Abstract
This study was performed to assess attribution of high grade cervical intraepithelial neoplasia (HG-CIN) and invasive cervical cancer (ICC) to human papillomavirus (HPV) genotypes and secondarily to assess reproducibility of HG-CIN/ICC diagnosis obtained in Poland. Formaldehyde fixed, paraffin embedded blocks of HG-CIN/ICC from two distant institutions were sent to a central laboratory together with original histological diagnoses. Central/expert review of histopathological specimens was performed and agreement between local and central/expert diagnoses was calculated. HPV detection and genotyping in the samples was carried out with the use of SPF10-LiPA25 technology. Results were analyzed for 205 HG-CIN and 193 ICC cases with centrally confirmed diagnoses. Kappa coefficients and 95 % confidence intervals for HG-CIN and ICC diagnoses were: 0.13 (0.09;0.17) and 0.19 (0.11;0.26) respectively. Cohen’s kappa coefficients for lesions with representative number of samples ranged from 0.01 for cervical intraepithelial neoplasia grade 2 to 0.75 for adenocarcinoma. HPV DNA was detected in 96.1 and 91.2 % of the confirmed HG-CIN and ICC specimens respectively. HPV positive HG-CIN was most commonly attributed to HPV types: 16 (62.8), 33 (7.8), 31 (6.6), 52 (3.7), 45 (2.6) and 58 (2.6 %). HPV positive ICC was most commonly attributed to HPV types: 16 (72.1), 18 (10.8), 33 (5.7), 45 (3.4) and 31 (1.7 %). Reproducibility of histological diagnosis of HG-CIN/ICC obtained in Poland generally increases with the severity of lesion and is lowest for cervical intraepithelial neoplasia grade 2 and highest for adenocarcinoma. Over 80 % of ICC cases are vaccine-preventable in Poland.
Highlights
Despite the long term opportunistic screening and initiation of active organized cytological screening in 2006 [1], cervical cancer (CC) age standardized mortality ratio of 5.8/100 000 in Poland in 2008 is estimated almost twice as high as the average 3.0/100 000 in the European Union [2]
Such comprehensive and reliable data obtained on histological samples both of high grade cervical intraepithelial neoplasia (HG-CIN) and invasive cervical cancer (ICC) using standardized methodology have been unavailable for Poland yet
Since this study focuses on HG-CIN/ICC diagnosed in Poland, the material used was collected at two distant sites in Poland: the First Department of Gynecology and Oncologic Gynecology of Medical University of Lublin and the Department of Gynecology and Oncology of the Jagiellonian University Medical College of Gynecology and Obstetrics in Krakow
Summary
Despite the long term opportunistic screening and initiation of active organized cytological screening in 2006 [1], cervical cancer (CC) age standardized mortality ratio of 5.8/100 000 in Poland in 2008 is estimated almost twice as high as the average 3.0/100 000 in the European Union [2]. Information on HPV-type distribution in cervical neoplasia is crucial for pharmacoeconomic modeling of HPV vaccination impact on the epidemiology of cervical lesions. Such comprehensive and reliable data obtained on histological samples both of high grade cervical intraepithelial neoplasia (HG-CIN) and invasive cervical cancer (ICC) using standardized methodology have been unavailable for Poland yet. Available studies were performed on relatively small numbers of cases, cytological samples and/or performed with the use of older diagnostic methods [5,6,7]
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