Detection of Human Papillomavirus among Cervical Cancer Patients by Qualitative Polymerase Chain Reaction on Formalin- fixed, Paraffin-embedded Tissue: A Retrospective Observational Analysis

Abstract

Introduction: Cervical cancer is second most commonly diagnosed and third most common cause for cancer death among women in the developing countries. It is now-established that Human Papillomavirus (HPV) infection is responsible for pathogenesis of cervical cancer. HPV Deoxyribonucleic Acid (DNA) detection is generally done on cytology specimens to triage women undergoing cervical cancer screening, but testing of Formalin-fixed, Paraffin- embedded tissue (FFPE) is not yet widely used. Aim: To study the detection of HPV by Qualitative PCR by extraction of DNA from FFPE. Materials and Methods: This retrospective observational analysis was carried out at Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India, managed at the centre from 2008 to 2015. The data analysis was done Aug 2013-Oct 2015 on 35 patients of cervical cancer which were reconfirmed by histopatholgical study of sections. Tissue blocks were obtained from the selected subjects and 3-5 micron sections were taken and prepared for Haematoxylin and Eosin (H&E) staining. Qualitative PCR was run on DNA extracted from FFPE tissue for evaluation of HPV. The amplified DNA varied between 230-270 base pairs (bp) and was analysed for oncogenic HPV type 16, 18, 31, 33, 35, 45, 52b and 58 by gel electrophoresis. Data was tabulated in Microsoft excel and mean, frequency and percentages were calculated. Pearson’s Chi-square test was used to calculate the significance. Results: Out of the total 35 samples analysed (mean age: 51.08±10.6 years),15 cases were large cell non keratinising carcinoma, 12 cases of keratinising squamous cell carcinoma, 5 cases of carcinoma in-situ and 3 cases were adenocarcinoma. A total of 13 cases out of 35 showed the bands of HPV genomes, indicating either of the HPV strain. Conclusion: Although molecular diagnostics on FFPE tissue is need of hour, stringent protocols for timing of fixation, technical expertise for extraction of DNA or Ribonucleic Acid (RNA), careful handling of the sample and quality control is of paramount importance. Fragmentation is a problem in DNA extracted from FFPE tissue, so primers having small base pairs should be used to maximise the yield.