Evaluation of high-risk human papillomavirus types PCR detection in paired urine and cervical samples of women with abnormal cytology
Introduction
Cevical cancer is strongly associated with infection by certain human papillomavirus (HPV) types. A yearly pelvic exam and Pap smear are recommended to look for cervical atypia, probably due to infection by high-risk HPV types. However, the majority of HPV infections might be undetectable by Pap test (Meisels, 1983). Also, histological diagnosis of HPV infection has certain limitations and do not correlate completely with viral detection by molecular assays (Salvia et al., 2004).
The drawbacks of Pap testing prompted the need for screening techniques that detect HPV DNA independently of cervical cytology, using cervical sampling and HPV DNA detection. However, this examination is impractical in some settings, considering that a gynaecological examination is required. Moreover, physician-obtained cervical sampling is considered uncomfortable, time-consuming and requires a degree of skill (Mandelblatt et al., 2002). Therefore, screening procedures based on self-sampling of urine, vulvar or vaginal samples for the detection of HPV DNA have been investigated (Brinkman et al., 2004, Sellors et al., 2000).
Urine testing for HPV has been previously examined in women at risk for disease (Brinkman et al., 2004, Forslund et al., 1993, Jacobson et al., 2000; Sellors et al., 2000, Strauss et al., 1999), as well as in women diagnosed with cervical cancer (Stanczuk et al., 2003, Vossler et al., 1995). However, the results vary due to differing methods and perhaps due to differences in studied populations. Recently, an optimization of methods to detect HPV in urine by PCR resulted in a modified protocol (Brinkman et al., 2004). This protocol, was evaluated in urine from women with abnormal cervical cytology.
Section snippets
Study population
Urine and cervical specimens (paired samples) were collected from 100 HIV-negative consecutive women referred with abnormal cervical cytology (atypical squamous epithelial cells of unknown significance [ASCUS] or worse) and normal urine parameters (acidic pH, non-detection of white blood cells, nitrites, proteins, crystals, and blood). All study participants were informed for the research purposes of the sampling by a specialist research nurse and gave their informed consent. The study was
Patient's characteristics
Histological examination revealed invasive cervical cancer in 9, high-grade intraepithelial lesions in 29, low-grade lesions 39, and various non-pre-malignant lesions in 23 women (Table 1).
HPV prevalence in urine and cervical samples
Cervical samples were tested positive for the oncogenic HPV types 16 or 18 in 37 of the 77 (48.1%) (95% CI 36.5–59.7%) women that proved to have a pre-malignant or malignant lesion by histology, while urine samples were positive in 26 (33.8%) (95% CI 23.4–45.4%) of these cases. This difference was not
Discussion
Many HPV types may contribute to the cervical carcinogenesis, with types 16 and 18, being considered among the most important ones (Lukaszuk et al., 2003). This is the reason for focusing on HPV 16 and 18.
In the literature, several studies have tested HPV in urine (Brinkman et al., 2004, Jacobson et al., 2000; Stanczuk et al., 2003, Strauss et al., 1999, Vossler et al., 1995). Urine HPV sampling for carcinogenic types was previously shown to be applicable to women attending a colposcopy clinic
Acknowledgements
The study was sponsored by the Procter & Gamble Papanikolaou award for the year 2004. We thankfully acknowledge the technical assistance of the laboratory technician Ioulia Kristo and the midwife Chrysa Kratsagoni.
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2019, Journal of Virological MethodsCitation Excerpt :Using PCR, (Forslund et al. (1993)) reported HR-HPV DNA in 49% of cervical samples compared to 38% in urine and Sellors et al. reported a comparison of 62.5% in cervical swabs to 34.5% in urines (Sellors et al., 2000) regardless of cytological status. ( Daponte et al. (2006)) found higher HR-HPV DNA rates related to cervical cytology severity and higher infection rates in cervical samples than in urine for LSIL (28.2% vs 12.8%), HSIL (58.6% vs 44.8%) and cancer (100% vs 88.9%). Using the Aptima mRNA assay showed similar trends between cervical samples and untreated urine related to cervical abnormalities (Table 3).
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