用聚合酶链反应技术对妊娠期HPV母婴间垂直感染的…

本文应用ＰＣＲ技术对妊娠期和分泌期间ＨＰＶ母婴垂直传播的可能性进行研究，于妊娠晚期收集合并尖锐湿疣孕妇的脱落宫颈细胞，病灶组织和静脉血，于分娩时收集羊水，新生儿咽分泌物和脐带血，应用ＰＣＲ方法检测ＨＰＶ－ＤＮＡ的存在，结果：孕妇宫颈细胞和病灶７３．３％ＨＰＶ阳性，９例羊水或新生儿口咽分泌物ＨＰＶ阳性，３例母亲静脉血ＨＰＶ阳性，这３例阳性的母亲中２例新生儿脐血ＨＰＶ阳性，１例可疑阳性，提示；妊娠期间     

应用计算机辅助细胞检测系统检测子宫颈涂片中人乳头状瘤病毒感染

目的评价计算机辅助细胞检测（ｃｏｍｐｕｔｅｒａｓｉｓｔｅｄｃｙｔｏｌｏｇｉｃｔｅｓｔ,ＣＣＴ）系统检测宫颈涂片中人乳头状瘤病毒（ｈｕｍａｎｐａｐｉｌｏｍａｖｉｒｕｓ,ＨＰＶ）感染的敏感性与准确性。方法对１５８例外阴尖锐湿疣患者的子宫颈涂片,采用ＣＣＴ检测技术进行细胞病理学诊断,其诊断标准依据ＴｈｅＢｅｔｈｅｓｄａＳｙｓｔｅｍ（ＴＢＳ）分类法。同期行阴道镜指引下的子宫颈活组织检查和聚合酶链反应（ＰＣＲ）技术检测宫颈拭子中的ＨＰＶＤＮＡ。结果ＣＣＴ诊断宫颈ＨＰＶ感染的敏感性：与组织学检查对照,为７４６２％;与ＰＣＲ检测对照,为６９１１％。准确性：与组织学检查对照,为６７７２％;与ＰＣＲ检测对照,为７０８８％。结论ＣＣＴ作为一种细胞病理学检测技术,用于诊断宫颈ＨＰＶ感染或亚临床感染,有临床应用价值     

新疆维吾尔族妇女子宫颈癌活检组织中人类乳头状瘤病毒DNA的检测

目的：研究我国宫颈癌高发区新疆维吾尔族妇女宫颈癌与人类乳头状瘤病毒（ＨＰＶ）感染的关系。方法：对６５例新疆维吾尔族妇女的宫颈癌活检组织标本，应用原位杂交法检测ＨＰＶ６／１１、１６／１８和３１／３３／３５ＤＮＡ；Ｌ１共有序列引物聚合酶链反应（ＰＣＲ）及Ｅ６特异型引物ＰＣＲ检测其中的５８例ＨＰＶ６、１６和１８ＤＮＡ。结果：６５例宫颈癌患者中，原位杂交法检测ＨＰＶＤＮＡ有２８例阳性（４３．１％）；Ｌ１ＰＣＲ和Ｅ６ＰＣＲ检测ＨＰＶＤＮＡ阳性分别为１３例（２２．４％）和４５例（７７．６％）。结论：对宫颈癌标本中的ＨＰＶＤＮＡ检测，Ｅ６特异性引物ＰＣＲ敏感性最高，Ｌ１ＰＣＲ及原位杂交相对较低。新疆维吾尔族妇女宫颈癌发病与ＨＰＶ感染有密切关系。     

子宫颈癌p53抑癌基因突变与病毒感染的研究

采用聚合酶链反应－单链构象多态性分析（ＰＣＲ－ＳＳＣＰ）、多重引物ＰＣＲ和巢式引物ＰＣＲ，对同一宫颈癌组织中ｐ５３基因（第６～８外显子）突变以及人乳头状瘤病毒（ＨＰＶ）和人巨细胞病毒（ＨＣＭＶ）感染进行相关性研究。并与正常宫颈组织进行对照。结果：３８例宫颈癌组中，２例有ｐ５３第７外显子突变。其中１例伴有ＨＰＶ１６感染，２例伴有ＨＣＭＶ感染。宫颈癌组ＨＰＶＩ６、１８ＤＮＡ的阳性率为６３．２％（２４／３８），ＨＣＭＶＤＮＡ为８４．２％（３２／３８）。２１例对照组中，ＨＰＶ１６、１８ＤＮＡ和ＨＣＭＶＤＮＡ的阳性率分别为４．８％和３８．１％（Ｐ＜０．００５）。ＨＰＶ１６、１８阳性的子宫颈癌中，８７．５％伴有ＨＣＭＶ感染。对照组中，无一例同时检测出ＨＰＶ１６、１８和ＨＣＭＶ者。提示：宫颈癌组织中，ｐ５３基因突变并不常见，其突变与ＨＰＶ１６、１８感染无显著关系。宫颈癌与ＨＰＶ１６、１８关系密切，ＨＣＭＶ可能与ＨＰＶ协同作用，导致宫颈癌的发生。     

人乳头状瘤病毒感染对孕妇和绒毛滋养细胞的影响

目的 探讨人乳头瘤病毒（ＨＰＶ）感染对孕妇和绒毛滋养细胞铁影响。方法 观察６２例早、中期孕妇尖锐湿疣的病理形态特点,用ＨＰＶ６／１１－ＤＮＡ探针原位杂交法检测其绒毛、胎盘组织及其中１０例外阴、阴道、宫颈尖锐湿疣组织,并用ＨＰＶ６／１１聚合酶链反应（ＰＣＲ）方法验证１０例绒毛及胎盘组织。结果 孕期尖锐湿疣病变发展快,多部位发生比例高,大体形态、组织形态典型者多。ＨＰＶ６／１１－ＤＮＡ原位杂交和ＰＣＲ     

非典型尖锐湿疣HPV—DNA分型与临床病理分析

探讨非典型尖锐湿疣例乳头状瘤病毒感染及其临床病理特点。方法采用ＰＣＲ法检测了４０例临床疑诊为ＨＰＶ感染患者外阴湿疣组织中ＨＰＶ－ＤＮＡ类型。结论非典型尖锐湿疣存在不同类型的ＨＰＶ感染,以ＨＰＶ６、１１型感染为主,ＨＰＶ－ＤＮＡ的检测有肋于正确判断尖湿疣和假性尖锐湿疣。     

子宫颈鳞癌组织中人乳头状瘤病毒E7蛋白与Rb基因产物的关系

目的：检测子宫颈鳞癌组织中是否存在人乳头状瘤病毒（ＨＰＶ）Ｅ７蛋白与Ｒｂ基因产物（ｐＲｂ）的结合物（ＨＰＶＥ７－ｐＲｂ）。方法：运用聚合酶链反应（ＰＣＲ）技术，对４０例宫颈鳞癌组织中ＨＰＶ６／１１、１６、１８、３３型ＤＮＡ进行检测，并用捕获酶联免疫吸附试验，探查ＨＰＶ感染的标本中有否ＨＰＶＥ７－ｐＲｂ存在。结果：４０例中，检出ＨＰＶＤＮＡ１８例（４５．０％）。１８例中９例存在ＨＰＶＥ７－ｐＲｂ，其中１例为ＨＰＶ１８，８例为ＨＰＶ１６。２例ＨＰＶ６／１１未检出ＨＰＶＥ７－ｐＲｂ。临床Ⅰ期患者ＨＰＶＥ７－ｐＲｂ的检出率高于Ⅱ～Ⅳ期患者（Ｐ＜０．０５）。ＨＰＶＥ７与ｐＲｂ的结合，与宫颈癌病理分级无关（Ｐ＞０．０５）。结论：在宫颈鳞癌组织中存在ＨＰＶＥ７－ｐＲｂ；ＨＰＶＥ７与ｐＲｂ的结合过程发生在宫颈癌变的较早阶段。     

应用聚合酶链反应技术测定正常子宫颈组织人乳头瘤病毒DNA的研究

应用兼并复合人乳头瘤病毒一聚合酶链反应（ＨＰＶ－ＰＣＲ）技术对１４８例外观正常的子宫颈分泌物拭子标本进行人乳头瘤病毒（ＨＰＶ）ＤＮＡ的测定。结果：正常子宫颈ＨＰＶＤＮＡ检出率为３１７６％（４７／１４８）。其中ＨＰＶ－６，１１型为６．７６％（１０／１４８）；ＨＰＶ－１６，１８型为３．３８％（５／１４８）；ＨＰＶ其它型为２１．６２％（３２／１４８）。外观正常的子宫颈，ＨＰＶ感染的主要易感年龄为２２～３４岁的青年妇女。本研究对女性生殖道ＨＰＶ感染的传播途径进行了探讨。     

外阴尖锐湿疣患者子宫颈人乳头瘤病毒感染的检测

从３６例外阴尖锐湿疣患者中取宫颈活检３２例进行检测，以诊断是否同时伴有宫颈人乳头瘤病毒（ＨＰＶ）感染。结果：临床肉眼诊断宫颈ＨＰＶ感染６例（１６％）；阴道镜诊断２５例（６９％）；病理诊断１８例（５６％），其中合并宫颈上皮内瘤变（ＣＩＮ）Ⅰ～Ⅱ级１０例（３１％）。９例同时取外阴、宫颈标本，进行印迹杂交、斑点杂交和多聚酶链反应检测，外阴标本中ＨＰＶＤＮＡ阳性７例（７／９）；宫颈标本ＨＰＶＤＮＡ阳性７例（７／８）。提示：外阴尖锐湿疣患者官颈ＨＰＶ感染相当常见；借助阴道镜取宫颈活检是诊断宫颈ＨＰＶ感染的最佳方法，并可以此发现合并ＣＩＮ的高危妇女。     

应用聚合酶链反应和酶联免疫吸附试验检测孕妇和胎儿巨细胞病毒感染的研究

目的探讨酶联免疫吸附试验（ＥＬＩＳＡ）和聚合酶链反应（ＰＣＲ）两种方法对孕妇和胎儿人巨细胞病毒（ｈｕｍａｎｃｙｔｏｍｅｇａｌｏｖｉｒｕｓ，ＨＣＭＶ）感染的临床诊断价值。方法１８８１例孕妇用ＥＬＩＳＡ检测血清ＨＣＭＶ－ＩｇＭ，其中６５６例同时用ＰＣＲ检测血ＨＣＭＶＤＮＡ。９９例感染孕妇和４７例非感染孕妇的胎儿同样应用ＥＬＩＳＡ和ＰＣＲ法检测。结果本组孕妇血清ＨＣＭＶ－ＩｇＭ阳性率为２．４％，血ＨＣＭＶＤＮＡ阳性率为１２．０％。感染孕妇的胎儿血ＨＣＭＶ－ＩｇＭ和（或）ＨＣＭＶＤＮＡ阳性率为１７．２％。ＨＣＭＶ－ＩｇＭ、ＨＣＭＶＤＮＡ单项阳性或合并阳性的孕妇宫内传播率分别为１８．５％、１４．８％、２７．３％。ＥＬＩＳＡ和ＰＣＲ同时检测６５６例孕妇和１４６例胎儿血，结果显示有相关性。ＰＣＲ检测阳性率显著高于ＥＬＩＳＡ检测阳性率。结论ＥＬＩＳＡ与ＰＣＲ同时检测可提高对孕妇和胎儿ＨＣＭＶ感染的诊断率。     

Prevalence of human papilloma virus infection of the uterine cervix in women with abnormal cervical cytology

PURPOSE OF INVESTIGATION: To determine the prevalence of human papillomavirus (HPV) using polymerase chain reaction (PCR) in women with abnormal cytology results. METHODS: A prospective study of 215 women with abnormal cytology results referred consecutively to the cervical pathology clinic was carried out. A second cervical cytology using the Bethesda System was performed on all the patients to confirm the initial diagnosis, as well as to test for the presence of HPV by PCR and a colposcopy and punch biopsy in cases presenting with an abnormal pattern on colposcopy. The sensivitiy, specificity, and positive and negative predictive value (PPV and NPV) were calculated using 2 x 2 tables. RESULTS: The women aged 35 years or younger presented a higher percentage of HPV infection (85.6%) than the women over 35 years of age (54%). The highest percentage of women with a positive result for HPV was found in those with a cytological high-grade squamous intraepithelial lesion (HSIL) (85.5%), as compared with 47.4% of the women with a cytological low-grade squamous intraepithelial lesion (LSIL). HPV infection has a high negative predictive value (93.2% of cases) and a high sensitivity (93.5%) for the detection of HSIL by biopsy, although the specificity and positive predictive value were low, 51.5% and 52.1%, respectively. CONCLUSION: Patients with cytological HSIL have a high prevalence of HPV infection.     

An analysis of high-risk human papillomavirus DNA-negative cervical precancers in the ASCUS-LSIL Triage Study (ALTS)

OBJECTIVE: To describe women diagnosed with cervical intraepithelial neoplasia-grade 3 (CIN-3) diagnosed over the 2-year duration of the atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) Triage Study (ALTS) that tested negative for high-risk human papillomavirus (HPV) at enrollment. METHODS: Clinical center pathologists and quality control pathology group reviewed all histology; any CIN-3 diagnosis on biopsy or loop electrosurgical excision procedure (n=621) by at least one pathology review over the duration of ALTS led to inclusion in this analysis. Enrollment cervical specimens were tested for high-risk HPV DNA by two HPV assays; results were combined to minimize simple testing errors. We compared the characteristics of baseline high-risk HPV-negative (n=33) to baseline high-risk HPV-positive (n=588) cumulative diagnosed CIN-3. RESULTS: High-risk HPV-negative CIN-3 cases were less likely to have a second, confirming diagnosis of CIN-3 (24% compared with 56%) by the other pathology group, were more likely to be diagnosed later in follow-up, and more likely to be referred into ALTS because of an ASCUS Pap test rather than an LSIL Pap. Upon review of case histories of the 33 baseline high-risk HPV-negative CIN-3 (5.3% of all cases), there was evidence that these cases were due to incident (new) cases (n=12, 1.9%), non-high-risk HPV (n=5, 0.8%), misclassified histology (n=8, 1.3%), and false-negative high-risk HPV (n=8, 1.3%). CONCLUSION: In any sizeable population, even among women with evidence of cytologic abnormalities, there will be a few cases of cervical precancer that will test high-risk HPV negative for one or more reasons.     

Significance of HPV tests on women with cervical smears showing ASCUS

BACKGROUND: The relationship between the human papillomavirus (HPV) tests and the cytological findings was evaluated. METHODS: Totally, 161 women participating in the organized cytological screening in the County of Uppsala and showing atypical squamous cells of uncertain significance (ASCUS) in their cervical smears were identified during 2002 and 2003. Those women were invited for a repeated examination about 3 months later. At that occasion, a smear sample was collected and used for cytological examination and a concomitant HPV test. Oncogenic HPV was identified by polymerase chain reaction and HPV deoxyribonucleoside acid (DNA) sequence analysis in 50 cases and by Hybrid Capture II in 111 cases. RESULTS: Women with an ASCUS diagnosis showed a normal cytology and a negative HPV test in 30% of the cases, abnormal cytology and a positive HPV test in 32% of the cases; in 26% of the women, the HPV test was positive, whereas cytology was normal; and in 11% of the women, the HPV test was negative, whereas cytology was abnormal (ASCUS or more). CONCLUSION: The results show that HPV tests identify a larger group of women at risk to develop cervical cancer in comparison with cytological examination. As the HPV tests have a higher sensitivity than the cytological screening, it is suggested that an HPV test in conjunction with a diagnosis of ASCUS can be employed to more efficiently select women, to whom further follow up is recommended.     

HPV detection and genotyping as an earlier approach in cervical cancer screening of the female genital tract

Human papillomavirus (HPV) infection is the leading risk factor for cervical intraepithelial neoplasia (CIN) and cervical cancer. More than 100 virus genotypes have been identified so far, some of them strongly associated with the development of neoplasia. The aim of this study was to evaluate the prevalence of the different HPV genotypes in women presenting no cytological alterations in cervical cells, in women presenting light alterations, and in women presenting severe alterations at routine gynecological examination. We retrospectively analyzed 97 HPV results of women submitted to cervical cancer screening compared to their Papanicolaou and colposcopy examinations. Data were analyzed individually and within groups to correlate the HPV genotypes identified by polymerase chain reaction (PCR) and the respective alterations in cervical cells. Among the nine cases diagnosed as CIN I (9.3%), two were positive for low-risk HPV genotypes (22%), and the other seven were negative for HPV by PCR (78%). CIN II or CIN III diagnoses were associated with positive HPV results by PCR in four cases (36%), for high-risk as well as low-risk genotypes. There were two patients with severe cytological alterations in cervical cells, but with an indeterminate HPV genotype (18%), and one case with a negative HPV result (9%). Among the 57 cases without cytological alterations, seven were positive for low-risk HPV (12%) and two for high-risk HPV genotypes (3.5%). In the 48 remaining cases, we observed one with an indeterminate HPV genotype (2%), and the other 47 were negative for HPV by PCR (47%). Our study demonstrates an important prevalence of high- and low-risk HPV genotypes in our population, including those not present in the commercially available vaccine, even in patients with no evidence of cytological alterations in cervical cells. These results highlight the usefulness of HPV detection and typing as an early approach for cervical cancer screening and prevention.     

LEEP术对绝经后妇女高级别宫颈上皮内瘤变的诊治

目的:探讨绝经后妇女高级别宫颈上皮内瘤变行宫颈环形电切术(LEEP)诊治的临床价值。方法:选择2017年2月-2018年12月于北京妇产医院妇科微创中心因宫颈高级别鳞状上皮内病变(HSIL)行LEEP术的患者共142例,其中绝经组40例,未绝经组102例。收集2组患者的液基薄层细胞学检查(TCT)、高危型人乳头瘤病毒(HPV)检测、阴道镜检查及其活检病理结果、LEEP术后病理结果、切缘病变情况,并将上述检查结果进行组间比较。结果:2组患者阴道镜下宫颈转化区类型比较,差异有统计学意义(χ~2=28.658,P=0.000)。绝经组阴道镜活检与LEEP术后病理符合率为50.00%(20/40),未绝经组符合率为51.96%(53/102),2组差异无统计学意义(χ~2=0.044,P=0.854)。绝经组1例LEEP术后病理升级为宫颈癌,未绝经组1例LEEP术后病理升级为原位腺癌。绝经组术后病理切缘阳性8例(20.00%),未绝经组术后病理切缘阳性16例(15.69%),2组比较差异无统计学意义(χ~2=0.381,P=0.537)。2组患者术后TCT检查比较及高危型HPV感染情况比较,差异均无统计学意义(均P>0.05)。结论:LEEP手术适用于宫颈无明显萎缩的绝经后妇女高级别宫颈上皮内瘤变的诊治,以避免对宫颈病变的漏诊和过度治疗。     

10年宫颈腺癌住院患者发病趋势及临床特点分析

目的:探讨10年来宫颈腺癌住院患者发病趋势及临床特点。方法:2006年1月至2016年5月北京大学第一医院确诊为宫颈腺癌并符合研究标准的住院患者99例,回顾性分析诊断途径、肿瘤分期及细胞学、病毒筛查情况等临床特点。结果:(1)近10年腺癌的发病比例呈现上升的趋势,不同时期宫颈腺癌临床分期差异有统计学意义(P0.05)。(2)宫颈腺癌排在前3位的临床症状为阴道不规则流血、性生活后阴道流血、阴道分泌物异常,分别占37.37%(37例)、34.34%(34例)和8.08%(8例)。症状就诊组与体检就诊组比较后发现,宫颈腺癌临床分期、肿块直径、肌层浸润程度差异有统计学意义(P0.05),而分化程度、病理类型、淋巴结转移、手术切缘等比较差异无统计学意义(P0.05)。(3)宫颈腺癌细胞学筛查仍以鳞状细胞改变为主(42.19%),HPV检测中最常见型别为HPV18,占36.21%(21/58),17例(29.31%)HPV检测阴性。HPV阴性患者与阳性患者比较,宫颈腺癌肿块直径、肌层浸润及脉管癌栓差异有统计学意义(P0.05),而发病年龄、病理类型、分化程度、临床分期、手术切缘及淋巴结转移比较差异无统计学意义(P0.05)。结论:宫颈腺癌发生率逐年上升,但部分宫颈腺癌患者在筛查中表现为细胞学及HPV阴性,容易被漏诊,应提高对宫颈腺癌患者筛查的关注。     

Human papillomavirus (HPV) DNA detection in self-collected urine

OBJECTIVE: Non-invasive sampling of human genitals to identify high-risk individuals with subclinical oncogenic HPV infection remains a challenge. The study was designed to see if self-collected urine can be used as a simple, non-invasive sampling for screening HPV, particularly for screening/monitoring general population or young adolescents or infants, if they are to be immunized by HPV vaccines. METHOD: Self-collected urine samples from 100 sexually unexposed college going girls and cervical scrapes from 104 normal healthy sexually active married women were used in this study. Additionally, a group of 55 women were recruited for collecting first urine and later scraped cervical cells to validate urine sampling by directly comparing HPV positivity between the two types of biological specimens. A dry 'paper smear' method for specimen collection and a simple single tube protocol was employed for PCR detection of HPV infection. RESULTS: Out of 100 sexually inexperienced college going girls, only 6 (6%) were positive for HPV infection as revealed by L1 consensus primer and 4 (4%) of them were positive for HPV 16 but none was found positive for HPV 18 DNA. Out of 104 sexually active married women who were cytologically reported as negative by Pap test, 11 (10.5%) were found HPV positive and 7 (6.7%) of them had infection of high-risk HPV type 16. Both urine and later cervical scrapes from a group of 55 women collected as dry 'paper smear' showed perfect matching positivity for HPV between urine and cervical scrape. CONCLUSIONS: The use of urine coupled with its dry collection as 'paper smear' facilitating their easy transport, storage and direct PCR detection of HPV DNA opens up an alternative non-invasive approach for population screening of HPV infection, at least in such cases as children and infants in whom invasive samples are difficult to obtain.     

HPV infection in etiology of uterine cervix cancer

Uterine cervical cancer may be the direct result of persistent HPV infection. The DNA analysis shows over 200 HPV types. The natural history of uterine cervix cancer is a constantly progressing process, from low pathology changes, through medium to major pathology changes, including microinvasion and invasive carcinoma. The population studies show that over 20% of women at the moment of examination is infected with HPV. The study of cervical cancer tissue revealed the HPV in the DNA, whereas the serological study revealed the presence of specific antibodies to HPV capsid antigens in most women (in USA the number amounts up to 70%). The serological conversion after HPV infection is not a common process. Therefore, the naturally infected women, still do not have enough antibodies and they are at the risk of infection, just as seronegative women. The vaccination of women between the ages of 15 and 25, causes the increase of the number of antibodies, several times higher than in the case of naturally acquired ones. The positive results of HPV examination is not a contraindication to vaccination. However, in case of vaccinated women, the negative test for 14 oncogenic HPV types has an overwhelmingly negative predictive value. Independent of the presence or absence of HPV infection, it is essential to continue cytological. The vaccination does not protect patients from all oncogenic HPV types. Cytological screening enables doctors to recognize cervical pathology at the early stage and introduce a proper treatment.     

Increased frequency of genital human papillomavirus infection in human immunodeficiency virus-seropositive Taiwanese women.

BACKGROUND AND PURPOSE: Human papillomavirus (HPV) infection is associated with increased incidence and severity of HPV-related cervical dysplasia and cervical cancer in women with human immunodeficiency virus (HIV) infection. This study examined the incidence of genital HPV infection in HIV-infected Taiwanese women and its relationship with cervical neoplasia. METHODS: This hospital-based, case-control study enrolled 31 consecutive HIV-seropositive women and 124 age-matched women who were free from HIV infection. Polymerase chain reaction (PCR) was used to distinguish high-risk (types 16, 18, 31, 33, 52 and 58) and low-risk HPV (types 6 and 11). The occurrence of genital HPV infection was compared between women with and without HIV infection. In addition, CD4 lymphocyte counts were determined by flow cytometry and Papanicolaou test was done in women with HIV infection. RESULTS: HPV and Papanicolaou test were done soon after the diagnosis of HIV infection. HIV seropositive women had a significantly greater high-risk HPV infection rate (48.4%; 15/31) than women without HIV infection (20.2%; 25/124; odds ratio, 3.71; p = 0.001). However, the prevalence of cervical intraepithelial neoplasia was similar between women with and without HIV infection. The CD4 lymphocyte counts in HIV-seropositive women were similar between those with and without genital HPV infection. CONCLUSIONS: The risk of genital HPV infection was significantly increased in HIV-infected women. Due to the association between high-risk HPV infection and the development of cervical dysplasia and cervical cancer, regular follow-up of Papanicolaou test is necessary in these women.     

Prevalence of high risk human papillomavirus types 16/18 in cytologically abnormal cervical smears in Alexandria,Egypt. A cytological and molecular study

IntroductionIn Egypt, cervical cancer ranks as the second most frequent cancer after breast cancer, among women between 15 and 44 years of age. High-risk human papillomavirus (HPV) 16 and 18 detection holds the potential to be used as a tool to detect women, at risk for consequent development of cervical cancer because of their predominance and potentially greater oncogenic nature than other high risk HPV subtypes.ObjectiveTo determine the prevalence of high-risk HPV 16/18 DNA in women with abnormal cervical cytology.Subjects and methods45 cases were collected from Egyptian women seeking routine gynecologic care. Ten cytologically normal cervical smear cell samples were included in the study as a control to be tested for the presence of HPV 16/18 DNA and were collected from asymptomatic patients having cystorectocele or coming for loop insertion or removal. The 45 specimens were subjected to real-time polymerase chain reaction, using multiplex HPV 16 and 18 PCR kit.Results45 cervical smears were collected in the present study. Cytopathological examination revealed that 5 (11.1%) were ASCUS, 8 (17.8) were LSIL, 5 (11.1%) were HSIL, 1 (2.2%) was squamous cell carcinoma (SCC), 1 (2.2%) was adenocarcinoma and 25 (55.6%) were benign (inflammatory). 20 patients with abnormal cervical cytology and 10 controls were included in the present study. In patients with abnormal cervical cytology, 5 (25%) were ASCUS, 8 (40%) were LSIL, 5 (25%) were HSIL, and 1 (5%) was SCC and 1 (5%) was adenocarcinoma. Statistical analysis revealed a significant difference between patient and control groups as regards regularity of menstruation where irregular menstruation and higher prevalence of menopausal women, abnormal vaginal bleeding, menorrhagia, vaginal infection, and abnormal cervical appearance were encountered in patients. A statistically significant higher prevalence of married women was found in the control group. There was no significant difference in the distribution of patients and control as regards HPV 16 or HPV 18 in which 20% of patients were HPV 16 positive and 10% of patients were HPV 18 positive compared with none in the control group. 6 were positive either for HPV 16 or 18, while 39 were negative. The HPV 16/18 positive patients had significantly higher age and marital duration when compared with HPV 16/18 negative group. Significantly, most of the HPV 16/18 positive patients were menopause. A significantly higher prevalence of women with cervicitis, contraceptive users and married women was in the HPV 16/18 negative group.ConclusionThe study generates epidemiological data of prevalence of HPV 16/18 in cytologically abnormal cervical smears in women seeking routine gynecologic care at the outpatient clinics of the Obstetrics and Gynecology Department at El Shatby University. High-risk HPV DNA testing by PCR of cervical samples diagnosed according to the Bethesda 2001 guidelines may benefit the management of patients with abnormal cervical smears, especially among women aged 46 years and older, in menopausal women and in women complaining of PMB. Therefore, HPV DNA testing should be made use of as an adjunct to cervical smears.