Human Papillomavirus Testing Research Articles

Outcomes and associated factors of cervical human papillomavirus infection among 608 women in Shenzhen, China, 2018–2023

ObjectiveThis study aimed to uncover the patterns of Human papillomavirus (HPV) infection outcomes in women and assess the risk factors that may affect these outcomes.MethodsA retrospective study was conducted on 608 women who tested positive for HPV-DNA during their initial visit to the outpatient department of Shenzhen Longgang Central Hospital from 2018 to 2023 and who had subsequent HPV-DNA testing as part of their post-visit monitoring. The monitoring intervals were every 6 months. The rank sum test was used to analyze ranked data. The Kaplan–Meier method was used to analyze the turning negative time. Univariate analysis was performed using the log-rank test, and multivariate analysis was performed using the Cox model to analyze independent risk factors.ResultsThe results showed that the median age was 40.00 years (interquartile 33.00–47.00 years), the total conversion rate of the HPV-negative patients was 38.98%, and the median conversion time of the HPV-negative patients was 8.95 months (interquartile 4.20–16.175 months). Age, infection status and type of health insurance were significantly correlated with HPV outcome (p < 0.05).ConclusionAmong women infected with HPV, the overall rate of negative HPV infection was 38.93%, and the duration of negative conversion was 8.95 months. The study revealed that age, HPV infection status, and type of medical insurance are independent predictors of the persistence of negative HPV test outcomes.

Research progress of DNA methylation in the screening of cervical cancer and precancerous lesions

AbstractCervical cancer is one of the most common malignant tumors that seriously threaten women's health. Persistent infection with high risk human papillomavirus (HPV) is closely related to the progression of cervical cancer. Cervical cancer screening is an effective measure to reduce the incidence and mortality of cervical cancer. The two most common screening strategies are cytology and HPV testing, but they easily lead to missed diagnosis or overdiagnosis. To overcome such limitations, a new triage method needs to be explored. The World Health Organization second edition guideline includes DNA methylation testing as a new method to be evaluated. DNA methylation is a common epigenetic modification and is considered to be closely related to the occurrence and development of tumors. In recent years, many methylated genes have been found to be biomarkers for cervical cancer and precancerous lesions diagnosis. In this paper, we focus on the role and application of host DNA methylation, HPV DNA methylation, as well as combined host and HPV DNA methylation in the screening of cervical cancer and precancerous lesions.

Applying Results of Extended Genotyping to Management of Positive Cervicovaginal Human Papillomavirus Test Results: Enduring Guidelines.

The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for the use of extended genotyping results in cervical cancer prevention programs. Risks of cervical intraepithelial neoplasia grade 3 or worse were calculated using data obtained with the Onclarity HPV Assay from large cohorts. Management recommendations were based on clinical action thresholds developed for the 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines. Risk estimates were reviewed in relation to clinical action thresholds and used as the basis for draft recommendations. After an open comment period, recommendations were finalized and ratified through a vote by the Consensus Stakeholder Group. Colposcopy is recommended after positive tests for human papillomavirus (HPV) types 16 and 18. For those positive for HPV 45, 33/58, 31, 52, 35/39/68, or 51 but negative for 16 or 18, triage with cytology or dual stain testing is recommended. When screening with primary HPV testing, for patients who test positive for HPV types 56/59/66 and no other carcinogenic types, repeat HPV testing in 1 year is recommended. When screening with cotesting, for those who test positive for HPV types 56/59/66 and no other carcinogenic types, 1-year return is recommended for negative for intraepithelial lesion or malignancy, atypical squamous cells of undetermined significance, and low-grade squamous intraepithelial lesion, and colposcopy is recommended for atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), atypical glandular cells, high-grade squamous intraepithelial lesion, or carcinoma. When patients without prior high-grade cytology (atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, atypical glandular cells, high-grade squamous intraepithelial lesion, or carcinoma) or histology (cervical intraepithelial neoplasia [CIN]2, CIN3, or adenocarcinoma in situ) are being followed, use of extended genotyping results is acceptable. When high-grade cytology or histology results are present, or when patients are being followed after treatment of CIN2+, management using the 2019 guidelines is recommended. Human papillomavirus extended genotyping can guide clinical management in the setting of a positive HPV test result.

Hyperproteinemia, Hematuria, and Squamous Cell Shedding in Elderly Cervical Cancer Patients and the Potential Alternative Screening Tool.

In Saudi Arabia, cervical cancer, frequently caused by human papillomavirus (HPV) infection, is a common cancer. The usual procedures for screening and diagnosing cervical cancer include Pap smears and HPV tests, even though they have considerable drawbacks, particularly for older women (> 60 years) who have limited access to or compliance with these tests. Urinalysis is a simple, noninvasive test that has been suggested as an alternative procedure. This study aimed to investigate the change in urinalysis characteristics in cervical cancer patients in elderly females and the possible use of urinalysis as a screening or diagnostic tool for cervical cancer in older women. This was an exploratory cross-sectional study of 190 cervical cancer patients diagnosed between January 2018 and August 2021. Based on age, the study included two groups, < 60 years and ≥ 60 years. Urinalysis characteristics, including bacterial count, blood level, protein level, and squamous epithelial cell shedding, were compared between the age groups by using the chi-squared and Kruskal-Walli tests. The results showed a significant difference between aged females and younger females with cervical cancer at the blood level, protein level, and squamous epithelial cell shedding in the urine. The older women (≥ 60 years) had higher incidences of increased bacterial count, blood levels, protein levels, and squamous epithelial cell shedding than the younger women (< 60 years). The main finding of the study implies that there are significant changes in urine characteristics in cervical cancer patients including hyperproteinemia, hematuria, and squamous cell shedding in elderly patients compared to younger patients, and it proposes a potential role for urinalysis as a screening tool for cervical cancer in older women. Urinalysis could be a potential screening tool for cervical cancer in older women who have not been screened or have no screening access. Further studies are needed to validate these findings.

How Does Transitioning to Primary Human Papillomavirus Screening Impact Colposcopy Services? Lessons From an Australian National Program.

In 2017, Australian's National Cervical Screening Program changed from 2-yearly cytology to 5-yearly primary human papillomavirus (HPV) testing. The Stakeholder Opinions of Renewal Implementation and Experiences Study (STORIES) aimed to capture stakeholder perspectives during implementation of the renewed National Cervical Screening Program. Qualitative semistructured interviews were conducted with key National Cervical Screening Program stakeholders 11-20 months following the change, either face-to-face, online, or via phone. Data related to colposcopy services were thematically analyzed using Proctor's conceptual framework for implementation outcomes. The authors identified 4 overarching themes: non-adherence to guidelines, lack of preparedness, unintended consequences, and mitigation strategies. While an initial increase in colposcopy referral was expected following transition, many stakeholders found increased referrals to be inequitably spread across services and exacerbated by confusion about, or overuse of testing for, symptoms. The study provides the first assessment of stakeholder perceptions and experiences relating to colposcopy services during a transition from cytology to HPV screening. Significant preparation is required to ensure equitable and timely access to colposcopy when transitioning cervical screening programs, including wide stakeholder communication to build confidence; clear guidelines, especially around symptoms; and adequate resourcing for colposcopy services to meet projected referral rates.

Clinicopathological characteristics of invasive stratified mucinous carcinoma of the cervix and the expression and clinical significance of SLC7A11, SLC3A2 and PD-L1.

Invasive Stratified Mucin-producing Carcinoma (ISMC) of the cervix is a newly named cervical adenocarcinoma associated with Human Papilloma virus (HPV). Due to its relative rarity, clinical data, pathological features, and molecular characteristics of ISMC are still under exploration. This study aims to retrospectively analyze the clinical data and pathological features of ISMC patients, summarizing the clinical and pathological morphological characteristics of ISMC. Immunohistochemistry for SLC7A11, SLC3A2, and PD-L1 will be performed on tumor tissues from ISMC patients to preliminarily explore potential therapeutic targets for ISMC. We retrospectively reviewed the electronic medical records and pathological slides of 22 ISMC patients, and performed immunohistochemical staining for solute carrier family 7 member 11 (SLC7A11), solute carrier family 3 member 2 (SLC3A2), and programmed death-ligand 1 (PD-L1). The patients were aged between 31 and 70 years old. The most common symptoms were abnormal vaginal bleeding and unusual vaginal discharge. HPV testing indicated that the infection rate of HPV type 18 was the highest. All patients underwent extensive hysterectomy and pelvic lymph node dissection. The progression-free survival (PFS) ranged from 3 to 112 months, with a postoperative recurrence rate of 22.7% (5/22). ISMC exhibited diverse characteristic microstructures. Immunohistochemistry results showed that the positive rates of SLC7A11 and SLC3A2 were both 91.0% (20/22). The staining intensity of SLC7A11 in frequent ISMC recurrence cases was significantly stronger than in non-recurrent ISMC cases. PD-L1 positivity was observed in 86.4% (19/22) of cases, defined as having a Combined Positive Score(CPS)≥1. ISMC demonstrates a high rate of lymph node metastasis and a high recurrence rate, indicating strong invasiveness. Additionally, ISMC exhibits a wide morphological spectrum. SLC7A11, SLC3A2, and PD-L1 are all highly expressed in ISMC tissues. The high expression of SLC7A11 may indicate a high recurrence rate for ISMC. Immunotherapy with checkpoint inhibitors and iron death-related treatments show potential in the treatment of ISMC, with SLC7A11, SLC3A2, and PD-L1 serving as potential therapeutic targets for ISMC.

Agreement Between High-Risk Human Papillomavirus Testing in Paired Self-Collected and Clinician-Collected Samples from Cervical Cancer Screening in Spain.

Background: Implementing self-sampling (SS) in cervical cancer screening requires comparable results to clinician-collected samples (CCS). Agreement measures are essential for evaluating HPV test performance. Previous studies on non-paired samples have reported higher viral cycle threshold (Ct) values in SS compared to CCS, affecting sensitivity for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Objectives: We aimed to evaluate the agreement of high-risk (hr)HPV testing results between SS and CCS using paired samples and to explore differences in Ct values. Methods: Women aged 30 to 65 years attending cervical cancer screening in two regions of Spain were invited to participated in this study. For each woman there was: CCS collected during the screening visit using liquid-based cytology and cytobrush, and a SS using a brush at home one month later. A PCR-based assay was used for hrHPV detection. Agreement in hrHPV results among both samples, Ct value differences, and their association with screening outcomes were analyzed. Results: This study included 981 women with paired samples. SS had a higher hrHPV prevalence than CCS (overall ratio of 1.3). Positive agreement for all hrHPV genotypes, HPV16, HPV18, and other hrHPV types were 85%, 91.3%, 66.7%, and 83.3%, respectively. Negative agreement was >95% for all results. Median Ct values was slightly higher in SS than in CSS (32.9 vs. 30.6, p = 0.02). Seven CIN2+ cases HPV positive were detected by both methods. One CIN3 case was missed by SS. Conclusions: This study showed a good agreement between SS and CCS for hrHPV testing in a routine screening in Spain. Despite the slightly higher Ct values for SS, no significant impact on sensitivity could be determined due to the low incidence of CIN2+ cases. Further research on larger paired samples is needed to assess the implications of Ct values on test sensitivity.

Exploring the Intricacies of Cervical Intraepithelial Neoplasia and Its Connection with HPV: A Narrative Review

Cervical Intraepithelial Neoplasia grade III (CIN III) represents a critical precursor to invasive cervical cancer, necessitating a comprehensive understanding of its etiology, progression, diagnosis, and preventive strategies. This review integrates an approach to synthesize current literature, conducted through a meticulous search of databases (Scopus, Web of Science, and Google Scholar) for relevant articles discussing CIN III and its association with Human Papillomavirus (HPV). The review delineates the multifaceted landscape of CIN III, elucidating the pathogenesis involving high-risk HPV types, demographic factors (age and sexual behavior), behavioral determinants (smoking and contraceptive use), and environmental influences impacting disease epidemiology. Diagnostic modalities, including Pap smears, HPV testing, and colposcopy, were assessed for their role in early detection and intervention. The results highlight the significance of HPV vaccination, screening programs, and robust public health policies in mitigating the burden of CIN III. Effective interventions, particularly excisional procedures, demonstrate efficacy in reducing the risk of progression to invasive cancer, emphasizing the importance of vigilant follow-up. A comprehensive approach integrating vaccination initiatives, early detection through screening, and equitable healthcare policies stands pivotal in combating CIN III. The review underscores the imperative of evidence-based interventions for disease prevention, reducing disparities, and enhancing public health outcomes for individuals affected by or at risk of CIN III.

Uptake and service preferences of human papillomavirus vaccination in men who have sex with men.

Human papillomavirus (HPV) vaccination could reduce HPV infection in men who have sex with men (MSM), but the published statistics on HPV vaccination uptake in MSM were scarce globally. This study estimated the uptake and profiled the service preferences of HPV vaccination of Chinese MSM in Hong Kong. Adult MSM were recruited through non-governmental organizations (NGOs) and online channels for completing an online baseline survey. Factors associated with self-reported history of HPV vaccination were identified using multivariable stepwise logistic regression model. Totally 701 Chinese MSM completed the online baseline survey, with the median age of 30 y (interquartile range [IQR] 26-35, range 18-67), and 23% of them had received HPV vaccination. More than half of vaccinated MSM (72%) rated convenient or very convenient for local HPV vaccination services. Among unvaccinated MSM, 50% considered high cost of HPV vaccine as the barrier of vaccination, 67% expressed willingness to pay below USD 128 per vaccine dose, and 65% preferred receiving vaccination in private clinics. MSM who had taken HIV pre-exposure prophylaxis (PrEP) (p < .001), had been tested for HPV (p = .018), and had (p = .005) multiple regular sex partners in the past 6 months were more likely to be vaccinated. The HPV vaccination uptake of Chinese MSM in Hong Kong remains low (23%), and high HPV vaccine cost is the main barrier. Preventive behaviors (HIV PrEP use and HPV testing) and high-risk sexual behavior (multiple regular sex partners) are potential targets for intervention to increase the uptake of HPV vaccination in MSM.

Risk factors for the onset of cervical intraepithelial neoplasia

BACKGROUND: Persistent human papillomavirus (HPV) infection is a well-established cause of cervical intraepithelial neoplasia (CIN). Epidemiological studies show that while HPV infection is common, it is far more prevalent than CIN itself. Consequently, HPV testing exhibits moderate specificity and positive predictive value for detecting high-grade CIN. Currently, there is no optimal strategy for identifying HPV-positive women at high risk of CIN. AIM: This study aims to assess the socioeconomic, behavioral, and comorbidity factors associated with an increased risk of developing cervical intraepithelial neoplasia. MATERIAL AND METHODS: The study included 121 women who presented to the Medical Research and Education Center of Moscow State University in the period from 2022 to 2023. Pap-smear revealed normal data in 66 women (Group 1, NILM), mild cervical intraepithelial neoplasia in 27 (Group 2, LSIL), and severe cervical intraepithelial neoplasia in 28 (Group 3, HSIL). A comparative analysis of clinical data and medical history, data of liquid cytology and HPV typing was performed in all patients. Statistical analysis was performed using the MedCalc software package. RESULTS: The analysis showed that the risk of severe cervical intraepithelial neoplasia increased 5.4-fold in patients aged 30 years, 3.4-fold in smokers, 9.9-fold in patients who had been sexually active for more than 10 years, 6.3-fold in patients who had ≥4 sexual partners, 4.1-fold in patients who used withdrawal method of contraception (coitus interruptus), 7.0-fold in patients who had ≥3 pregnancies, 4.7-fold in patients with HPV infection (in particular, 4.3-fold in women infected with HPV 16). Patients with cervical intraepithelial neoplasia had significantly greater probability to be infected with high-risk HPV types (88.9% in patients with LSIL and 85.7% in patients with HSIL vs. 56.1% in NILM women), in particular, HPV 16 was detected in more than half of patients with HSIL. CONCLUSION: In this study sample, the risk of cervical intraepithelial neoplasia was associated with age over 30 years, smoking, duration of the sexual activity 10 years, number of sexual partners (4), lack of barrier contraception, number of past pregnancies (3), and persisting high-risk HPV infection, especially HPV 16.

Evaluation of primary HPV-based cervical screening among older women: Long-term follow-up of a randomized healthcare policy trial in Sweden.

Evidence on invasive cervical cancer prevention among older women is limited, especially with the introduction of human papillomavirus (HPV)-based screening and longer interval. We conducted a long-term follow-up of the first phase of a randomized healthcare policy trial in cervical screening, targeting women aged 56 to 61 years old, to investigate the effectiveness of primary HPV-based screening in preventing invasive cervical cancer (ICC) and the safety of extending screening interval. The randomized healthcare policy trial of primary HPV-based cervical screening targeted women residing in Stockholm-Gotland region during 2012 to 2016, aged 30 to 64 years. The trial aimed to investigate the detection rate of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) within 24 months and long-term protection against invasive cervical cancer, comparing primary HPV-based screening to primary cytology-based screening. The initial phase of the trial, which was the focus of this study, targeted women aged 56 to 61 years old in 2012 to 2014 who were randomized to primary cytology arm (n = 7,401) or primary HPV arm (n = 7,318). We used national registries to identify the subsequent cervical tests and all histopathological diagnoses including ICC before December 31, 2022. We calculated cumulative incidence, incidence rate (IR) and IR ratio (IRR) of ICC, by baseline test result. Furthermore, we calculated longitudinal sensitivity and specificity for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by receipt of primary cytology or primary HPV test for the recommended screening intervals in this age group. We found that the IR of ICC among women in the primary HPV arm was 7.2/100,000 person-years (py) and 3.0 for women who tested HPV negative, compared to 18.4/100,000 py among women in the primary cytology arm and 18.8 for women who tested cytology negative. We further found that the overall point estimate for the risk of ICC over 10 years of follow-up among women in the primary HPV arm was 0.39 compared to women in the primary cytology arm, but this was not statistically significant (IRR: 0.39; 95% confidence interval, CI [0.14, 1.09]; p = 0.0726). However, among women with a negative test result at baseline, women in the primary HPV arm had an 84% lower risk of ICC compared to women in the primary cytology arm (IRR: 0.16; 95% CI [0.04, 0.72]; p = 0.0163). Moreover, primary HPV testing had a higher sensitivity for detecting CIN2+ within a 7-year interval than primary cytology testing within a 5-year interval (89.6% versus 50.9%, p < 0.0001). We were limited by a partial imbalance of invitations during the follow-up between the 2 arms which may have led to an underestimation of the effectiveness of primary HPV-based screening. In this study, we observed that women over 55 years of age who received a primary negative HPV test result had substantially lower risk of CIN2+, and ICC, compared to women who received a primary negative cytology result. This should apply even if the screening interval were prolonged to 7 years. NCT01511328.

The performance of JAM3/PAX1 methylation in the diagnosis of high-grade squamous intraepithelial lesions for women with high-risk HPV infection

ObjectiveTo assess the clinical value of DNA methylation measurement in exfoliated cervical cells for distinguishing high-grade squamous intraepithelial lesions (HSIL) from other cervical abnormalities.MethodsA total of 276 patients were enrolled, and general clinical information was collected. Exfoliated cervical cells were obtained to assess human papillomavirus (HPV) infection, conduct ThinPrep cytology tests (TCT), and measure methylation levels of JAM3 (△CtJ) and PAX1 (△CtP). Logistic regression was performed to identify factors significantly associated with HSIL diagnosis. A conditional inference tree model and the area under the curve (AUC) were employed to evaluate the efficacy of JAM3 and PAX1 methylation in detecting HSIL.ResultsIndependent risk factors for HSIL diagnosis included △CtJ, △CtP, atypical squamous cells of undetermined significance (ASCUS), and HPV16 infection. The conditional inference tree indicated that 96.4% of patients were non-HSIL when △CtJ > 11.66, and 99.1% were non-HSIL when △CtP > 10.97. The diagnostic performance of △CtJ/△CtP surpassed that of TCT/HPV alone. Among six methods, the combination of △CtP, TCT, and high-risk HPV (hr-HPV) testing achieved the highest sensitivity (91.2%), positive predictive value (50.0%), negative predictive value (98.6%), and AUC (0.932).ConclusionIn women with hr-HPV infection, DNA methylation analysis of cervical cytology outperformed traditional TCT or HPV testing. The combination of △CtP with TCT and HPV may offer the most accurate screening approach for HSIL.

Utilization and outcomes of serial cervical cancer screening in a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in a non-Medicaid expansion state.

Since 1990, the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has offered free cervical cancer screening to low-income, uninsured patients, increasing single time point screening and early detection rates. Little is known about NBCCEDP's longitudinal effectiveness. The objective of this study was to assess utilization of Kansas's NBCCEDP, early detection works (EDW) for one-time versus serial screening and compare rates of cervical dysplasia between groups. A retrospective cohort study was conducted among patients who received cervical cancer screening through EDW from 2001 to 2021. Demographic factors, Papanicolaou (Pap) test, and human papillomavirus (HPV) results were compared between patients with one screening versus multiple. Descriptive statistics were performed. From 2014 to 2021, 3.71-7.06% of eligible patients completed screening through EDW annually. 17.4% of 58,582 eligible patients were up-to-date with screening in 2020. Rural patients and those under age forty were less likely to have EDW screening. Of 43,916 ever-screened patients, 14,638 (33.3%) received multiple screenings. 77% of patients did not have HPV testing; rates were lower in serially screened patients. Cervical dysplasia rates differed minimally between groups. Despite screening 24,017 patients over 7years, EDW maintains up-to-date screening for under one-fourth of eligible Kansans. Young and rural patients less frequently access EDW. HPV testing is underutilized, which limits the negative predictive value of screening. Serial screening is largely used by low-risk patients currently. Identification and prioritization of serial screening in high risk could increase program impact.

Cervical Cancer Screening: Patient Perspectives on Transitioning to Primary High-Risk Human Papillomavirus Testing Alone.

In 2018, the US Preventive Services Task Force updated cervical cancer screening recommendations to allow for screening every 5 years with primary human papillomavirus (HPV) testing in combination with cytology (cotesting) or every 5 years with primary HPV screening alone. Despite these changes, the uptake of primary HPV screening has been lower than expected. The purpose of this study was to evaluate the patient perspective of an integrated health system transition from cotesting to primary HPV testing among a 30- to 65-year-old cohort. Semistructured phone interviews were conducted from July to December 2023 at Kaiser Permanente Colorado with 16 members aged 30-65 years. Interviews asked about reactions to the forthcoming change in cervical cancer screening, personal concern about cervical cancer risk, feedback on patient-facing education materials, and preference on communication timing and modality. Participants reported concerns about cervical cancer screening intervals, primarily the reduction in frequency leading to underdiagnosis of sexually transmitted infections (STIs). Participants recommended defining the rationale for the change to primary HPV testing in the patient education materials. Participants preferred communication about the change in-clinic between practitioner and patient. The interviews identified key themes, including the differentiation between cervical cancer and STI screening methodologies, potential underdiagnosis of STI and cervical cancer, and the rationale supporting primary HPV testing and associated screening intervals. These qualitative findings can inform health systems of potential patient concerns to address when considering the transition from cotesting every 3 years to primary HPV testing every 5 years for cervical cancer screening.

Poor Performance of Applicator Tampon-Based Self-Collection for Liquid-Based Cytology Among Women Attending a Tertiary Hospital in South Africa.

The South African Cervical Cancer Prevention and Control Policy was updated in June 2017, recommending liquid-based cytology (LBC) as the preferred screening method and the investigation of self-sampling for cervical cancer screening. To compare the performance of the Self Collection Cervical Health Screening Kit [SelfCerv (applicator tampon)] to the Cervex-Brush Combi for cytology screening. The study further aimed to compare high-risk (hr-) human papillomavirus (HPV) and LBC test results from both methods. The study included 446 paired samples, comprising self-collected (SelfCerv) and healthcare provider-collected (Cervex-Brush Combi) samples from women aged ≥ 18 years attending gynaecology outpatient clinics at a tertiary hospital in Pretoria, South Africa. LBC slides were prepared using the ThinPrep 5000 processor and manually stained with Hematoxylin and Eosin (H&E). Detection of 14 hr-HPV types was performed using the Abbott RealTime HR-HPV assay. Statistical analyses were performed using STATA version 17.0 (Stata Corp., College Station, Texas, USA). A statistically significant difference in cervical cytology detection between the two methods was observed (p = 0.0025). The Cervex-Brush Combi was more effective in collecting endocervical cells (73.4%; 95% CI: 69.0-77.9) compared to the SelfCerv applicator tampon (7.3%; 95% CI: 4.7-9.9); (p < 0.001). Cytological abnormalities were detected in 65.4% (136/208) of participants who tested positive for hr-HPV by healthcare provider sampling compared to 40.8% (84/206) by self-sampling. A fair agreement (κ: 0.35) with a concordance rate of 96.2% (95% CI: 94.4-98.0) was observed for specimen adequacy and diagnosis parameters [κ: 0.34, with a concordance rate of 67.7% (95% CI: 63.2-72.1)] between the two methods. The findings of this study do not support the implementation of applicator tampon-based self-collection as a method for cytology-based cervical cancer screening.

MicroRNA-Based Liquid Biopsy for Cervical Cancer Diagnostics and Treatment Monitoring.

Despite prevention strategies, cervical cancer remains a significant public health issue. Human papillomavirus plays a critical role in its development, and early detection is vital to improve patient outcomes. The incidence of cervical cancer is projected to rise, necessitating better diagnostic tools. Traditional screening methods like the cytological examination and human papillomavirus testing have limitations in sensitivity and reproducibility. Liquid-based cytology offers some improvements, but the need for more reliable and sensitive techniques persists, particularly for detecting precancerous lesions. Liquid biopsy is a non-invasive method that analyzes cancer-derived products in biofluids like blood, offering potential for real-time monitoring of tumor progression, metastasis, and treatment response. It can be based on detection of circulating tumor cells (CTCs), circulating free DNA (cfDNA), and microRNAs (miRNAs). This review particularly underlines the potential of microRNAs, which are transported by extracellular vesicles. Overall, this article underscores the importance of continued research into non-invasive diagnostic methods like liquid biopsy to enhance cervical cancer screening and treatment monitoring.

Application of Human Papillomavirus-DNA Test on Salivary Gland Fine Needle Aspiration Cytology Samples Confirms the Absence of the Virus in Primary Neoplasms and Demonstrates for the First Time Its Presence in Salivary Intraglandular Cysts.

The correlation between Human Papillomavirus (HPV) and salivary gland neoplasms is still controversial. Data in the literature are conflicting, reporting the presence of the HPV-DNA in a significant percentage of cases or none. We investigated the presence of HPV in a series of salivary gland neoplasms using fine needle aspiration cytology (FNAC) samples to explore its potential oncogenic role in salivary gland tumor development. The study included 66 salivary gland lesions from 65 patients. For all cases, residual cytological material in the needle hub, once direct smears were obtained, was fixed by rinsing the needle in Cytolyt hemolytic and preservative solution (Hologic Inc. Marlborough, MA 01752 USA). The samples fixed in the Cytolyt hemolytic and preservative solution (Hologic Inc. Marlborough, MA 01752 USA) were centrifuged at 252 g, then the sediment was transferred to the Preservcyt solution and used for the detection of HPV-DNA. We found evidence of the presence of HPV in two salivary intraglandular cysts lined by squamous cell epithelium. Furthermore, we also found HPV in three metastatic oropharyngeal squamous cell carcinomas (SCC) located in the parotid gland. Regarding primary salivary gland tumors, the HPV test produced negative results in all cases. HPV testing produced negative results in all primary salivary gland tumors, failing to confirm the potential involvement of HPV infection in the pathogenesis of salivary gland tumors. Instead, the presence of HPV DNA in samples of salivary intraglandular cysts, never reported before, may be an interesting fact, which however requires further evaluation.

High Risk of HPV Related Preneoplastic and Neoplastic Vulvar Lesions in Women Living With HIV.

We aimed to investigate the epidemiology of human papilloma virus (HPV)-related preneoplastic and neoplastic vulvar lesions in a large cohort of women living with HIV (WLWH). We retrospectively selected 1,796 WLWH who had a gynecological examination, cervical cytology, high-risk (HR-) HPV test, vulvoscopy, and colposcopy with targeted biopsies when necessary between 1987 and 2020 at 2 Italian institutions. Univariable and multivariable regression analyses were carried out to test the association of the anamnestic and clinical data with the development of precancerous and cancerous lesions. At baseline, 348 (19.4%) of 1,796 WLWH had genital warts, 30 (1.7%) had vulvar high-grade intraepithelial neoplasia (VHSIL), and 2 (0.1%) had squamous cell carcinoma of the vulva. Among 895 WLWH who had more than 1 year of follow-up, we found 40 (4.5%) new cases of VHSIL and 7 (0.8%) cases of vulvar cancer. The cumulative incidence of VHSIL and vulvar cancer was respectively 0.56 and 0.10 per 100 person-years. Risk factors independently associated with the development of vulvar HSIL and cancer included history of injection drug use (p < .01), genital warts at baseline (p < .001), HR-HPV test positivity at diagnosis (p < .001), and severe immunodepression (CD4 cell count <200 cells/mL) at diagnosis (p < .01). WLWH are at high risk of vulvar high-grade intraepithelial neoplasia and cancer, especially those with severe immunodepression. A careful inspection of vulva, perineum and anus, possibly with the aid of colposcopy, should become part of the surveillance protocol of HIV-infected women.

Survey of anatomic and clinical pathology services and infrastructure in Nigeria.

The paucity of data regarding the availability and extent of diagnostic medical services across sub-Saharan Africa hinders appropriate allocation of resources to improve health care in these regions. We assessed anatomic pathology (AP) and clinical pathology (CP) services in Nigeria, one of the most populous and fastest-growing countries in the world. Two individual surveys (AP focused and CP focused) were developed by subject matter experts and administered to individuals involved in pathology and laboratory medicine diagnostic services at hospitals and laboratories across Nigeria between June and August 2022 using the American Society for Clinical Pathology email listserv. A total of 75 responses (29 AP and 46 CP) were received from 48 unique laboratories. Twenty-four sites provided AP services and 35 provided CP services. Eleven respondents performed both AP and CP services. Among AP services, basic surgical and cytopathology capabilities were available at most sites; however, the availability of automated technologies (eg, automated sample processing and staining) was more variable. Advanced diagnostic techniques, (eg, immunohistochemistry, human papillomavirus testing, molecular diagnostics) were rarely performed. The most frequently available CP services included hematology, microbiology, and chemistry. Microbiology services appeared to be among the most robust laboratory medicine services, particularly parasitology and bacteriology testing. Similar to AP services, more advanced diagnostic assays, such as flow cytometry, cytogenetics, and molecular testing, were largely unavailable. These findings augment earlier studies and identify gaps that should be prioritized from a policy perspective to improve medical services and the overall health care infrastructure in Nigeria.

Value of intraoperative post-conisation human papillomavirus testing in predicting residual or recurrence after treatment with a loop electrosurgical excision procedure in women with HR-HPV positive and cervical high-grade squamous intraepithelial lesion

ObjectiveTo evaluate the feasibility of intraoperative human papillomavirus (IOP-HPV) testing for the prediction of postoperative treatment failure in patients with high-grade squamous intraepithelial lesion (HSIL) undergoing loop electrosurgical excisional procedure (LEEP).MethodsA total of 114 women diagnosed with HSIL by biopsy and/or endocervical curettage who underwent LEEP were included in a prospective cohort study. IOP-HPV testing was performed immediately after the procedure. Patients were followed up for 24 months. Logistic regression was used to analyse the factors influencing the residual or recurrent lesions. Further stratified analyses were performed to investigate the differences in prognosis of IOP-HPV positivity in patients of different age and menopausal status.Results1. Of the 114 patients, 6 (5.26%) were pathologically upgraded to cervical cancer, and 21 (18.42%) were lost to follow-up. Recurrence or residual HSIL lesions occurred in 9.20% (8/87) of cases. Of the 8 women who developed post-treatment HSIL, 7 (26.92%) were positive for IOP-HPV, and only 1 (1.64%) was negative for IOP-HPV (< 0.01).2. Transformation zones of type 2 (P = 0.0306) or type 3 (P = 0.0446), diagnosed as LSIL/negative by cervical biopsy (P = 0.0396), margin involvement (P = 0.0233), positive endocervical curettage after conisation (P = 0.0028), intraoperative HPV-positive (P < 0.01), cytological abnormalities (P = 0.0038), DNA ploidy positivity (P = 0.0172), postoperative HPV (P < 0.01) and DNA ploidy (P = 0.0078) positivity at 6 months were associated with higher risk of residual or recurrent lesions. 3. The results of the multivariate regression analysis showed that IOP-HPV positivity was the independent risk factor for residual or recurrent lesions (OR=10.69 , 95% CI:3.41, 33.51, P<0.01). IOP-HPV positivity was strongly associated with the occurrence of residual/recurrent LSIL (OR=6.42 , 95% CI:1.74, 23.70,P=0.0053) and HSIL (OR=32.08 , 95% CI:3.60, 285.64, P=0.0019).4. Stratified analyses showed that IOP-HPV positive in patients younger than 50 years or premenopausal patients was associated with a significantly higher risk of recurrence or residual lesions (p<0.05).ConclusionsIOP-HPV positivity is an independent risk factor for residual or recurrent HSIL lesions. In addition, IOP-HPV positivity was more associated with residual or recurrent lesions in those younger than 50 years or premenopausal. IOP-HPV testing may be of critical clinical value in providing the early and accurate prediction of residual or recurrent lesions.