaginal cytology with negative human papilloma virus testing. Cancer. 2007;111(5):280-284.

Menzo S, Ciavattini A, Bagnarelli P, Marinelli K, Sisti S, Clementi M. Molecular epidemiology and pathogenic potential of under diagnosed human papillomavirus types. BMC Microbiol. 2008;8(1):112.

Menegazzi P, Barzon L, Palu G, Reho E and Tagliaferro L: Human papillomavirus type distribution and correlation with cyto-histological patterns in women from the south of Italy. Inf Dis Obstet Gynecol. 2009;19:842-5.

Huang LW, Lin YH, Pan HS, Seow KM and Lin CY. Human papillomavirus genotyping as a predictor of high-grade cervical dysplasia in women with mildly cytologic abnormalities: A two year follow-up report. Diagn Cytopathol. 2012;40(8):673-7.

Evans MF, Adamson CSC, Papillo JL, St. John TL, Leiman G, Cooper K. Distribution of human papillomavirus types in thin prep Papanicolaou tests classified according to the Bethesda 2001 terminology and correlations with patient age and biopsy outcomes. Cancer. 2006;106(5):1054-64.

Santos ALF, Derchain SFM, Martins MR, Sarian LOZ, Martinez EZ, Syrjänen KJ. Human papillomavirus viral load in predicting high-grade CIN in women with cervical smears showing only atypical squamous cells or low-grade squamous intraepithelial lesion. Sao Paulo Med J. 121(6):238-43.

Szostek S, Klimek M, Zawilinska B and Kosz-Vnenchak M. Genotype-specific human papillomavirus detection in cervical smears. Acta Biochim Pol. 2008;55(4):687-92.

Bardin A, Vaccarella S, Clifford G, Lissowska J, Rekosz M, Bobkiewicz P, et al. Human papillomavirus infection in women with and without cervical cancer in Warsaw, Poland. Eur J Cancer. 2008;44(4):557-64.

Dybikowska A, Licznerski P and Podhajska A: HPV detection in cervical cancer patients in northern Poland. Oncol Rep. 2002;9(4):871-4.

Uusküla A, Kals M, Kosenkranius L, McNutt L-A and DeHovitz J. Population-based type-specific prevalence of high-risk human papilloma virus infection in Estonia. BMC Infect Dis. 2010;10(1):63.

Stamataki P, Papazafiropoulou A, Elefsiniotis I, Giannakopoulou M, Brokalaki H, Apostolopoulou E, et al. Prevalence of HPV infection among greek women attending a gynecological outpatient clinic. BMC Infect Dis. 2010;10(1):27.

Clifford GM, Rana RK, Franceschi S, Smith JS, Gough G, Pimenta JM. Human papillomavirus genotype distribution in low-grade cervical lesions: Comparison by geographic region and with cervical cancer. Cancer Epidemiol Biomarkers Prev. 2005;14(5):1157-64.

Rossi PG, Bisanzi S, Paganini I, Di Iasi A, Angeloni C, Scalisi A, et al. Prevalence of HPV high and low risk types in cervical samples from the Italian general population: A population-based study. BMC Infect Dis. 2010;10(1):214.

Downloads

Published

2024-09-30

How to Cite

Shaheen, N., Afrin, S. S., Ripon, M. R. K., Nahar, K., Khan, A. A., & Haque, S. (2024). Assessment of cervicovaginal smear and HPV DNA co-test for cervical cancer screening: implications for diagnosis and follow-up strategies. International Journal of Research in Medical Sciences, 12(10), 3641–3647. https://doi.org/10.18203/2320-6012.ijrms20242921

Issue

Section

Original Research Articles