Role Of Human Papillomavirus Testing Research Articles

A Brief Summary of the Current Role of Human Papillomavirus Testing in Cervical Cancer Screening

Cervical cancer screening recommendations proposed by natural societies and organizations have been reviewed and revised numerous times over the last decade. The most recent guidelines from the American Cancer Society and U.S. Preventive Services Task Force added human papillomavirus (HPV) primary screening for women starting at age 25 or 30 years, respectively, and ending at age 65 for those with an adequate history of negative screening. Cervical cancer screening for HPV has significantly reduced the incidence of cervical cancer. Currently, the majority of cervical cancers are reported among women who have never been screened or who were under-screened. Many organizations and institutions have explored different strategies to improve screening participation among the difficult-to-reach populations, including community outreach and specimen self-collection for HPV testing.

Erratum

The Obstetrician & GynaecologistVolume 19, Issue 4 p. 278-278 ErratumFree Access Erratum This article corrects the following: Cervical cancer prevention and screening: the role of human papillomavirus testing Mehrnoosh Aref-Adib MBBS MA MRCOG, Theresa Freeman-Wang MBChB MRCOG, Volume 18Issue 4The Obstetrician & Gynaecologist pages: 251-263 First Published online: June 17, 2016 First published: 24 October 2017 https://doi.org/10.1111/tog.12393AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the following article1, there was an error in the Conclusion section on page 260. In the second paragraph, the sentence reads: It is hoped that HPV vaccination will ultimately reduce cervical and other lower genital tract premalignant and malignant disease, as will advances in emerging markets and therapeutic vaccines. The sentence should read: It is hoped that HPV vaccination will ultimately reduce cervical and other lower genital tract premalignant and malignant disease, as will advances in emerging markers and therapeutic vaccines. Reference 1Aref-Adib M, Freeman-Wang T. Cervical cancer prevention and screening: The role of human papillomavirus testing. The Obstetrician & Gynaecologist 2016; 18: 251– 63. Volume19, Issue4October 2017Pages 278-278 ReferencesRelatedInformation

Re: Cervical cancer prevention and screening: the role of human papillomavirus testing

Re: Cervical cancer prevention and screening: the role of human papillomavirus testing

Cervical cancer prevention and screening: the role of human papillomavirus testing

Key content An organised screening programme has reduced the incidence of cervical cancer in the UK. Cervical screening aims to detect and treat premalignant, low‐ or high‐grade disease. Oncogenic or high‐risk human papillomaviruses (HR‐HPV) account for over 99.7% of cervical cancer cases; the most common subtypes are HPV‐16, 18, 31, 33 and 45. HPV vaccination was introduced as part of the childhood vaccination programme in 2008 and will probably save 400 lives per year. HPV testing is useful: in triage of women with borderline or low‐grade cytology; as a test of cure after treatment, in the management of uncertainty, and in primary HPV screening. Learning objectives To review the history of cervical screening and colposcopy. To understand the role of HR‐HPV in the development of cervical premalignancy and malignancy. To understand the potential of HPV vaccination and the uses of HPV testing in reducing the burden of cervical cancer. Ethical issues HPV infection is common, so should women with only transient HPV infection be informed of their diagnoses, given that disclosures provide little benefit and may cause significant emotional harm? HPV is related to other premalignant and malignant diseases of the lower genital tract and oropharynx affecting males and females. Should boys therefore be also offered HPV vaccination?

What is the role of human papillomavirus testing in head and neck cancer?

What is the role of human papillomavirus testing in head and neck cancer?

Role of Human Papillomavirus Testing in Screening of Cervical Neoplasia

Human papillomavirus (HPV) is the causative agent of cervical intraepithelial neoplasia and cervical cancer. HPV and cytology co-tests in women aged 30 years or older every 5 years as primary cervical screening is recommended for developed countries. In HPV-positive and cytology-negative women, follow-up with co-tests at 12 months is recommended. Nevertheless, if HPV-16 or HPV-18 is positive, direct colposcopy is recommended. In mild cytological abnormality and HPV-negative women, routine screening should be continued as per age-specific guidelines. Women with history of cervical intraepithelial neoplasia grade 2 or more should be followed at least 20 years even after age 65 years. In area with very limited resource, a single visit “screen-and-treat” visual inspection with acetic acid might be reasonable. Although the policies of cervical screening vary in different regions, the future screening strategies when the young HPV vaccinated population reaches the screening age will need to be renovated.

The role of human papillomavirus (HPV) testing in the follow-up of patients after treatment for cervical intraepithelial neoplasia (CIN)

Introduction: The aim of this study was to examine the role of human papillomavirus testing in the follow-up after treatment for CIN, as a prognostic sign for residual/recurrent cervical precancerous lesions.Methods: A hospital-based analysis was performed on 460 patients previously treated for CIN with cold knife conization, at the University Clinic for Gynecology and Obstetrics and General Hospital Remedika, in Skopje, Republic of Macedonia, in a period of 3 years. The patients were followed-up with HPV testing in addition to cytology, colposcopy and/or biopsy. The first after treatment HPV testing was performed8 months after cold knife conization, proceeded by follow-up within 24 months after treatment, at 4 months intervals.Results: Among 460 treated patients, at the fi rst HPV and cytologic testing, 8 months after treat-ment, 69 (15%) were HPV+, and 391 (85%) HPV negative. From the 69 HPV+ patients, 41 (59.4%) were withcytologic abnormalities and 28 (40.6%) without abnormalities. 12 months after treatment, the number of HPV+ patients developing cytologic abnormalities raised to 45/70 (64.29%). Within the 24 months aftertreatment, the number of patients who had recurrent/ residual CIN from the HPV+ patients reached 50/71 (70.42%); which was 10.87% from all 460 treated patients.Conclusion: Persistence or clearance of HPV especially 8 months after treatment even in patients with normal cytology, is an early valid prognostic marker of treatment failure, and is more accurate than cytologyat the same follow-up intervals.

The Role of Human Papillomavirus Testing in the Management of Women With Low-Grade Abnormalities: Multicentre Randomized Controlled Trial

Cytology testing in the NHS Cervical Screening Programs in the United Kingdom has identified over a quarter of a million women with precancerous low-grade abnormalities (mild dyskaryosis or borderline nuclear abnormalities [BNA]). Some investigators have suggested that human papillomavirus (HPV) testing could help decide which of these women should be referred for colposcopy and which could safely be returned to routine recall. This multicenter randomized-controlled trial used data from a previous Trial Of Management of Borderline and Other Low-grade Abnormal smears Group (TOMBOLA) trial to determine whether an HPV test is useful among women with mild dyskaryosis or BNA in the choice between cytological surveillance and colposcopy, and after referral whether HPV testing is useful in choosing treatment (either immediate large loop excision of the transformation zone (LLETZ) or biopsy with selective recall. The study subjects were 4439 women, 20 to 59 years of age, with mild dyskaryosis or BNA at enrollment. HPV analysis was performed using the polymerase chain reaction assay with the GP5+/6+ general primer system. Both the study subjects and those involved in management were blinded to the HPV testing results. In the first of 2 randomizations, women were assigned to either cytological surveillance every 6 months or referral for immediate colposcopy. In the second randomization, women referred for colposcopy were assigned either to immediate LLETZ or biopsies with selective recall for LLETZ. Both randomizations were stratified for HPV status and age. In addition, the association between HPV status and the presence of cervical intraepithelial neoplasia (CIN) grade 2 or more severe disease (CIN2 or worse) was examined in women who underwent colposcopy. At the end of the 3-year follow-up, all women were invited for an exit examination, which included colposcopy. No significant interactions were found between management and HPV status, showing that HPV positivity among women with low-grade cytologic abnormalities at recruitment was not effective in the choice of immediate colposcopy over cytological surveillance (P = 0.76) or immediate LLETZ over biopsy and recall (P = 0.27). No difference was found between women with mild dyskaryosis and BNA in the sensitivity of a single HPV test in detection of CIN2 or worse, whereas specificity was higher in those with BNA (71.3%; 95% confidence interval [CI], 68.5%–74.1% vs. 46.9%; 95% CI, 42.2%–51.6%). With increasing age, the sensitivity decreased and the specificity increased. There was a high negative predictive value, especially among women with BNA (94.5%; 95% CI, 92.9%–96.0%). About 22% of women across all ages with CIN2 or worse were HPV negative. Conversely, 40% of HPV positive women did not have CIN. HPV was a more reliable predictor among women aged 40 or more compared with younger women. These findings indicate that a single HPV test may be useful in women over 40 years of age in determining which women with low-grade abnormal cytology should be referred for colposcopy, but may not be useful in women 40 years of age or less, or for determining the most effective management at colposcopy.

The role of human papillomavirus testing in the management of women with low‐grade abnormalities: multicentre randomised controlled trial

To assess the value of a single human papillomavirus (HPV) test in making decisions on management of women with cervical cytology showing borderline nuclear abnormality (BNA) or mild dyskaryosis. In particular, to determine whether information on high-risk (hr) HPV status would be valuable in the choice between (1) cytological surveillance versus immediate referral to colposcopy, and (2) at colposcopy, between biopsy and recall versus immediate large loop excision of the transformation zone (LLETZ). Multicentre individually randomised controlled trial, nested within the NHS Cervical Screening Programmes, investigating the value of HPV testing by testing for interactions between HPV status and (1) cytological surveillance versus colposcopy, and (2) biopsy and recall versus immediate LLETZ. Setting Grampian, Tayside and Nottingham. Population Women (n = 4439), aged 20-59 years, with a cytology test showing borderline nuclear abnormalities or mild dyskaryosis during October 1999 to October 2002. High-risk HPV status was determined at recruitment using the polymerase chain reaction assay with the GP5+/6+ general primer system. The results of this HPV testing were not disclosed to either the participating women or to those involved in their management. Women were randomised to either (1) 6-monthly cytological screening in primary care or (2) referral for colposcopy. Human papillomavirus status was used to stratify both randomisations. All women were followed for 3 years, concluding with an invitation to an exit appointment at which colposcopic examination was undertaken. In addition, in women who were randomised to initial colposcopy and underwent colposcopy, the association between hrHPV status and presence of cervical intraepithelial neoplasia (CIN) grade 2 or more severe disease (henceforth CIN2 or worse) was examined. Sensitivity, specificity, positive and negative predictive values of the HPV test for predicting CIN2 or worse and the implications for the choice of management between cytological surveillance and immediate referral for colposcopy. There were no significant interactions between management and HPV status. Hence, in women with mild dyskaryosis or BNA who are HPV positive, there is no advantage of (1) immediate colposcopy over cytological surveillance (P = 0.76) or (2) immediate LLETZ over biopsy and recall (P = 0.27). The sensitivity of HPV testing for detection of CIN2 or worse was 75.2% (95% CI 68.8-81.0%) among women with mild dyskaryosis and 69.9% (95% CI 61.7-77.3%) among those with BNA. Specificity was higher in those with BNA (71.3%; 95% CI 68.5-74.1%) than in those with mild dyskaryosis (46.9%; 95% CI 42.2-51.6%). Sensitivity decreased with increasing age whereas specificity increased. The negative predictive value was high, particularly among women with BNA (94.5%; 95% CI 92.9-96.0%). Across all ages, 22% of women who had CIN2 or worse were HPV negative. Conversely, 40% of those who were HPV positive did not have CIN. HPV was a much more reliable predictor in women aged over 40 years. We conclude that in younger women with low-grade cytological abnormalities, a single HPV test would not be useful in determining who should be referred for colposcopy or the most effective management at colposcopy. In women over 40, a negative HPV test could be used to rule out further investigation.

The role of human papillomavirus testing in cervical cancer screening

The role of human papillomavirus testing in cervical cancer screening

The role of HPV testing in patients with possible high‐grade cervical cytology

To assess the role of human papillomavirus (HPV) testing for high-risk types in an Australian population with the equivalent cytological result of atypical squamous cells of undetermined significance - possible high-grade (ASC-H). A retrospective review was conducted of all patients referred with a 'possible high-grade squamous abnormality' Pap-smear result who underwent HPV testing for 13 high-risk types, colposcopy and directed biopsy, and any subsequent treatment. The study included 100 patients. Overall, 79% of patients had a positive test for high-risk HPV DNA types. Histopathology was available for 98 patients and demonstrated that 47% of patients had confirmed high-grade dysplasia. HPV testing had a high sensitivity (98%), but low specificity (40%) for the detection of high grade dysplasia, and a negative predictive value of 95%. The results of this study suggest that among patients with the equivalent of ASC-H cytology, a negative HPV DNA test for high-risk types is a good predictor of the absence of high-grade dysplasia. HPV testing in this patient population therefore has the potential to reduce the number women referred for colposcopy.

Prediction of recurrence after treatment for high‐grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation

The aim of this study was to examine the accuracy of the presence of high-risk human papillomavirus (HR-HPV) DNA (HR-HPV DNA test) postconisation as prediction of recurrent or residual cervical intraepithelial neoplasia (CIN) after treatment of high-grade cervical intraepithelial lesions (CIN2+) in a prospective study and to compare this with follow-up cytology and the marginal status of the excised tissue. Prospective follow-up study. Unselected women presenting at colposcopy clinic of University Hospital Gasthuisberg, Leuven. Seventy-two women treated with conisation for CIN2 or CIN3. Women were followed by HR-HPV DNA test (Hybrid Capture II test of Digene) every 3 to 6 months. The same vial was used for cytology and the HR-HPV DNA test (SurePath). All women were further followed by colposcopy and cytology for 24 months at 6-month intervals. The outcome of the study was presence of >CIN2, proven with colposcopy-directed biopsy occurring within 24 months after treatment. HR-HPV status was correlated with recurrent or residual CIN2+. Sensitivity, specificity, predictive values and diagnostic odds ratios to predict treatment failure or cure were computed for HR-HPV testing, marginal status and follow-up cytology. HR-HPV status was also correlated with section margins postconisation and with the first cervical smear. In 6 of the 72 treated women (8%), residual or recurrent CIN occurred. Women with recurrence were significantly older than women without a recurrence (51.5 +/- 9.6 versus 39.8 +/- 12.2 years, P= 0.007). All six women with recurrence were HR-HPV positive, four had a positive follow-up smear (>or=atypical squamous cells of uncertain significance = ASCUS+) and only two had involved section margins. Among the 66 cured women, 15 were HR-HPV positive, 6 had an abnormal smear and 12 had positive section margins. Sensitivity of cytology, positive section margins and HR-HPV DNA positivity was 66.7, 33.3 and 100% to predict treatment failure. Specificity of the three tests was, respectively, 90.9, 81.8 and 77.3%. Women with HR-HPV DNA at 3 to 6 months showed recurrent or residual CIN in 15% (2/13) if they had normal follow-up Pap smears and in 50% (4/8) if they had abnormal Pap smears. Margin status was not statistically significantly associated with human papillomavirus status. Persistence or clearance of HR-HPV DNA is an early valid prognostic marker of failure or cure after treatment for CIN2+ and is more accurate than cytology or section margin status at the time of conisation. The absence of HR-HPV DNA has a 100% negative predictive value. Higher age at conisation may be a previously unrecognised risk factor for recurrence.

The role of human papillomavirus testing in cervical screening

Organised, cytology-based cervical screening has led to a reduction in deaths associated with cervical cancer. Human papillomavirus (HPV) is necessary for the development of cervical cancer and associated pre-cursor cervical intraepithelial neoplasia and accumulated evidence suggests that incorporation of HPV testing could further refine screening programmes. HPV testing is discussed in the context of primary screening, for triage, and as a test of cure of treatment and possible value in developing countries. The high negative predictive value of a "double negative" cytology and HPV result could allow considerable changes in policy such as increased intervals between screening rounds, adjustment of age ranges for testing and schedule for return to routine screening post treatment. HPV testing for the triage of women to colposcopy with borderline or atypical squamous cells of undetermined significance (ASCUS) cytology could be clinically effective, but may be limited in women with low-grade squamous intraepithelial lesions (LSIL) or mild dyskaryosis by high HPV prevalence. Markers of HPV persistence harbour enormous potential to identify women at greatest risk of disease progression. Due to the diversity of existing cytology-based screening programmes, full cost-effectiveness analyses of HPV testing should be performed and assessed within local contexts.

Role for HPV testing in ASCUS: a cytologic-histologic correlation.

Human papilloma virus (HPV) Hybrid Capture II testing was introduced at our institution in mid-April, 2001. Relatively little data exists on the histologic follow-up of "high-risk HPV-positive ASCUS" patients without a previous abnormal Pap result. The results of the cytologic-histologic correlation of 50 patients over an 11-mo period are presented. Our results indicate that significant lesions may be discovered in patients of the "high-risk HPV-positive ASCUS" category who have no previous abnormal Pap history. Of the 50 patients presented in this study, histologic follow-up demonstrated evidence of squamous carcinoma in one patient (2%), high-grade squamous intraepithelial lesion (HSIL) in eight patients (16%), and low-grade squamous intraepithelial lesion (LSIL) in 19 patients (38%). The other 22 (44%) showed chronic cervicitis, reactive changes, or no pathologic changes. These findings suggest a more aggressive clinical approach may be warranted in the management of new onset ASCUS positive for high risk HPV.

Is There a Role for Human Papillomavirus Testing in Clinical Practice?

Is There a Role for Human Papillomavirus Testing in Clinical Practice?

Will New Human Papillomavirus Diagnostics Improve Cervical Cancer Control Efforts?

With the causal link between specific types of human papillomavirus (HPV) and cervical cancer firmly established, efforts have turned to assessing the relative merits of offering HPV testing in screening, triage, and posttreatment management. Many unanswered questions remain, but a growing body of evidence supports a role for HPV testing in cervical cancer prevention programs. Already, clinical centers that serve thousands of women in Europe and the United States have incorporated HPV DNA tests in triage algorithms.

A systematic review of the role of human papilloma virus (HPV) testing within a cervical screening programme: summary and conclusions.

A systematic review of the available evidence on the role of HPV testing in cervical screening has been published by the Health Technology Assessment Committee of the UK Department of Health. The review summarized relevant data on testing methods, natural history, and prevalence of the virus in different disease groups. Cost-effectiveness modelling was undertaken. Ten major conclusions were reached and are reported here. The key conclusions were that HPV testing was more sensitive than cytology, but that there were concerns about specificity, especially in young women. The increased sensitivity led to a recommendation that HPV testing be introduced on a pilot basis for women with borderline and mild smears. HPV testing has great potential as a primary screening test, but large trials are needed to properly evaluate this application and to determine if its introduction can reduce invasive cancer rates. There is an urgent need to undertake a large trial of HPV testing in conjunction with other new technologies (liquid-based cytology and computer-assisted cytology reading) to determine the best way to integrate them into ongoing screening programmes. A range of issues including the age to start and stop screening, the appropriate screening interval, the role of self-sampling for HPV testing and the choice of primary test (HPV and/or cytology) require further evaluation. © 2000 Cancer Research Campaign

The role of human papillomavirus testing in cervical screening

International Journal of Gynecology & ObstetricsVolume 70, Issue S3 p. C59-C59 Free communication lower genital tract: Intraepithelial neoplasms The role of human papillomavirus testing in cervical screening E. Paraskevaidis, E. ParaskevaidisSearch for more papers by this authorG. Koliopoulos, G. KoliopoulosSearch for more papers by this authorM. Paschopoulos, M. PaschopoulosSearch for more papers by this authorE. Kontostolis, E. KontostolisSearch for more papers by this authorK. Zikopoulos, K. ZikopoulosSearch for more papers by this authorL. Pappa, L. PappaSearch for more papers by this authorM. Malamou-Mitsi, M. Malamou-MitsiSearch for more papers by this authorS.N. Kalantaridou, S.N. KalantaridouSearch for more papers by this authorI. Georgiou, I. GeorgiouSearch for more papers by this authorH.C. Kitchener, H.C. KitchenerSearch for more papers by this authorD.E. Lolis, D.E. LolisSearch for more papers by this author E. Paraskevaidis, E. ParaskevaidisSearch for more papers by this authorG. Koliopoulos, G. KoliopoulosSearch for more papers by this authorM. Paschopoulos, M. PaschopoulosSearch for more papers by this authorE. Kontostolis, E. KontostolisSearch for more papers by this authorK. Zikopoulos, K. ZikopoulosSearch for more papers by this authorL. Pappa, L. PappaSearch for more papers by this authorM. Malamou-Mitsi, M. Malamou-MitsiSearch for more papers by this authorS.N. Kalantaridou, S.N. KalantaridouSearch for more papers by this authorI. Georgiou, I. GeorgiouSearch for more papers by this authorH.C. Kitchener, H.C. KitchenerSearch for more papers by this authorD.E. Lolis, D.E. LolisSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)80488-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS32000Pages C59-C59 RelatedInformation

The role of human papillomavirus testing in cervical screening

The role of human papillomavirus testing in cervical screening

A systematic review of the role of human papillomavirus testing within a cervical screening programme.

A systematic review of the role of human papillomavirus testing within a cervical screening programme.