HPV DNA testing as an adjunct in the management of patients with low grade cytological lesions in Finland

Jussi Tarkkanen, Eeva Auvinen, Pekka Nieminen, Raija Malmi, Juhani Vartiainen, Tuomo Timonen, Pekka Laurila, Ilkka Räisänen, Hans-Anders Unnerus, Arja Sakki, Petri Mattila, Adriaan van den Brule, Anna-Maija Tapper

    Research output: Contribution to journalArticleScientificpeer-review

    Abstract

    Background. Patients with recurrent low grade cytological abnormalities are at increased risk for high grade lesions. We wanted to see whether these patients could be identified by HPV DNA and pap tests. Methods. A prospective study of 663 patients referred for a colposcopy on the basis of ASC-US or LSIL cytology. High-risk HPV DNA positivity and cytology were compared with histology. Results. In total 65.6% samples were positive for HC2, and the overall proportion of CIN2 + lesions was 14.6%. No CIN2 + lesions were found in patients testing HC2 -, pap -. There were 5/97 (5.2%) high grade lesions, which were HC2-negative but pap-positive, including 1 cervical adenocarcinoma in situ. The corresponding histological sections were all positive for p16INK in immunostaining. In further analysis by PCR, 3 samples were positive for HPV DNA. High-risk HPV type 67, which is not included in the HC2 probe cocktail, was found in 1 case, and 2 cases were HPV positive but could not be typed. One CIN3 and one AIS remained HPV negative. In these 5 cases, the concomitant pap smear showed ASC-US x 1, LSIL x 1, HSIL x 2 and AGC x 1. During 6-month follow-up, a relatively high number of CIN2 + (28/557, 5.0%) emerged from the non-CIN x CIN1 group. Conclusions. The HC2 test or pap test alone were not sensitive enough to detect all CIN2 + lesions. A relatively high number of CIN2 + cases emerged from the non-CIN - CIN1 group after 6 months. Adequate follow-up of patients with mild cytological abnormalities, including a repeat pap smear taken during colposcopy and control at 6 months is underscored. Combination of hrHPV DNA and pap test should be considered, since it had high negative predictive value.
    Original languageEnglish
    JournalActa Obstetricia et Gynecologica Scandinavica
    Volume86
    Issue number3
    Pages (from-to)367-372
    Number of pages6
    ISSN0001-6349
    DOIs
    Publication statusPublished - 2007
    MoE publication typeA1 Journal article-refereed

    Fields of Science

    • HPV DNA
    • HC2
    • ASC-US
    • CIN
    • low grade cytology
    • CERVICAL INTRAEPITHELIAL NEOPLASIA
    • HUMAN-PAPILLOMAVIRUS
    • COST-EFFECTIVENESS
    • FOLLOW-UP
    • RISK
    • WOMEN
    • ABNORMALITIES
    • TRIAGE
    • ASCUS
    • ALTS
    • 312 Clinical medicine
    • Obstetrics and gynecology

    Cite this

    Tarkkanen, Jussi ; Auvinen, Eeva ; Nieminen, Pekka ; Malmi, Raija ; Vartiainen, Juhani ; Timonen, Tuomo ; Laurila, Pekka ; Räisänen, Ilkka ; Unnerus, Hans-Anders ; Sakki, Arja ; Mattila, Petri ; van den Brule, Adriaan ; Tapper, Anna-Maija. / HPV DNA testing as an adjunct in the management of patients with low grade cytological lesions in Finland. In: Acta Obstetricia et Gynecologica Scandinavica. 2007 ; Vol. 86, No. 3. pp. 367-372.
    @article{36b63d9a87c1421688021793b51c908b,
    title = "HPV DNA testing as an adjunct in the management of patients with low grade cytological lesions in Finland",
    abstract = "Background. Patients with recurrent low grade cytological abnormalities are at increased risk for high grade lesions. We wanted to see whether these patients could be identified by HPV DNA and pap tests. Methods. A prospective study of 663 patients referred for a colposcopy on the basis of ASC-US or LSIL cytology. High-risk HPV DNA positivity and cytology were compared with histology. Results. In total 65.6{\%} samples were positive for HC2, and the overall proportion of CIN2 + lesions was 14.6{\%}. No CIN2 + lesions were found in patients testing HC2 -, pap -. There were 5/97 (5.2{\%}) high grade lesions, which were HC2-negative but pap-positive, including 1 cervical adenocarcinoma in situ. The corresponding histological sections were all positive for p16INK in immunostaining. In further analysis by PCR, 3 samples were positive for HPV DNA. High-risk HPV type 67, which is not included in the HC2 probe cocktail, was found in 1 case, and 2 cases were HPV positive but could not be typed. One CIN3 and one AIS remained HPV negative. In these 5 cases, the concomitant pap smear showed ASC-US x 1, LSIL x 1, HSIL x 2 and AGC x 1. During 6-month follow-up, a relatively high number of CIN2 + (28/557, 5.0{\%}) emerged from the non-CIN x CIN1 group. Conclusions. The HC2 test or pap test alone were not sensitive enough to detect all CIN2 + lesions. A relatively high number of CIN2 + cases emerged from the non-CIN - CIN1 group after 6 months. Adequate follow-up of patients with mild cytological abnormalities, including a repeat pap smear taken during colposcopy and control at 6 months is underscored. Combination of hrHPV DNA and pap test should be considered, since it had high negative predictive value.",
    keywords = "HPV DNA, HC2, ASC-US, CIN, low grade cytology, CERVICAL INTRAEPITHELIAL NEOPLASIA, HUMAN-PAPILLOMAVIRUS, COST-EFFECTIVENESS, FOLLOW-UP, RISK, WOMEN, ABNORMALITIES, TRIAGE, ASCUS, ALTS, 312 Clinical medicine, Obstetrics and gynecology",
    author = "Jussi Tarkkanen and Eeva Auvinen and Pekka Nieminen and Raija Malmi and Juhani Vartiainen and Tuomo Timonen and Pekka Laurila and Ilkka R{\"a}is{\"a}nen and Hans-Anders Unnerus and Arja Sakki and Petri Mattila and {van den Brule}, Adriaan and Anna-Maija Tapper",
    year = "2007",
    doi = "10.1080/00016340601185343",
    language = "English",
    volume = "86",
    pages = "367--372",
    journal = "Acta Obstetricia et Gynecologica Scandinavica",
    issn = "0001-6349",
    publisher = "Wiley",
    number = "3",

    }

    HPV DNA testing as an adjunct in the management of patients with low grade cytological lesions in Finland. / Tarkkanen, Jussi; Auvinen, Eeva; Nieminen, Pekka; Malmi, Raija; Vartiainen, Juhani; Timonen, Tuomo; Laurila, Pekka; Räisänen, Ilkka; Unnerus, Hans-Anders; Sakki, Arja; Mattila, Petri; van den Brule, Adriaan; Tapper, Anna-Maija.

    In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 86, No. 3, 2007, p. 367-372.

    Research output: Contribution to journalArticleScientificpeer-review

    TY - JOUR

    T1 - HPV DNA testing as an adjunct in the management of patients with low grade cytological lesions in Finland

    AU - Tarkkanen, Jussi

    AU - Auvinen, Eeva

    AU - Nieminen, Pekka

    AU - Malmi, Raija

    AU - Vartiainen, Juhani

    AU - Timonen, Tuomo

    AU - Laurila, Pekka

    AU - Räisänen, Ilkka

    AU - Unnerus, Hans-Anders

    AU - Sakki, Arja

    AU - Mattila, Petri

    AU - van den Brule, Adriaan

    AU - Tapper, Anna-Maija

    PY - 2007

    Y1 - 2007

    N2 - Background. Patients with recurrent low grade cytological abnormalities are at increased risk for high grade lesions. We wanted to see whether these patients could be identified by HPV DNA and pap tests. Methods. A prospective study of 663 patients referred for a colposcopy on the basis of ASC-US or LSIL cytology. High-risk HPV DNA positivity and cytology were compared with histology. Results. In total 65.6% samples were positive for HC2, and the overall proportion of CIN2 + lesions was 14.6%. No CIN2 + lesions were found in patients testing HC2 -, pap -. There were 5/97 (5.2%) high grade lesions, which were HC2-negative but pap-positive, including 1 cervical adenocarcinoma in situ. The corresponding histological sections were all positive for p16INK in immunostaining. In further analysis by PCR, 3 samples were positive for HPV DNA. High-risk HPV type 67, which is not included in the HC2 probe cocktail, was found in 1 case, and 2 cases were HPV positive but could not be typed. One CIN3 and one AIS remained HPV negative. In these 5 cases, the concomitant pap smear showed ASC-US x 1, LSIL x 1, HSIL x 2 and AGC x 1. During 6-month follow-up, a relatively high number of CIN2 + (28/557, 5.0%) emerged from the non-CIN x CIN1 group. Conclusions. The HC2 test or pap test alone were not sensitive enough to detect all CIN2 + lesions. A relatively high number of CIN2 + cases emerged from the non-CIN - CIN1 group after 6 months. Adequate follow-up of patients with mild cytological abnormalities, including a repeat pap smear taken during colposcopy and control at 6 months is underscored. Combination of hrHPV DNA and pap test should be considered, since it had high negative predictive value.

    AB - Background. Patients with recurrent low grade cytological abnormalities are at increased risk for high grade lesions. We wanted to see whether these patients could be identified by HPV DNA and pap tests. Methods. A prospective study of 663 patients referred for a colposcopy on the basis of ASC-US or LSIL cytology. High-risk HPV DNA positivity and cytology were compared with histology. Results. In total 65.6% samples were positive for HC2, and the overall proportion of CIN2 + lesions was 14.6%. No CIN2 + lesions were found in patients testing HC2 -, pap -. There were 5/97 (5.2%) high grade lesions, which were HC2-negative but pap-positive, including 1 cervical adenocarcinoma in situ. The corresponding histological sections were all positive for p16INK in immunostaining. In further analysis by PCR, 3 samples were positive for HPV DNA. High-risk HPV type 67, which is not included in the HC2 probe cocktail, was found in 1 case, and 2 cases were HPV positive but could not be typed. One CIN3 and one AIS remained HPV negative. In these 5 cases, the concomitant pap smear showed ASC-US x 1, LSIL x 1, HSIL x 2 and AGC x 1. During 6-month follow-up, a relatively high number of CIN2 + (28/557, 5.0%) emerged from the non-CIN x CIN1 group. Conclusions. The HC2 test or pap test alone were not sensitive enough to detect all CIN2 + lesions. A relatively high number of CIN2 + cases emerged from the non-CIN - CIN1 group after 6 months. Adequate follow-up of patients with mild cytological abnormalities, including a repeat pap smear taken during colposcopy and control at 6 months is underscored. Combination of hrHPV DNA and pap test should be considered, since it had high negative predictive value.

    KW - HPV DNA

    KW - HC2

    KW - ASC-US

    KW - CIN

    KW - low grade cytology

    KW - CERVICAL INTRAEPITHELIAL NEOPLASIA

    KW - HUMAN-PAPILLOMAVIRUS

    KW - COST-EFFECTIVENESS

    KW - FOLLOW-UP

    KW - RISK

    KW - WOMEN

    KW - ABNORMALITIES

    KW - TRIAGE

    KW - ASCUS

    KW - ALTS

    KW - 312 Clinical medicine

    KW - Obstetrics and gynecology

    U2 - 10.1080/00016340601185343

    DO - 10.1080/00016340601185343

    M3 - Article

    VL - 86

    SP - 367

    EP - 372

    JO - Acta Obstetricia et Gynecologica Scandinavica

    JF - Acta Obstetricia et Gynecologica Scandinavica

    SN - 0001-6349

    IS - 3

    ER -