Abstract
BackgroundTo investigate high-risk HPV (hr-HPV) genotype distributions and the association between hr-HPV infection with severity of the cervical lesions in women with normal cytology.MethodsIn this cross-sectional study, the result of the hr-HPV test and biopsy of colposcopy of women with normal cytology from January 2012 to January 2019 were analyzed. The detection rate of high-grade squamous intraepithelial lesion (HSIL) and cervical cancer were calculated among different hr-HPV genotypes, viral load group, and age groups.ResultsFive thousand eight hundred eighty women were enrolled in this study. Overall, 59.97% had normal histological results, 19.32% had HSIL, and 1.07% had cervical cancer. The detection rate of HSIL or worse (HSIL+) in women with single HPV16(34.00%), HPV31(27.50%), HPV33(25.58%), and HPV52(20.88%) infection were higher significantly than single HPV18 (15.59%) infection, respectively. The HSIL+ detection rate between HPV16 single infection and multiple infections (excluding HPV18) was no significant difference (34% vs 35.47%, P = 0.638), contrary to HPV18(12.59% vs 21.67%, P = 0.022). In women without HPV16/18 infections, HSIL+ detection rates for single, double, and triple or more hr-HPV infections were 12.28, 20.31, and 37.50%, the risk of detection of HSIL+ significantly increasing. With the hr-HPV DNA load increases, the risk of detection of HSIL+ (χ2 = 91.01, P < 0.0001) and invasive cervical cancer (χ2 = 5.757, P = 0.016) increase. In age < 30, 31–40, 41–50, 51–60, > 60 group, HSIL+ detection rate were 24.80%、22.10%、19.59%、14.29, and 12.61%, respectively.ConclusionWomen who have normal cytology with HPV 16/18/31/33/52/58 infections, multiple HPV infections and high viral load, have a higher detection rate of HSIL+.
Highlights
High-risk HPV infection is the main etiological factor for the development of cervical neoplasia [1], and routine cervical cancer screening includes hrHPV and cervical cytology tests
Given that cumulative incidence of cervical intraepithelial neoplasia (CIN) 3 or cancer 5 years after an HPV-negative test was lower than the risk 3 years after a negative Pap test [6, 7], HPV testing was introduced as the supplementary test in conventional cytology-based screening, even gradually replacing cytology-based screening in primary screening for cervical cancer in some countries [8, 9]
Choosing CIN3 + as the endpoint would miss some invasive cancers which developed from a part of CIN2, it will increase the rate of referral of colposcopy
Summary
High-risk HPV (hr-HPV) infection is the main etiological factor for the development of cervical neoplasia [1], and routine cervical cancer screening includes hrHPV and cervical cytology tests. HPV testing are higher sensitivity and negative predictive value than cervical cytology. The guidelines recommend managing HPV-positive/cytology-negative results by return testing at 1 year or HPV genotyping for HPV16 and HPV18 [10]. If women have negative cytology but HPV16 and HPV18 infection(s), immediate colposcopy is recommended instead of a 1-year return. HPV16 has higher relevance with cervical lesions than other hr-HPV types [9, 11, 12]. To investigate high-risk HPV (hr-HPV) genotype distributions and the association between hr-HPV infection with severity of the cervical lesions in women with normal cytology
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