- Volume 15 Issue 24
DOI QR Code
Performance of HPV DNA Testing with Hybrid Capture 2 in Triaging Women with Minor Cervical Cytologic Abnormalities (ASC-US/LSIL) in Northern Thailand
- Khunamornpong, Surapan (Department of Pathology, Faculty of Medicine, Chiang Mai University) ;
- Settakorn, Jongkolnee (Department of Pathology, Faculty of Medicine, Chiang Mai University) ;
- Sukpan, Kornkanok (Department of Pathology, Faculty of Medicine, Chiang Mai University) ;
- Srisomboon, Jatupol (Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
- Suprasert, Prapaporn (Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
- Siriaunkgul, Sumalee (Department of Pathology, Faculty of Medicine, Chiang Mai University)
- Published : 2015.01.22
Background: Minor cervical cytologic abnormalities include atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Approximately 10-20% of women with minor cytologic abnormalities have histologic high-grade squamous intraepithelial or worse lesions (HSIL+). In Thailand, women with minor cytologic abnormalities have a relatively high risk of cervical cancer, and referral for colposcopy has been suggested. A triage test is useful in the selection of women at risk for histologic HSIL+ to reduce the colposcopy burden. The aim of this study was to assess the performance of high-risk HPV DNA test in triage of women with minor cytologic abnormalities in northern Thailand. Materials and Methods: All women with ASC-US/LSIL cytology who were referred to our colposcopy clinic from October 2010 to February 2014 were included. HPV DNA testing was performed using Hybrid Capture 2 (HC2). All patients received colposcopic examination. Accuracy values of HC2 in predicting the presence of histologic HSIL+ were calculated. Results: There were 238 women in this study (121 ASC-US and 117 LSIL). The HC2 positivity rate was significantly higher in the LSIL group than in ASC-US group (74.8% versus 41.0%, p<0.001). Histologic HSIL+ was detected in 9 women (7.4%) in the ASC-US group and 16 women (13.7%) in the LSIL group (p=0.141). There was no histologic HSIL+ detected among HC2-negative cases (sensitivity and negative predictive value of 100%). The performance of HC2 triage was highest among women aged >50 years with ASC-US cytology. An increase in the cut-off threshold for positive HC2 resulted in a substantial decrease of sensitivity and negative predictive value. Conclusions: HPV DNA testing with HC2 shows very high sensitivity and negative predictive value in triage of women with minor cervical cytologic abnormalities in northern Thailand. An increase of the cut-off threshold for HC2 triage is not recommended in this region.
- ASCUS-LSIL Triage Study (ALTS) Group (2003a). A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Am J Obstet Gynecol, 188, 1393-400. https://doi.org/10.1016/S0002-9378(03)00413-7
- ASCUS-LSIL Triage Study (ALTS) Group (2003b). Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol, 188, 1383-92. https://doi.org/10.1016/S0002-9378(03)00418-6
- Arbyn M, Martin-Hirsch P, Buntinx F, et al (2009). Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate. J Cell Mol Med, 13, 648-59. https://doi.org/10.1111/j.1582-4934.2008.00631.x
- Arbyn M, Roelens J, Cuschieri K, et al (2013a). The APTIMA HPV assay versus the Hybrid Capture 2 test in triage of women with ASC-US or LSIL cervical cytology: a meta-analysis of the diagnostic accuracy. Int J Cancer, 132, 101-8. https://doi.org/10.1002/ijc.27636
- Arbyn M, Roelens J, Simoens C, et al (2013b). Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions. Cochrane Database Syst Rev, 3, 8054.
- Castle PE, Sideri M, Jeronimo J, et al (2007). Risk assessment to guide the prevention of cervical cancer. Am J Obstet Gynecol, 356, 1-6.
- Chujan S, Kitkumthorn N, Siriangkul S, et al (2014). CCNA1 promoter methylation: a potential marker for grading papanicolaou smear cervical squamous intraepithelial lesions. Asian Pac J Cancer Prev, 15, 7971-5. https://doi.org/10.7314/APJCP.2014.15.18.7971
- Ekalaksananan T, Pientong C, Kongyingyoes B, et al (2011). Combined p16INK4a and human papillomavirus testing improves the prediction of cervical intraepithelial neoplasia (CIN II-III) in Thai patients with low-grade cytological abnormalities. Asian Pac J Cancer Prev, 12, 1777-83.
- Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
- Fujii T, Saito M, Hasegawa T, et al (2014). Performance of p16/Ki-67 immunocytochemistry for identifying CIN2+ in atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion specimens: a Japanese Gynecologic Oncology Group study. Int J Clin Oncol, [Epub ahead of print].
- Junyangdikul P, Tanchotsrinon W, Chansaenroj J, et al (2013). Clinical prediction based on HPV DNA testing by hybrid capture 2 (HC2) in combination with liquid-based cytology (LBC). Asian Pac J Cancer Prev, 14, 903-7. https://doi.org/10.7314/APJCP.2013.14.2.903
- Kantathavorn N, Kietpeerakool C, Suprasert P, et al (2008). Clinical relevance of atypical squamous cells of undetermined significance by the 2001 Bethesda system: experience from a cervical cancer high incidence region. Asian Pac J Cancer Prev, 9, 785-8.
- Katki HA, Schiffman M, Castle PE, et al (2013). Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US Pap results. J Low Genit Tract Dis, 17, S36-42. https://doi.org/10.1097/LGT.0b013e3182854253
- Kelly RS, Patnick J, Kitchener HC, et al (2011). HPV testing as a triage for borderline or mild dyskaryosis on cervical cytology: results from the sentinel sites study. Br J Cancer, 105, 983-8. https://doi.org/10.1038/bjc.2011.326
- Kiatiyosnusorn R, Suprasert P, Srisomboon J, et al (2010). High-grade histologic lesions in women with low-grade squamous intraepithelial lesion cytology from a region of Thailand with a high incidence of cervical cancer. Int J Gynaecol Obstet, 110, 133-6. https://doi.org/10.1016/j.ijgo.2010.03.022
- Kiatpongsan S, Niruthisard S, Mutirangura A, et al (2006). Role of human papillomavirus DNA testing in management of women with atypical squamous cells of undetermined significance. Int J Gynecol Cancer, 16, 262-5. https://doi.org/10.1111/j.1525-1438.2006.00342.x
- Kietpeerakool C, Tangjitgamol S, Srisomboon J (2014). Histopathological outcomes of women with abnormal cervical cytology: a review of literature in Thailand. Asian Pac J Cancer Prev, 15, 6489-94. https://doi.org/10.7314/APJCP.2014.15.16.6489
- Laowahutanont P, Karalak A, Wongsena M, et al (2014). Prevalence of high risk human papillomavirus infection with different cervical cytological features among women undergoing health examination at the National Cancer Institute, Thailand. Asian Pac J Cancer Prev, 15, 5879-82. https://doi.org/10.7314/APJCP.2014.15.14.5879
- Li J, Huang R, Schmidt JE, et al (2013). Epidemiological features of human papillomavirus (HPV) infection among women living in Mainland China. Asian Pac J Cancer Prev, 14, 4015-23. https://doi.org/10.7314/APJCP.2013.14.7.4015
- Massad LS, Einstein MH, Huh WK, et al (2013). 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis, 17, 1-27.
- Ordi J, Sagasta A, Munmany M, et al (2014). Usefulness of p16/Ki67 immunostaining in the triage of women referred to colposcopy. Cancer Cytopathol, 122, 227-35. https://doi.org/10.1002/cncy.21366
- Persson M, Elfstrom KM, Brismar Wendel S, et al (2014). Triage of HR-HPV positive women with minor cytological abnormalities: a comparison of mRNA testing, HPV DNA testing, and repeat cytology using a 4-year follow-up of a population-based study. PLoS One, 9, 90023. https://doi.org/10.1371/journal.pone.0090023
- Poomtavorn Y, Suwannarurk K, Thaweekul Y, et al (2014). Diagnostic value of endocervical curettage for detecting dysplastic lesions in women with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou smears. Asian Pac J Cancer Prev, 15, 3461-4. https://doi.org/10.7314/APJCP.2014.15.8.3461
- Pothisuwan M, Pataradool K, Tangjitgamol S, et al (2011). Visual inspection with acetic acid for detection of high grade lesion in atypical squamous cells and low grade squamous intraepithelial lesions from cervical Pap smear. J Gynecol Oncol, 22, 145-51. https://doi.org/10.3802/jgo.2011.22.3.145
- Ronco G, Cuzick J, Segnan N, et al (2007). HPV triage for low grade (L-SIL) cytology is appropriate for women over 35 in mass cervical cancer screening using liquid based cytology. Eur J Cancer, 43, 476-80. https://doi.org/10.1016/j.ejca.2006.11.013
- Sargent A, Bailey A, Turner A, et al (2010). Optimal threshold for a positive hybrid capture 2 test for detection of human papillomavirus: data from the ARTISTIC trial. J Clin Microbiol, 48, 554-8. https://doi.org/10.1128/JCM.00896-09
- Sigurdsson K (2013). Is a liquid-based cytology more sensitive than a conventional Pap smear? Cytopathology, 24, 254-63. https://doi.org/10.1111/cyt.12037
- Siriaunkgul S, Settakorn J, Sukpan K, et al (2014). Population-based cervical cancer screening using high-risk HPV DNA test and liquid-based cytology in northern Thailand. Asian Pac J Cancer Prev, 15, 6837-42. https://doi.org/10.7314/APJCP.2014.15.16.6837
- Solomon D, Davey D, Kurman R, et al (2002). The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA, 287, 2114-9. https://doi.org/10.1001/jama.287.16.2114
- Tezcan S, Ozgur D, Ulger M, et al (2014). Human papillomavirus genotype distribution and E6/E7 oncogene expression in Turkish women with cervical cytological findings. Asian Pac J Cancer Prev, 15, 3997-4003. https://doi.org/10.7314/APJCP.2014.15.9.3997
- Verdoodt F, Szarewski A, Halfon P, et al (2013). Triage of women with minor abnormal cervical cytology: meta-analysis of the accuracy of an assay targeting messenger ribonucleic acid of 5 high-risk human papillomavirus types. Cancer Cytopathol, 121, 675-87. https://doi.org/10.1002/cncy.21325
- High performance of combined HPV testing and genotyping for HPV16/18/52/58 in triaging women with minor cervical cytological abnormalities in northern Thailand vol.88, pp.1, 2015, https://doi.org/10.1002/jmv.24290