Pap Smear Knowledge Among Young Women Following the Introduction of the HPV Vaccine

Study ObjectiveInvestigate sexually active young women's knowledge of the term Pap smear since development of the HPV vaccine.DesignCross-sectional study conducted January–May 2007.SettingUniversity health services clinic at a university in southern United States.ParticipantsSexually active women, age 18–24, presenting for a Pap smear or STD testing (N = 145).Main Outcome MeasuresPap smear knowledge was assessed by participants' written definition of the term Pap smear and by multiple choice responses indicating Pap smear as a test for cervical cancer/ HPV and not a pelvic exam, STD test, or pregnancy test.Results9.7% provided accurate definitions; 12.4% checked appropriate Pap smear synonyms. 68.5% incorrectly responded that Pap smear was the same as “pelvic exam”; 42.5% indicated “STD test”; 11.7% indicated “pregnancy test.” Indicators of HPV risk (age of sexual debut, previous abnormal Pap smear, previous STD diagnosis) were not associated with knowledge. Never using condoms, increasing age, and lower depression scores predicted accurate Pap smear definition rating (R² = 0.08). Never using condoms, Caucasian race, and decreased lifetime number of sex partners predicted accurate identification of Pap smear synonyms (R² = 0.15).ResultsFew participants understood the meaning of the term Pap smear; there does not appear to be improvement in women's knowledge after development of the HPV vaccine. Poor Pap smear knowledge may affect young women's understanding of their overall sexual health.     

A Study of Cervical Intraepithelial Neoplasia in Pregnancy

Objective

To find the incidence of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in pregnant women and compare Pap smear with the HPV DNA test in detecting HPV infection.

Materials and Methods

Hundred antenatal women, irrespective of gestational age, were enrolled as subjects in this prospective pilot study for blood investigations, wet mount examination of cervical discharge, Pap smear, and high-risk HPV DNA detection of cervical scrape by PCR. Women showing abnormality in Pap smear and/or those who were high-risk HPV DNA positive were subjected to colposcopy.

Results

The incidence of HPV-positive pregnant women was 18 %. Koilocytosis on Pap smear was observed in six women. Three high-risk HPV DNA-positive women showed changes consistent with CIN 1 on colposcopy.

Conclusions

The HPV DNA test is the most sensitive and reliable in detecting HPV infection as compared to Pap smear, but considering the cost of PCR, Pap smear screening of all antenatal women was recommended.     

Comparison of Cytology and Cervkography in Screening a High Risk Australian Population for Cervical Human Papillomavirus and Cervical intraepithelial Neoplasia

Summary: Two different screening methods, the Papanicolaou (Pap) smear and cervigram were compared in screening 245 Sydney women over a 6-month period in 1988 at a city sexually transmitted diseases (STD) centre, for cervical human papillomavirus (HPV), cervical intraepithelial neoplasia (CIN) and cervical cancer. The Pap smear through the identification of cytologically abnormal cells correctly detected 54% of cases of histologically proven CIN and 39.2% of cases of HPV. The cervigram through the identification of acetowhite epithelium and/or abnormal vessels on the cervix correctly detected 64% of cases of histologically proven CIN and 70.6% of cases of HPV. However, when both tests were used together, 92% of CIN lesions and 82.4% of HPV lesions were correctly identified. Histology of a colposcopically directed biopsy was used as the 'gold standard'. The sensitivity and specificity of the Pap smear after correction for verification bias was 46% and 78% respectively, and for the cervigram was 49% and 60% respectively. Hence neither screening test appears adequate on its own, at least in an STD population.     

HPV, cervical neoplasia and smoking: knowledge among colposcopy patients

OBJECTIVE: To assess colposcopy patients' knowledge of human papillomavirus (HPV) infection and the role of smoking in cervical neoplasia and, if patients were current smokers, their willingness to quit smoking. STUDY DESIGN: Between January and June 2001, 250 women seen in a colposcopy clinic for the evaluation of an abnormal Pap smear or previously diagnosed cervical neoplasia participated in a survey designed to evaluate knowledge of HPV infection, smoking and neoplasia. Participants who smoked were questioned regarding their smoking behaviors and readiness to quit. In the analysis, the population was stratified by age (< 25 years versus > or = 25 years) to determine differences in knowledge, perception of risk and behaviors. RESULTS: The study population was in general young and racially/ethnically diverse. Fifty-seven percent (143 of 250) thought that HPV was a risk factor in cervical neoplasia, and 58% (146 of 250) associated smoking with neoplasia. Among smokers who discussed risk reduction with their providers, 75% (50 of 66) were advised to stop smoking. Of the 39% (98 of 250) who were current smokers, 63% (62 of 98) agreed that having an abnormal Pap smear would make them consider smoking cessation, and 58% (57 of 98) reported that they would use medical therapy (nicotine replacement or medication) to aid in that process. There were age-related differences in smoking behaviors and attitudes toward cessation (e.g., younger smokers were less likely to desire nicotine replacement). CONCLUSION: Given the high prevalence of smoking and a demonstrated desire by many of the colposcopy patients to stop smoking in the context of a cervical abnormality, further efforts at encouraging cessation are warranted.     

Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear.

OBJECTIVE: To test whether the performance of visual inspection using acetic acid (VIA) could be improved through adjunctive testing and to determine whether the combination of visual inspection of the cervix and HPV testing could prove useful for identifying those at highest risk of cervical precancer. METHODS: Between October 1995 and August 1997, 2199 women willing to be screened for cervical cancer in peri-urban clinics in Harare, Zimbabwe received VIA, Pap smear and HPV as screening tests. The presence or absence of (pre)cancer was confirmed via colposcopy with biopsy as indicated for >97% of all women. Computerized simulations of sequential testing scenarios provided estimates of the joint (net) test qualities of different paired combinations of the three tests and allowed for comparisons with the individual test qualities. RESULTS: Using HGSIL/CIN II-III as the reference threshold of disease, the net sensitivity and specificity of VIA and HPV when used sequentially were 63.6 and 81.9%, respectively, compared to 43.3 and 91%, respectively, when Pap smears were followed by HPV testing. VIA followed by the Pap smear yielded a net sensitivity of 37.5% and net specificity of 94.3%. CONCLUSIONS: For programs with limited resources but with the capacity for HPV testing, sequential testing involving the use of VIA followed by HPV could yield fewer false positives than the use of VIA alone at a cost of relatively few additional false negatives.     

Knowledge of Human Papillomavirus and Acceptability to Vaccinate in Adolescents and Young Adults of the Moroccan Population

Study ObjectiveHuman papillomavirus (HPV) infection is estimated to play an etiologic role in 99.7% of cervical cancer. Vaccines can prevent up to 70% of the cervical cancer caused by HPV 16 and 18. The present study was designed to define the knowledge of HPV and HPV vaccine acceptability among Moroccan youth.Design, Setting, Participants, Interventions, and Main Outcome MeasuresA nationwide anonymous questionnaire with a sample of 688 adolescents (12-17 years) and 356 young adults (18-30 years) was organized, that asked about HPV, origin of cervical cancer, Papanicolaou (Pap) test, and acceptability of HPV vaccine. Data were analyzed using univariate and multivariate logistic regression methods.ResultsOverall, a low frequency (213/1044 = 20%) of HPV knowledge was observed among the studied population. A multivariate model analysis showed that age, educational level, and knowledge of the Pap test remained significantly associated factors with HPV knowledge. Additionally, only 27% (282/1044) of participants were willing to accept HPV vaccination. Highest acceptability was observed among young adults compared with adolescents (166/356 = 46.6% vs 116/688 = 16.9%). Sixty-two percent (103/165) of male participants accepted the HPV vaccine compared with only 20.4% (179/879) of female participants. Educational level, type of school, and knowledge of the Pap test were associated factors with HPV vaccine acceptability in a multivariate model analysis.ConclusionThe present study showed a low level of HPV knowledge and HPV vaccine acceptability among Moroccan youth. Promotion of activities and sensitization are required to maximize public awareness in the future. This objective can be achieved with the use of media, active efforts by health care providers, and introduction of sexual education in school programs.     

Comparison of HPV test versus conventional and automation-assisted Pap screening as potential screening tools for preventing cervical cancer

OBJECTIVE: To evaluate new techniques in primary cervical cancer screening programmes. DESIGN: Cross sectional pilot study. SETTING: Department of Obstetrics and Gynaecology, Helsinki University Hospital. POPULATION: Consecutive 2032 human papillomavirus (HPV) DNA and Pap smear samples were taken. Histological diagnoses were obtained from 460 patients. METHODS: We compared the validity of the high risk (HR) HPV DNA detection test to automation-assisted and conventional Pap smear screening. MAIN OUTCOME MEASURES: Specificity and sensitivity of screening methods. RESULTS: Twenty-three percent of women were HPV positive. Forty-five of 46 had high grade lesions and cancers were HR HPV DNA positive, whereas 72/93 of low grade and more severe lesions were HR HPV DNA positive. When histologically verified high grade lesions were observed, the relative sensitivity of HR Hybrid Capture 2 (HR HC2) test was 98% compared with conventional Pap smear and Papnet tests, which performed 54%versus 58%, 83%versus 86% and 93%versus 98% relative sensitivity respectively, using cytological diagnoses HSIL (high grade squamous intraepithelial lesion), LSIL (low grade squamous intraepithelial lesion) or ASCUS (atypical squamous cells of undetermined significance) as the cutoff. The specificity of HC2 test (77-79%) was comparable with the ASCUS+ (ASCUS and more severe) cytology (68-79%), but lower when compared with LSIL+ (91-95%) or especially HSIL+ (97-99%) Pap smear results. CONCLUSION: Pap smear, as a screening test, is very different from HPV DNA detecting test HR HC 2. If cutoff LSIL or more severe lesions is used, primary Pap smear is clearly more specific than HR HC2, but markedly less sensitive. Due to high relative sensitivity of the HPV, only very few histologically confirmed high grade lesions would be detected among HPV negatives using simultaneous cytology. On the other hand, using HPV DNA test alone would lead to multifold amounts of referrals for colposcopy. A posterior Pap smear assessment among HPV positives might be helpful in increasing sensitivity and specificity of screening and defining those who need an immediate referral or treatment. We plan to incorporate primary HR HPV DNA test with posterior Pap smear reading of HPV positives into our ongoing randomised prospective multiarm trial evaluating new techniques in organised screening for cervical cancer in Finland.     

河北丰宁地区妇女人乳头瘤病毒感染及疫苗认知状况调查

目的调查河北省丰宁满族自治县妇女人乳头瘤病毒（HPV）感染及对宫颈癌、HPV和HPV疫苗的认知情况,并探讨宣教对其认知度的影响。方法对河北丰宁地区717例18~45岁妇女进行HPV相关知识的问卷调查及宣教,对其中647例妇女留取宫颈脱落细胞进行高危型HPV DNA检测。结果高危型HPV总检出率为16.07%（104/647）;14.78%（106/717）的妇女曾听说过HPV,HPV知晓率与年龄、婚姻情况、户口类型及教育程度有关（P〈0.05）;84.38%（605/717）的妇女从未行宫颈癌筛查,在112例行宫颈癌筛查的妇女中,末次筛查为巴氏涂片、宫颈液基细胞学和HPV检测者分别为16.07%（18/112）、39.29%（44/112）和8.04%（9/112）;宣教后HPV知晓率显著提高（P〈0.05）;15.76%（113/717）的妇女既往听说过HPV疫苗,75.59%（542/717）的妇女倾向于接种医疗机构提供的疫苗,24.41%（175/717）的妇女倾向于接种政府或医药公司提供的疫苗。结论河北丰宁地区妇女HPV现患率较高,对HPV及宫颈癌的认知率偏低,宣教后人群认知程度显著提高,因此公众教育可以显著提高人群对HPV疫苗相关知识的认知水平。     

Comparison of three management strategies for patients with atypical squamous cells of undetermined significance, after six months delay: A three-year experience in an Iranian university hospital

Background: A Pap test result of atypical squamous cells of undetermined significance (ASCUS) presents a clinical challenge. Only 5–10% of women with ASCUS harbour serious cervical disease.
Methods: We screened 3619 women, who attended to Mirza Koochak Khan Hospital at Tehran University of Medical Sciences with Pap smears, of whom 100 returned with ASCUS. After six months, each subject underwent a standard cytology (conventional Pap smear), human papillomavirus (HPV) DNA testing (identifying high-risk HPV types with polymerase chain reaction) and colposcopy with multiple cervical biopsies.
Results: Mean age was 44.09 ± 8.6 years. The estimated prevalence of cervical intraepithelial neoplasia (CIN) II or higher was 4%. When histologically verified high-grade lesions (≥ CIN II) were observed, the relative sensitivity of HPV DNA testing was 100% compared with conventional Pap smear, which performed 75% versus 100% relative sensitivity, respectively, using cytological diagnosis high-grade squamous intraepithelial lesion, or low-grade squamous intraepithelial lesion (LSIL) as the cut-off. Negative and positive predictive values (NPV and PPV) of Pap test were 98.9% and 100%. The NPV and PPV of HPV DNA testing were 100%.
Conclusions: Although less complicated than colposcopy, the repeat Pap smear triage algorithm for ASCUS may underdiagnose some women with high-grade CIN, when compared with colposcopy. Considering the high sensitivity of HPV testing, it may be useful as an alternative to the current policy of six-month repeat cytology for women with ASCUS results.     

Assessment of knowledge and attitudes of young uninsured women toward human papillomavirus vaccination and clinical trials

STUDY OBJECTIVE: To assess knowledge and attitudes of young uninsured women toward human papillomavirus (HPV) vaccination and clinical trials. DESIGN: Cross-sectional study. SETTING: Clinic-based sample in Brazil. PARTICIPANTS: A consecutive sample of 204 women aged 16 to 23 years, attending a public outpatient gynecological clinic. INTERVENTIONS: A questionnaire administered by in-person interview. MAIN OUTCOME MEASURES: Data on knowledge and attitudes towards HPV vaccination. RESULTS: Overall, 72% of the respondents would enroll in a HPV vaccine trial, despite the fact that 69% of women were ignorant of what HPV may cause, and only 10% acknowledged that HPV might lead to cervical cancer. The need of a placebo arm (31%) and three vaccinations injections (26%) were the trial design characteristics most cited for deterring participation. Factors promoting participation were "careful/detailed consultations by the same physician" (92%), "access to more information on women's health" (84%), and "office visits on time" (79%); whereas "clinic too far from home" (36%), "fear of adverse events" (29%), and "gynecologic examination discomfort" (25%) were the most commonly reported reasons for not enrolling in a trial. Being sexually active, more than three lifetime sexual partners and perception of high risk for cervical cancer were predictors of participation in a HPV vaccine trial. CONCLUSIONS: Knowledge of HPV infection and cervical cancer is low in this urban, young population. Thus, when planning HPV vaccine trials, it is important to consider implementing educational programs to provide knowledge of the benefits of a preventive vaccine and information on the etiology of and risk factors for cervical cancer.     

Knowledge and general consideration about Pap test screening among women from Finland and Greece

It seems that lack of regular Pap smear screening is a risk factor for cervical cancer. Since women started having Pap smears the number of deaths from cervical cancer has dropped dramatically. The purpose of this study was to investigate the knowledge of women about the essential and basic parameters related to the Pap test in the general population of two European countries: Finland and Greece. The same percentages (> 50%) of women in Athens and Helsinki had good knowledge of the Pap test. Comparing country populations, greater numbers of Finnish women had a better level of Pap test knowledge. Additionally, older women in Finland were more educated and informed about the usage of Pap testing due to the good health service information in this country.     

The relationship between human papillomavirus infection and cervical intraepithelial neoplasia in Turkish women

To compare the prevalence of cervical human papillomavirus (HPV) infection in Turkish women with normal Papanicolaou (Pap) smear and cervical intraepithelial neoplasia (CIN). In between March 2002 and November 2005, the study was designed as case-control study. Cytologic abnormalities in Pap smears were classified according to the Bethesda System (2001). Identification of the presence of HPV was carried out by the Hybrid Capture II test for all patients. To compare the groups, Chi-square test was used. A total of 1353 reproductive aged women were screened. Of them, 1344 (99.3%) had normal or class I Pap smear. Remaining nine cases (0.7%) had CIN at several degrees (five CIN I, three CIN II, and one carcinoma in situ). While all these nine cases with cervical pathologies had HPV, only 20 cases from the other group (1.5%) had HPV (chi(2) 466.1; P = 0.0001). This is the first study of the evaluation of the association between HPV and preinvasive cervical lesions in Turkish population. In spite of low general frequency (2.1%) of cervical HPV colonization in this population, a strong correlation was found between HPV and CIN.     

Age-specific detection of high risk HPV DNA in cytologically normal, computer-imaged ThinPrep Pap samples

OBJECTIVE: Recent cervical cancer screening guidelines for women over age 30 seek to improve the sensitivity of cytology by incorporating high-risk (HR) human papillomavirus (HPV) DNA testing into the screening algorithm, a recommendation based largely on data that utilized the conventional Pap smear and were not stratified by patient age. Data on the rate of HR HPV among women over age 30 undergoing liquid-based Pap test screening are limited. The objective of this study was to determine the rate of HR HPV DNA positivity in women ages 30 and over with a cytologically negative liquid-based Pap test result. METHODS: Consecutive residual ThinPrep Pap samples from women with a cytologically negative result following computer-assisted screening were tested for HR HPV using the Hybrid Capture 2 (HC2) method. All HC2-positive samples were additionally tested with the Linear Array (LA) HPV Genotyping Test. RESULTS: 1000 cytologically negative specimens from women aged 30 to 45 years (38.9+/-4.7 years) were evaluated. The overall HC2 HR HPV positivity rate in this age group was 3.9% (confidence interval 2.8-5.3%). When stratified by age group, the rate was inversely proportional to age (ages 30-35: 6.7%; 36-40: 3.0%; 41-45: 2.6%) and lower than most previous reports (1-17%). Some of the cases that were positive for HR HPV by HC2 were negative by LA, or showed only low-risk virus. CONCLUSIONS: The HR HPV rates in women ages 30-45 with a cytologically negative, computer-imaged ThinPrep test result are low. If these findings are confirmed in future studies, the added benefit of HPV testing to liquid-based cytology for women ages 30 and over should be critically evaluated.     

Detection of HPV by PCR—A Novel Step in the Prevention of Cancer Cervix

Objectives

(1) To compare the efficacy of Pap smear and HPV PCR for detection of CIN; and (2) To study the distribution of HPV genotypes.

Methods

One hundred women presenting at the female Outpatient Department with unhealthy cervices were subjected to a detailed history, clinical examination, Pap smear, HPV DNA PCR test, and colposcopic-directed biopsy (where indicated).

Results

This study has shown that there is a strong association of HPV infection with higher grades of CIN (100 % in patients with CIN 2, CIN 3, and CIS). The detection of CIN by HPV PCR was more accurate than by Pap smear. The most prevalent HPV genotype found in our study was HPV 16.

Conclusion

The advent of HPV testing has opened the doors for more accurate cervical cancer surveillance strategies than Pap smear. Early detection and treatment of CIN will considerably reduce the incidence of cervical cancer.     

Managing atypical squamous cells of undetermined significance in Papanicolaou smears

OBJECTIVE: To assess strategies using repeated conventional Pap smear and human papillomavirus (HPV) DNA testing, alone or in combination, for identifying women with concomitant cervical intraepithelial neoplasia 2 and 3 (CIN 2/3) in women with atypical squamous cells of undetermined significance (ASCUS) in their Pap smears. STUDY DESIGN: A total of 360 women cytologically diagnosed with ASCUS were referred for colposcopy and underwent a repeat Pap smear, a biopsy when necessary and HPV testing using three different modes of detection of high-oncogenic-risk HPV types: 1, first-generation Hybrid Capture test (HC-1) (Digene Diagnostics, Gaithersburg, Maryland); 2, second-generation Hybrid Capture test (HC-2); and 3, polymerase chain reaction (PCR). RESULTS: Nineteen patients (5.3%) had histologic CIN 2/3. The sensitivity and specificity of the repeat Pap smear alone for the detection of CIN 2/3 were 73.7% and 62.9%, respectively, when referring all women with a repeat Pap smear using an ASCUS-positive threshold. The proportion of women referred for colposcopy was 39.0%. When HPV testing for high risk was used for identification of women with histologic CIN 2/3, sensitivity and specificity were, respectively, 68.4% and 85.9% for HC-1, 89.5% and 73.9% for HC-2 and 89.5% and 59.0% for PCR. The rate of referral for colposcopy of these three modes of HPV testing was 16.9%, 29.4% and 44.0%, respectively. The sensitivity and specificity for identification of women with concomitant CIN 2/3 using a combination of repeat cytology showing a low grade squamous intraepithelial lesion or high grade squamous intraepithelial lesion and/or a test positive for high-oncogenic-risk HPV group were, respectively, 94.7% and 73.2% when used in combination with HC-2. The referral rate of women for colposcopy of this combined strategy was 30.4%. CONCLUSION: As compared to the strategy using abnormal repeat Pap smear alone, those using high-risk HPV testing with Hybrid Capture showed statistically significantly higher specificities and lower proportions of women with ASCUS referred for colposcopy. In particular, a promising strategy would be to refer for colposcopy only women with repeat Pap smears showing squamous intraepithelial lesion and/or those positive for high-risk HPV detected by Hybrid Capture testing.     

Human papillomavirus typing in HIV-positive women

OBJECTIVE: Human papillomavirus (HPV) is the major cause of cervical carcinoma and cervical intraepithelial neoplasia worldwide. Certain HPV types have a strong association with and probably a causative role in the pathogenesis of premalignant cervical lesions. Epidemiologic studies in women infected by the human immunodeficiency virus (HIV) have shown an increased incidence of squamous intraepithelial lesions (SILs), which were predominantly high-grade. Six to 30 per cent of women diagnosed with atypical squamous cells of undetermined significance (ASCUS) on a Papanicolaou (Pap) smear harbor SIL in normal screening populations. This study was undertaken to determine the presence of low-and high-risk HPV types in women infected by HIV and to correlate the results to those of the Pap smear. STUDY DESIGN: HPV DNA typing (low- and high-risk) by Digene (Digene Corporation, Gathesburg, MD) hybrid capture methodology was performed on cervical swabs from 209 HIV-positive women. The results of HPV typing were correlated with those of the Pap smear in a retrospective analysis. RESULTS: One hundred and one women (48%) tested positive for HPV subtypes by DNA typing by the hybrid capture method. Of these, 64 patients (63%) had Pap smears which were read as being normal, having benign cellular changes, or having ASCUS (favor reactive process). Of these, 19 patients tested positive for both high-risk and low-risk subtypes, 32 patients tested positive only for high-risk subtypes, and 13 patients tested positive only for low-risk subtypes. CONCLUSION: HPV subtyping identifies a significant group of HIV-positive women who are at risk for developing cervical intraepithelial neoplasia, although they may not show significant abnormalities on their Pap smears.     

Expanded cytological referral criteria for colposcopy in cervical screening: comparison with human papillomavirus testing

OBJECTIVE: The goal of this study was to investigate whether expanded cytologic referral criteria for colposcopy or the addition of human papillomavirus (HPV) testing on cervical screening could improve the rates of detection of cervical intraepithelial neoplasia (CIN). METHODS: HPV testing by semiquantitative polymerase chain reaction/ELISA was performed in 1000 women who were self-referred for routine Pap smear. They underwent colposcopy following an abnormal smear result or a positive HPV test. As abnormal smear results were considered reports of low- or high-grade squamous intraepithelial lesion, atypical squamous cells of undetermined significance, and even HPV-associated reactive cellular changes (mild koilocytosis, mild dyskeratocytosis, hyperchromatic nuclei, bimultinucleation, and cleared cytoplasm). Loop excision of the transformation zone was performed in women with cytology and colposcopy indicative of CIN, as well as in women with normal cytology but positive HPV test and colposcopic impression of CIN. RESULTS: The Pap test was abnormal in 89% of the cases of CIN 1 (34/38) and 96% of CIN 2/3 (27/28) diagnosed in our population. HPV testing picked up four additional cases of CIN 1 (11%) and one case of CIN 2/3 (4%). Overall the HPV test detected 95% of the cases of CIN 1 (36/38) and 89% of the cases of CIN 2/3 (25/28). CONCLUSION: HPV testing does not appear to add significantly to cytology in terms of positive predictive value or detection rate, if extended cytologic indications for colposcopy are used.     

The relationship of human papillomavirus (HPV) detection to pap smear classification of cervical-scraped cells in asymptomatic women in northeast Thailand

OBJECTIVE: To correlate the detection of human papillomavirus (HPV) with the Pap smear classification of cervical-scraped cells from asymptomatic women living in northeast Thailand. METHODS: A total of 260 asymptomatic women attending the Obstetrics and Gynecology's Outpatient Clinic, Srinagarind Hospital, Thailand, were interviewed for risk factors and cervical scrapes were taken. The cells were examined by Pap smear for cytological changes and by PCR for HPV DNAs--nononcogenic (HPVs 6 and 11) and oncogenic (HPVs 16, 18 and 33) types. Cervical biopsies were taken from women with abnormal Pap smears for histological examination. RESULTS: Of the 260 cervical smear samples, the cervical cells were classified as normal and abnormal in 174 and 86, respectively. Twenty-three percent of all samples were positive for overall HPV DNA. HPV DNAs (mostly HPVs 6 and 11) were detected in 21% of normal cells, and the higher detection rate (27%) for HPV DNA in abnormal cells gradually increased in severity from 16% in Class 3 to 35 and 60% in Classes 4 and 5, respectively. Histologically 46, 90 and 100% of HPV detection was associated with CIS, SCC and adenocarcinoma, respectively. Almost all of the HPV DNAs detected were types 16, 18 or 33. There was no significant association between HPV infection and reproduction history, sexual behavior and demographic variables. CONCLUSION: We speculated that an abnormal Pap smear and the detection of an oncogenic type HPV may indicate the presence of neoplastic cells in asymptomatic woman who might be at risk for the development of cervical cancer.     

Screening of premalignant cervical lesions for HPV 16 DNA by sandwich and in situ hybridization techniques

A series of 97 cervical smears and 69 directed punch biopsies derived from 84 consecutive women prospectively followed-up for cervical HPV (human papillomavirus) infections were studied using the sandwich hybridization and in situ hybridization techniques with HPV 16 DNA probes. The aim was to test the sensitivity and applicability of these two techniques in routine diagnosis of cervical HPV infections from smears. As a measure of specimen adequacy, the number of cells recovered in the cervical scrape was determined along with HPV 16 DNA in the sandwich hybridization test using human pro-alpha 2(I)-collagen gene probe. CIN (cervical intraepithelial neoplasia) was suggested in 56% of the patients by the Pap smear, and disclosed in 65% of the biopsies. HPV 16 DNA was present in 57% of cervical scrapes consistent with CIN, i.e., were of Pap smear classes III or IV. Forty percent of the scrapes not suggestive of CIN, i.e., Pap smear classes I or II, also contained HPV 16 DNA. The detection rate for HPV 16 DNA of the sandwich hybridization method was 89% of that of the in situ method in adequate scrapes, but only 43% in cell-poor specimens. The number of HPV 16 DNA-positive scrapes as compared with the total number of diagnoses obtained by studying also the biopsies was 31/36 (69 patients). The results indicate that the cervical scrape as a noninvasive specimen is applicable for screening of cervical HPV infections, and it can be studied with acceptable sensitivity by the rapid sandwich hybridization technique. However, if a punch biopsy is indicated it should be studied using the in situ hybridization technique that allows more sensitive detection of HPV DNA than any other hybridization method and enables the analysis of several HPV types in the same sample instead of only one HPV type in the scrapes.     

A comparison of the human papillomavirus test and Papanicolaou smear as a second screening method for women with minor cytological abnormalities

BACKGROUND: Of the estimated one million Papanicolaou (pap) smears performed annually in Sweden, about 4% show any degree of abnormality. Approximately, 1% of these cases contain moderate or severe atypia (high-grade squamous intraepithelial lesions) and the rest contain low-grade atypia. Recommendations for the management of minor abnormalities vary in various parts of Sweden. Generally, a second Pap smear is obtained 4-6 months after the first one showing low-grade atypia. The aim of this study is to compare the sensitivity of human papilloma virus (HPV)-DNA testing for the detection of cervical intraepithelial neoplasia (CIN) 2-3 with that of a second Pap smear in women, who had low-grade atypia in their first Pap smear. METHODS: Women with low-grade atypia in the Stockholm area, detected at a population-based cytology screening, were enrolled. A repeat Pap smear, HPV test, and colposcopically directed biopsies were obtained. For the detection of HPV, Hybrid Capture II (HC II) was used. RESULTS: The HPV-DNA test was positive in 66% of the 177 participating women. The sensitivity of the second Pap smear and HPV-DNA test to detect CIN 2-3 was 61 (95% CI = 45-74) and 82% (95% CI = 67-91), respectively. The positive and negative predictive values of HPV testing were 27 (95% CI = 18-35) and 89% (95% CI = 80-97), respectively. CONCLUSIONS: In Sweden, a second Pap smear is often obtained for the follow-up of women with low-grade atypia. The results of our study show that compared to the second Pap smear, HPV testing with HC II is a more sensitive method for detecting high-grade lesions.