Abstract
Many epidemiological studies have shown that human papillomavirus related infections play a major role in cervical preinvasive and invasive lesions. ASCUS (atypical cells of undetermined significance) observed in about 4-5% of all cervical cytology specimens. We searched for the presence of HPV with immunohistochemical methods in the biopsy material of patients diagnosed with ASCUS using cytology. The colposcopic biopsy or Loop Electro Excisional Procedure (LEEP) material of 115 patients with a diagnosis of ASCUS were evaluated. HPV (type 6,11,16,18,31,33,42,51,52,56 and 58) immunohistochemistry was applied to all materials. The relationship between the biopsy results and HPV positivity was investigated. Cervical intraepithelial neoplasia (CIN) I was found in 34.8%, CIN II in 13% and CIN III in 9.6% of the patients and cervicitis was present in 42.6% of the patients. HPV immunohistochemistry was positive in 11 cases (9.6%) and no staining was seen in 104 cases (90.4%). No positive staining was seen in the chronic cervicitis cases. The rate of positive staining was 15% (6/34) in the CIN I diagnosed group, 20% (3/12) in the CIN II diagnosed group and 18.2% (2/9) in the CIN III diagnosed group. HPV positivity was found to be lower compared to the literature both in total and in cases diagnosed by biopsy. No staining occurred in any patient with cervicitis. In conclusion, we believe that immunohistochemical examination is not an appropriate method for the determination of HPV.
Highlights
Cytology-based screening programs are widely used in the diagnosis of cervical precancerous lesions and significantly decrease the incidence of cervical cancer [1]
Cervical intraepithelial neoplasia (CIN) I was found in 34.8%, CIN II in 13% and CIN III in 9.6% of the patients and cervicitis was present in 42.6% of the patients
Human papilloma virus (HPV) immunohistochemistry was positive in 11 cases (9.6%) and no staining was seen in 104 cases (90.4%)
Summary
Cytology-based screening programs are widely used in the diagnosis of cervical precancerous lesions and significantly decrease the incidence of cervical cancer [1]. A direct colposcopic evaluation as well as smear follow-up or HPV DNA test with PCR can be performed. A higher rate of CIN 2-3 diagnosis was reported to be made with colposcopy in patients diagnosed with ASCUS who were found be positive with the HPV DNA test before colposcopy and biopsy [6]. While high-risk (HR) HPV DNA positivity in ASCUS diagnosed cytologies was 43%, the incidence of CIN 2 and above lesions was 10.3% and the place of the HR HPV DNA test in ASCUS diagnosed cytologies could be limited [8,9]. HPV 16 and 18 are responsible for about 70% of cervical cancers and HPV genotyping has been thought to be potentially useful in the distinction of the group at risk in terms of CIN 2 and above lesions [10,11]
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