Abstract
PurposeCervical cytology and human papillomavirus (HPV) DNA co-testing is recommended as a screening method for detecting cervical lesions. However, for women who are HPV-positive but cytology-negative, the appropriate management and significance of HPV-58 infection remain unknown.MethodsThis study of prevalent HPV detected at baseline with a median follow-up of 3.2 years evaluated the risk factors associated with cervical abnormalities and assessed the significance of HPV-58 infection. A total of 265 women were enrolled. All high-grade squamous intraepithelial lesions (HSIL) that were detected by cytology were confirmed by histology. Histological diagnoses of cervical intraepithelial neoplasia 2/3 were classified as HSIL. Women were classified into four groups according to the HPV genotype that was detected at their first visit: HPV-58 (n = 27), HPV-16 (n = 52; 3 women had HPV-58 co-infection), ten other high risk (HR) types (n = 79), or low/undetermined risk types (n = 107).ResultsOf 265 women, 20 (7.5%) had HSIL on their follow-up examinations. There were significant differences in the cumulative incidence of HSIL between the four groups (p<0.001). The 5-year cumulative incidence rates of HSIL were 34.0% (95% CI: 17.3–59.8%) in HPV-58 positive cases, 28.0% (95% CI: 13.8–51.6) in HPV-16 positive cases, 5.5% (95% CI: 2.1–14.0%) in one of the ten other types of HR-HPV positive cases, and 0% in women with low/undetermined risk HPV. When seen in women with HR-HPV (n = 158), persistent HPV infection was a significant factor associated with the development of HSIL (hazard ratio = 15.459, 95% CI: 2.042–117.045). Women with HPV-58 had a higher risk (hazard ratio = 5.260, 95% CI: 1.538–17.987) for the development of HSIL than women with HPV-16 (hazard ratio = 3.822, 95% CI: 1.176–12.424) in comparison with women with other types of HR-HPV.ConclusionHPV-58 has a high association with the development of HSIL in women who are HPV-positive and cytology-negative.
Highlights
The use of the Papanicolaou (Pap) smear as a screen for cervical cancer has significantly decreased the incidence of cervical cancer and its associated mortality in recent years
There were three women who were diagnosed with human papillomavirus (HPV)-16 and HPV-58 who were classified as HPV-16 positive in order to identify the risk of high-grade squamous intraepithelial lesions (HSIL) development in women infected with HPV-58
When seen in women with high risk (HR)-HPV infection, persistent HPV infection was still a significant factor associated with the development of HSIL (Table 2)
Summary
The use of the Papanicolaou (Pap) smear as a screen for cervical cancer has significantly decreased the incidence of cervical cancer and its associated mortality in recent years. The Pap smear has a low sensitivity (,70%) for detecting high-grade squamous intraepithelial lesions (HSIL), which has raised a number of issues regarding the need for additional methods to improve detection [1,2]. The combination of HPV DNA testing and cytology has raised a new issue regarding the management of women who are HPV-positive but cytologynegative. In these cases, the current recommendations include two options: 1) repeated co-testing in 12 months; or 2) immediate HPV genotype-specific testing for HPV-16 alone or for HPV-16 and/or -18 [4]. There are limited studies that have identified the risk factors for the development of HSIL in women who are HPV-positive but cytology-negative on follow-up examinations
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