• Asian Pacific Journal of Cancer Prevention
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• v.16 no.6
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• pp.2327-2331
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• 2015

Purpose: To determine the accuracy of visual inspection with acetic acid (VIA) in detecting high-grade cervical intraepithelial neoplasia (CIN) in pre- and post-menopausal women with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou (Pap) smears. Materials and Methods: Two hundred women (150 pre-menopausal and 50 post-menopausal) with ASC-US and LSIL cytology who attended the colposcopy clinic, Thammasat University Hospital, between March 2013 and August 2014 were included. All women underwent VIA testing and colposcopy by gynecologic oncologists. Diagnostic values of VIA testing including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting high-grade CIN were determined using the histopathology obtained from colposcopic-directed biopsy as a gold standard. Results: VIA testing was positive in 54/150 (36%) pre-menopausal women and 5/50 (10%) post-menopausal women. Out of 54 pre-menopausal women with positive VIA testing, 15 (27.8%) had high-grade CIN and 39 (72.2%) had either CIN 1 or insignificant pathology. Ten (10.4%), 43 (44.8%) and 43 (44.8%) out of the remaining 96 pre-menopausal women with negative VIA testing had high-grade CIN, CIN 1 and insignificant pathology, respectively. Out of 5 post-menopausal women with positive VIA testing, there were 4 (80%) women with high-grade CIN, and 1 (20%) women with insignificant pathology. Out of 45 VIA-negative post-menopausal women, 42 (93.3%) women had CIN 1 and insignificant pathology, and 3 (6.7%) had high-grade CIN. Sensitivity, specificity, PPV and NPV of the VIA testing were 59.4%, 76.2%, 32.2% and 90.8%, respectively (60%, 68.8%, 27.8% and 89.6% in pre-menopausal women and 57.1%, 97.7%, 80% and 93.3% in post-menopausal women). Conclusions: VIA testing may be used as a screening tool for detecting high-grade CIN in women with minor cervical cytological abnormalities in a low-resource setting in order to lower the rate of colposcopy referral.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.18
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• pp.8491-8494
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• 2016

Purpose: To compare unsatisfactory rates and detection of abnormal cervical cytology between conventional cytology or Papanicolaou smear (CC) and liquid-based cytology (LBC). Materials and Methods: A total of 23,030 cases of cervical cytology performed at King Chulalongkorn Memorial Hospital during 2012-2013 were reviewed. The percentage unsatisfactory and detection rates of abnormal cytology were compared between CC and LBC methods. Results: There was no difference in unsatisfactory rates between CC and LBC methods (0.1% vs. 0.1%, p = 0.84). The detection rate for squamous cell abnormalities was significantly higher with the LBC method (7.7% vs. 11.5%, p < 0.001), but those for overall abnormal glandular epithelium were similar (0.4% vs. 0.6%, p = 0.13). Low grade squamous lesion (ASC-US and LSIL) were more frequently detected by the LBC method (6.1% vs. 9.5%, p < 0.001). However, there was no difference in high gradd squamous lesions (1.1% vs. 1.1%, p = 0.95). When comparing between types of glandular abnormality, there was no significant difference the groups. Conclusions: There was no difference in unsatisfactory rates between the conventional smear and LBC. However, LBC could detect low grade squamous cell abnormalities more than CC, while there were similar rates of detection of high grade squamous cell lesions and glandular cell abnormalities.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.13
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• pp.5415-5420
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• 2015

Background: The present study was designed to ascertain knowledge about HPV, cervical cancer (CC) and the Pap test among female dental students of Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. Materials and Methods: A self-administered questionnaire covering demographic details, knowledge relating to human papilloma virus (HPV) (8 items), cervical cancer (4 items) and the Pap smear (6 items) was employed. Responses were coded as "True, False and Don't Know". Mean and standard deviation (SD) for correct answers and levels of knowledge were determined. Results: Based on the year of study, significant differences in knowledge of HPV werenoted for questions on symptoms (p=0.01); transmission from asymptomatic partners (p=0.002); treatment with antibiotics (p=0.002); start of sexual activity (p=0.004); and recommended age for HPV vaccination (p=0.01). For knowledge regarding CC, significance was observed for the age group being affected (p=0.008) and symptoms of the disease in early stages (p=0.001). Indications for Pap smear tests like symptoms' of vaginal discharge (p=0.002), marital status (p=0.01) and women with children (p=0.02) had significant difference based on the year of study. Based on religion, transmission of HPV via pregnancy, HPV related diseases except CC and preventive measures except condom use and oral contraceptives showed significant differences. However, significant variation with religion was observed only for two preventive measures of CC (Pap test; p=0.004) and HPV vaccination (p=0.003). Likewise, only the frequency of Pap test showed a significant difference for religion (p=0.001). Conclusions: This study emphasizes the lack of awareness with regard to HPV, CC and screening with pap smear even among health professionals. Hence, regular health campaigns are essential to reduce the disease burden.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.8
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• pp.3527-3531
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• 2015

Background: Serbia is one of the countries with highest incidence and mortality rates for cervical cancer in Central and South Eastern Europe. Introducing a risk index could provide a powerful means for targeting groups at high likelihood of having an abnormal cervical smear and increase efficiency of screening. The aim of the present study was to create and assess validity ofa index for prediction of an abnormal Pap test result. Materials and Methods: The study population was drawn from patients attending Departments for Women's Health in two primary health care centers in Serbia. Out of 525 respondents 350 were randomly selected and data obtained from them were used as the index creation dataset. Data obtained from the remaining 175 were used as an index validation data set. Results: Age at first intercourse under 18, more than 4 sexual partners, history of STD and multiparity were attributed statistical weights 16, 15, 14 and 13, respectively. The distribution of index scores in index-creation data set showed that most respondents had a score 0 (54.9%). In the index-creation dataset mean index score was 10.3 (SD-13.8), and in the validation dataset the mean was 9.1 (SD=13.2). Conclusions: The advantage of such scoring system is that it is simple, consisting of only four elements, so it could be applied to identify women with high risk for cervical cancer that would be referred for further examination.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.24
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• pp.10809-10812
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• 2015

Background: Human papillomavirus (HPV) DNA testing is an effective method to screen for precancerous changes in the cervix. Samples from self-collection rather than Pap smear can potentially be used to test for HPV as they are more acceptable and preferred for use in certain settings. The objective of this study was to compare HPV DNA testing from self-collected vaginal swabs and physician-collected cervical swabs. Materials and Methods: A total of 101 self-collected vaginal and physician-collected cervical swabs of known cytology from Thai women were tested by electrochemical DNA chip assay. The specimens were divided into 4 groups: 29 with normal cytology, 14 with atypical squamous cells of undetermined significance (ASCUS), 48 with low-grade squamous intraepithelial lesion (LSIL), and 10 with high-grade squamous intraepithelial lesion (HSIL). Results: Positive detection rates of HPV from self-collected swabs were similar to those from physician-collected swabs. Among specimens with abnormal cytology, HPV was found in 50% of self-collected swabs and 47.2% of physician-collected swabs. In specimens with normal cytology, 17.2% of self-collected swabs and 24.1% of physician-collected swabs were positive for HPV. Concordance was relatively high between results from self-collected and physician-collected samples. The most common HPV genotype detected was HPV 51. Conclusions: HPV DNA testing using self-collected swabs is a feasible alternative to encourage and increase screening for cervical cancer in a population who might otherwise avoid this important preventive examination due to embarrassment, discomfort, and anxiety.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.12
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• pp.5223-5227
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• 2016

Background: Cervical cancer is the second most common cancer among women in many populations. While the Pap smear is a well established screening test it suffers from both false-positive and false-negative results in diagnosis of cancers and precancerous states. In this study, immunocytochemistry of the P16 biomarker and HPV-PCR were compared for their diagnostic potential. Materials and methods: In the study, we obtained pairs of specimens from 45 women with cervical dysplasia. One sample was placed in a liquid-based solution, and processed for staining of sections with antibodies to P16. HPV-PCR was performed on the other and the results obtained were analyzed by T-test using SPSS v. 15. Results: Using HPV-PCR 71% of the samples were found to be infected with either HPV 16 or HPV 18, and the rate of infection did not have a statistically significant relationship with higher grades of dysplasia (p= 0.253). In contrast, with immunocytochemistry evaluation of P16, 64% of the specimens were positive, but the percentage of positive results significantly increased with higher grades of dysplasia (p= 0.0001). Conclusion: Employment of the P16 marker as an optional test might be preferable over HPV-PCR for cervical dysplasia in our geographical region.

• Korean Journal of Community Nutrition
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• v.28 no.1
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• pp.61-73
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• 2023

Objectives: Prophylactic vaccines against high-risk human papillomaviruses (HR-HPVs) hold promise to prevent the development of higher grade cervical intraepithelial neoplasia (CIN 2+) and cervical cancer (CC) that develop due to HR-HPV genotypes that are included in HPV vaccines, but women will continue to develop CIN 2+ and CC due to HR-HPV genotypes that are not included in the quadrivalent HPV vaccine (qHPV) and 9-valent HPV vaccine (9VHPV). Thus, the current vaccines are likely to decrease but not entirely prevent the development of CIN 2+ or CC. The purpose of the study was to determine the prevalence and determinants of CIN 2+ that develop due to HR-HPVs not included in vaccines. Methods: Study population consisted of 1476 women tested for 37 HPVs and known to be negative for qHPVs (6/11/16/18, group A, n = 811) or 9VHPVs (6/11/16/18/31/33/45/52/58, group B, n = 331), but positive for other HR-HPVs. Regression models were used to determine the association between plasma concentrations of micronutrients, socio-demographic, lifestyle factors and risk of CIN 2+ due to HR-HPVs that are not included in vaccines. Results: The prevalence of infections with HPV 31, 33, 35 and 58 that contributed to CIN 2+ differed by race. In group A, African American (AA) women and current smokers were more likely to have CIN 2 (OR = 1.76, P = 0.032 and 1.79, P = 0.016, respectively) while in both groups of A and B, those with higher vitamin B12 were less likely to have similar lesions (OR = 0.62, P = 0.036 and 0.45, P = 0.035, respectively). Conclusions: We identified vitamin B12 status and smoking as independent modifiable factors and ethnicity as a factor that needs attention to reduce the risk of developing CIN 2+ in the post vaccination era. Continuation of tailored screening programs combined with non-vaccine-based approaches are needed to manage the residual risk of developing HPV-related CIN 2+ and CC in vaccinated women.

• Journal of Microbiology and Biotechnology
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• v.33 no.8
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• pp.1091-1100
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• 2023

Human papillomavirus (HPV) types 16 and 18 are the major causes of cervical lesions and are associated with 71% of cervical cancer cases globally. However, public health infrastructures to support cervical cancer screening may be unavailable to women in low-resource areas. Therefore, sensitive, convenient, and cost-efficient diagnostic methods are required for the detection of HPV16/18. Here, we designed two novel methods, real-time ERA and ERA-LFD, based on enzymatic recombinase amplification (ERA) for quick point-of-care identification of the HPV E6/E7 genes. The entire detection process could be completed within 25 min at a constant low temperature (35-43℃), and the results of the combined methods could be present as the amplification curves or the bands presented on dipsticks and directly interpreted with the naked eye. The ERA assays evaluated using standard plasmids carrying the E6/E7 genes and clinical samples exhibited excellent specificity, as no cross-reaction with other common HPV types was observed. The detection limits of our ERA assays were 10⁰ and 10¹ copies/µl for HPV16 and 18 respectively, which were comparable to those of the real-time PCR assay. Assessment of the clinical performance of the ERA assays using 114 cervical tissue samples demonstrated that they are highly consistent with real-time PCR, the gold standard for HPV detection. This study demonstrated that ERA-based assays possess excellent sensitivity, specificity, and repeatability for HPV16 and HPV18 detection with great potential to become robust diagnostic tools in local hospitals and field studies.

• Biomedical Science Letters
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• v.29 no.3
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• pp.144-151
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• 2023

A Pap smear is the most important screening test for the diagnosis of cervical cancer. However, subjective judgment by the operator cannot be excluded, and replicability may greatly be reduced if uncertain specimens are examined. Examiners often experience difficulties in differentiating atrophy with inflammatory changes and ASCUS when diagnosing squamous epithelial lesions from a pap smear. Reports often vary between cytologists and pathologists, and misdiagnosis may result in delayed follow-ups and advanced diseases. Hence, auxiliary examinations are necessary when confusing results between atrophy and ASCUS are obtained. The importance of p16^INK4a activation due to HPV infection, which is an important factor in the outbreak of cervical cancer, has been highlighted. Recent studies have reported that p16^INK4a immunocytochemical staining and HPV high-risk type tests using liquid-based cervical specimens are effective to detect the presence of lesions of grade HSIL or higher in patients with ASC-H. However, no research exists on the utility of HPV and p16^INK4a tests on the differential diagnosis of atrophy and ASCUS. This study focused on whether p16^INK4a immunocytochemical staining and HPV tests can help diagnose borderline lesions between atrophy and ASCUS. The results reported that p16^INK4a activation can significantly (P<0.001) differentiate atrophy from ASCUS in atrophic lesions infected with High risk-HPV. Therefore, it may be concluded that p16^INK4a immunocytochemical staining is an effective auxiliary test in lesions infected with HR-HPV when atrophic lesions are difficult to differentiate by morphology. Such results are expected to help decide on adequate follow-up and treatment.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.17
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• pp.7437-7441
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• 2014

Background: Acceptability of self-sampling HPV testing is confirmed worldwide. However, some cultural differences may affect this question. Therefore, this study was conducted to evaluate the acceptability of self-sampling HPV testing in Thai women. Materials and Methods: One hundred women aged 30-65 years with an intact cervix were included in this study. The participants were asked to do the Pap test by physicians and then brush type self-sampling instruments were assigned for self-collection and finally completed a questionnaire for acceptability evaluation. The questionnaire contains 2 parts. Part one covered general information of the participants and part two is the acceptability questions. Results: Mean age was 40.6 years. The incidence of high risk HPV detection in this study was 16%. The most common reason for doing Pap smear was for annual checkup. On the topic of ease of use, 85 % of the subjects agreed. Most of the participants (82%) reported that they felt less pain. However, reliability of the result was not satisfactory because 37% of the participants hesitated to rely on the results of the test. According to the price, if the price is less than 1,000 Baht (32.59 Baht = 1USD), 82% of the subjects would use it for their next screening. Conclusions: The acceptability of self-sampling device in this study is quite good but the reliability of the test was questioned by some of the participants. Moreover, the price of the test in Thailand may also influence the acceptability of the test.