Behavior of cervical intraepithelial neoplasia (CIN) associated with various human papillomavirus (HPV) types

Summary 201 cervical punch biopsies which showed CIN lesions and were obtained between 1967 to 1977 from Falu Hospital patients, with long-term follow-up data were examined histologically and by DNA typing for human papillomavirus (HPV). We used in situ hybridization for HPV types 6, 11, 16, 18, 31 and 33 and related our findings to the behaviour of the lesion (103 regressed spontaneously and 98 progressed, some of them to invasive cervical carcinoma). There was evidence of HPV infection in 75.6% (152/201) of these lesions on histological examination, and in 53.2% (107/201) on in situ DNA hybridization. Lesions positive for HPV by both methods occurred in the younger age group (Pearson’s correlation coefficient,P=0.008). HPV 16 was found in 51/152 (33.6%) of the HPV lesions, HPV in 12.5%, and HPV 33 in 8.5% HPV 16 was highly significantly (P=0.0001), and HPV 18 and HPV 33 were significantly (P=0.008 andP=0.007, respectively) associated with increasing grades of CIN. Progression to invasive carcinoma was directly (and regression inversely) correlated with the severity of CIN in the first biopsy (P=0.005). Almost 74% (17/23) of the HPV-CIN III lesions progressed, while only 25% of the HPV-NCIN lesions (6/24) did so. The progression rate was 84.6% for HPV 33 lesions and 52.9% for HPV 16. On the other hand, progression was less common with HPV 6 (25%), and HPV 31 (30.0%). Histological grade and HPV type appear to be of value as prognostic indices. An erratum to this article is available at .     

Diagnosis of cervical intraepithelial neoplasia and human papillomavirus infection: punch biopsy versus cervical smear

Summary In 102 patients referred to our colposcopy clinic because of one to three Papanicolaou smears indicating cervical intraepithelial neoplasia (CIN) and/or abnormal colposcopy, routine smears and colposcopically directed punch biopsies were taken simultaneously. For detection and typing of human papillomavirus (HPV)-DNA in situ hybridization was performed in all biopsies and in 46 of the cervical smears. In cases of dysplastic lesions the number of HPV 16/18 (40.5%) and 31/33 (42.9%) was markedly higher than HPV 6/11 (16.6%) infection rate. In cases where simultaneous in situ hybridization in biopsy specimen and cervical smears was performed 21.7% showed a HPV negative smear and a positive biopsy, in 6.5% the results were the other way round. In 34.9% of cases with CIN I and 9.5% of cases with CIN II verified by punch biopsy the cytological smear did not indicate dysplasia. Our data show that mild and moderate CIN lesions of the cervix as well as HPV infection are detected more frequently by a combination of cervical smear and colposcopically directed punch biopsy than by cervical smear alone.     

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.     

The possibility of viral etiology in cervical carcinogenesis

Oncogenic potential of herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) which are both associated with occurrence of cervical cancer and the mechanism of oncogenesis by these viruses were investigated by transformation experiments in vitro. The results were obtained as follows. 1) HSV-2 induced neoplastic transformation of normal diploid cells is a multistep process. Cervical cancer associated antigen AG-4 is encoded within the specific region of HSV-2 DNA which converts immortalized cells to tumorigenic lines. 2) Tumor cells express cellular oncogene at a final stage of neoplastic transformation induced by HSV-2 and "hit and run" theory is applicable to oncogenesis of this virus. 3) Complete carcinogenesis can be mediated by HPV-16 or HPV-18 DNA under collaboration with other cofactors such as HSV-2. 4) It is suggested that neoplastic transformation induced by HPV-18 DNA is based on "hit and run" oncogenesis. 5) HPV-16 or HPV-18 DNA can immortalize primary diploid cells and convert them to fully tumorigenic phenotype by repeating cell passage. 6) It has been experimentally proved that the difference in transforming potential exists between HPV 6/11 and HPV 16/18. 7) Amplification and overexpression of c-myc oncogene was detected in transformed cells obtained by HPV-16 transfection. While overexpression of c-myc was detected in transformed cells induced by HPV-18 DNA, but no amplification was observed. On the other hand, detection of HPV, DNA and amplification or overexpression of protooncogenes was performed in cervical intraepithelial neoplasias (CIN) and invasive cervical carcinomas. The results were summarized as follows. 1) HPV DNA was detected in approximately 70% of a population with CIN by in situ hybridization. CIN II showed the highest incidence of positive HPV DNA (91%), and the positive ratio decreased in CIN III (56%). 2) Immunohistochemical study of paraffin-embedded specimens with monoclonal antibodies to oncogene products revealed that only some of cervical invasive carcinomas expressed c-myc protein, ras p21 or EGFR. 3) HPV DNA was detected in 46% of invasive cervical carcinomas by Southern blot hybridization. The percentage of patients with positive results for HPV 16/18 was 29%. However, it increased up to 58% by use of polymerase chain reaction (PCR), suggesting that there are many cervical cancer tissues in which a number of cells lack viral DNA. 4) Northern blot hybridization analysis revealed overexpression of c-myc mRNA in 30% of cervical invasive carcinomas although amplification of c-myc oncogene was detected in only one of invasive carcinomas.(ABSTRACT TRUNCATED AT 400 WORDS)     

Detection of HPV DNA in the uterine cervical lesions by polymerase chain reaction and in situ hybridization]

Human papillomavirus (HPV) is found in close association with carcinogenesis of the uterine cervix. We applied a new in vitro gene amplification technology, the polymerase chain reaction (PCR) to detect HPV 16 and 18 in cervical exfoliated cells. HPV infections were detected in 5 (16%) of 31 women with no pathological lesions of the uterine cervix (normal), 16 (24%) of 67 with cervical intraepithelial neoplasia (CIN) and 6 (38%) of 16 with invasive cervical cancer. Moreover, 10% formalin-fixed and paraffin-embedded tissue sections were prepared from the uterine cervix of these 27 women with PCR-proven HPV infection and were examined for the histological localization of HPV-DNA by in situ hybridization with biotin-labeled DNA probes of HPV types 6/11, 16/18 and 31/33/35. HPV-DNA type 16/18 was detected in 3 of 5 normal women, 2 of 4 CINs I, 2 of 3 CINs II, 6 of 9 CINs III and 6 of 6 invasive cervical cancers. HPV-DNA type 6/11 was detected in 6 of 6 condylomas. Viral DNA sequence was detected in the superficial cells of CIN I and II, and it was distributed through entire thickness layer of undifferentiated cells derived from CIN III and squamous cell carcinoma. In addition, the staining intensity became weak as the lesion progressed. These differences between lesions might be due to the difference in the viral form in the nuclei, ie whether an episomal or integrated form. Thus, an in situ hybridization technique with a biotin-labeled DNA probe as well as the PCR method is useful for the detection of HPV in clinical samples.     

Virological studies on generation of cervical carcinomas

1. Detection of HPV in cytologically normal cervices: We have detected by filter in situ hybridization human papillomavirus (HPV) types 6/11, 16 and 18 DNA sequences in 6(0.9%), 12(1.8%) and 4(0.6%), respectively, out of 666 swab specimens from normal cervices (mean age; 49.1 years). The positive rate for HPV 16 and HPV 18 was significantly lower compared with 27.1%(26/96) of CIN and 48.4%(15/31) of cervical cancers. HPV DNA occurred more often in women under 50 years old than in those 50 years old or older (5.1% versus 1.0%). 2. Detection of HPV in cervical intraepithelial neoplasia (CIN): Eighty nine patients with CIN I-III were examined by Southern blot analysis with HPV 11, HPV 16 and HPV 18 DNAs in stringent conditions (Tm -18 degrees C) and with HPV 16/18 mixed probe in relaxed conditions (Tm -37 degrees C). We found HPV 11, HPV 16, HPV18 and other types of HPV in 0%(0/37)/2.7%(1/37)/2.7% (1/37)/16.2%(6/37) of CIN I, 0% (0/11)/9.1%(1/11)/0%(0/11)/45.5%(5/11) of CIN II and 0% (0/41)/26.8%(11/41)/2.4%(1/41)/24.4%(10/41) of CIN III. 3. Detection of HPV in cervical carcinomas: One hundred sixty seven cervical carcinomas and 6 metastatic tumors from cervical carcinomas were examined by Southern blot analysis with HPV 16 and HPV 18 DNAs in stringent conditions (Tm -18 degrees C). HPV 16 and HPV 18 were found in 35.3% (59/167) and 7.2%(12/167), respectively. The incidence of HPV 16/18 was higher in the patients under 60 years old (55.1% [27/49]). HPV 18 was detected more often in adenosquamous carcinomas and adenocarcinomas (31.8% [7/22]) than in squamous cell carcinomas (3.4% [5/145]). Five out of 6 metastatic tumors were positive for HPV 16 or HPV 18. 4. Physical state of HPV DNA in CIN and cervical carcinomas: The physical state of HPV 16 and HPV 18 DNAs was determined by electrophoresis after digestion with uncut and single-cut enzymes and two-dimensional electrophoresis after digestion with uncut enzyme. Three out of 3 CIN had only free episomal HPV DNA. HPV 16 DNA was existed as free episomal DNA in 4, as free episomal DNA and integrated DNA in 7, as integrated DNA in 8 out of 19 cervical carcinomas. HPV 18 DNA was integrated into the host cell genome in 3 out of 3 cervical carcinomas.(ABSTRACT TRUNCATED AT 400 WORDS)     

Detection of human papillomavirus DNA in human cervical lesions by tissue in situ nucleic acid hybridization

Cervical cancer is one of the most common female cancers in Taiwan. Certain types of human papillomavirus (HPV) are frequently detected in the epithelial precancerous and cancerous lesions of the cervix. By the use of tissue in situ hybridization, we investigated the relationship of various types of HPV (group I, HPV-6 & 11, group II, HPV-16 & 18, group III, HPV-31, 33 & 35) with cervical condyloma, carcinoma as well as precancerous lesions. Group I HPV DNAs were mainly found in cervical condylomatous lesions (2/2) of the cervix and cervical intraepithelial neoplasia I (CIN I) (2/4), but were only occasionally found in CIN II (1/4), CIN III (1/9) or non-keratinized squamous cell carcinoma (1/15). HPV DNAs of groups II and III were mainly detected in lesions of CIN III (5/9) and invasive squamous cell carcinoma (large cell, keratinized type: 4/7; large cell, non-keratinized type: 11/15). HPV DNA sequences were invariably detectable only in the cell nuclei of condyloma or dysplastic epithelium or invasive carcinoma. However, they could not only be detected in the upper layer dysplastic cells and koilocytes but also in the well and poorly differentiated cervical cancer cells. The distribution of HPV DNA positive cells in the carcinomas fell into four different patterns: (1) upper zone and non-invasive regions of the carcinoma (11/22, 50%), (2) basal zone and invasive regions (2/22, 9%), (3) randomly scattered (7/22, 32%), and (4) extensively distributed over the whole tumor lesions (2/22, 9%). Thus, our results are consistent with a strong correlation between the presence of HPV-16, 18, 31, 33 and 35 and malignant conversion of cervical epithelial cells.     

人乳头瘤病毒生物状态和人端粒酶RNA组分基因扩增与宫颈病变的关系

目的:探讨人乳头瘤病毒(HPV)生物状态和人端粒酶RNA组分(hTERC)基因扩增与子宫颈病变之间的关系。方法:应用原位杂交(ISH)和荧光原位杂交(FISH)方法,分别检测114例宫颈石蜡包埋组织HPV生物状态及hTERC基因的异常扩增。结果:在非CIN、CINⅠ、CINⅡ、CINⅢ、宫颈癌宫颈组织标本中hTERC基因表达率分别为2.78%、10.00%、50.00%、78.37%和86.67%,差异有统计学意义(χ2=55.56,P<0.001)。随着病变程度升高,HPV整合发生率逐渐升高(0.0%、10.00%、18.75%、72.97%、80.00%)。不同程度的宫颈病变HPV整合率有显著差异(χ2=52.49,P<0.001)。其中,非CIN组与CINⅢ、宫颈癌组之间差异有统计学意义,CINⅠ与CINⅢ、宫颈癌组之间差异有统计学意义,CINⅡ与CINⅢ、宫颈癌组之间差异有统计学意义。HPV DNA整合情况和hTERC基因扩增情况一致,用两种方法预测宫颈癌的效果一致。结论:HPV生物状态和TERC基因扩增与子宫颈病变的发生发展相关。HPV感染与HPV整合、端粒酶激活有时序性差异,但HPV整合和hTERC基因扩增的时序性和关联性有待进一步探讨。     

Human papillomavirus (HPV) DNA sequences demonstrated by in situ DNA hybridization in serial paraffin-embedded cervical biopsies

An in situ DNA hybridization technique was used to identify various types of Human papillomavirus (HPV) in paraffin sections of serial punch biopsies taken from 64 patients having colposcopy because of abnormal smears. There women were in fact 64 consecutive patients out of 505 attending our clinic (at 6-month intervals) since 1981 for HPV infections. HPV 6 DNA sequences were found in 20%, HPV 11 in 17%, HPV 16 in 8% and HPV 18 in 5% of the 64 biopsies analysed with this method so far. More than 60% of HPV 6-positive lesions belong to HPV-NCIN (HPV lesion without concomitant CIN) or HPV-CIN I categories, as contrasted with HPV 16-positive lesions, 80% of which belong to HPV-CIN II and III categories. None of the HPV 16- or HPV 18-infected lesions regressed, as contrasted with 23% and 45% in those infected with HPV 6 and HPV 11, respectively (P less than 0.01). The rate of progression (38.4% and 45.5%, respectively) was markedly lower in HPV 6- and HPV 11 lesions as compared with that (80%) of HPV 16 lesions. The present results while supporting the concept on HPV 16 and HPV 18 as the high risk HPV types in cervical carcinogenesis also emphasize the applicability of the in situ DNA hybridization as a powerful tool in analysis of the specific HPV DNA sequences in routinely progressed biopsies of these lesions.     

Human papillomavirus DNA in adenocarcinoma in situ, microinvasive adenocarcinoma of the uterine cervix, and coexisting cervical squamous intraepithelial neoplasia

Previously, human papillomavirus (HPV) DNA, mainly HPV-18 DNA, was detected in more than 40% (17/40 cases) of invasive adenocarcinoma of the uterine cervix in our laboratory. In order to identify HPV DNA in the precursor lesions of adenocarcinoma of the cervix, 11 cases of adenocarcinoma in situ containing microinvasive adenocarcinoma and 10 cases of adenocarcinoma in situ were studied for the presence of HPV DNA by in situ hybridization using highly sensitive 3H-labeled HPV-16 and HPV-18 DNA probes. HPV types present in cervical squamous intraepithelial neoplasia (CIN) coexisting with adenocarcinoma in situ and microinvasive adenocarcinoma were also studied. Apart from the coexisting CIN II-III with glandular neoplasms, 48 cases of CIN III (severe dysplasia and squamous carcinoma in situ) removed by conization or hysterectomy and known to be free of adenocarcinoma were used for comparison. HPV DNA was detected in 64% of microinvasive adenocarcinoma, 70% of adenocarcinoma in situ, and 63% of the control CIN III. HPV-18 DNA was the preponderant type of HPV DNA found in adenocarcinoma in situ and microinvasive adenocarcinoma. All cases of HPV DNA-positive microinvasive adenocarcinoma contained the same type of HPV DNA as the lesions of coexisting adenocarcinoma in situ. CIN coexisting with microinvasive adenocarcinoma or adenocarcinoma in situ contained the same type of HPV as identified in the glandular lesions, whereas all of the HPV DNA-positive control CIN III cases contained HPV-16 DNA. These results suggest that adenocarcinoma in situ is a precursor lesion of adenocarcinoma of the cervix that contains HPV DNA, and that CIN coexisting with adenocarcinoma may be a result of a metaplastic process of adenocarcinoma or of bidirectional differentiation of the affected reserve cells.     

Detection of human papillomavirus DNA in cervical lesions by in situ hybridization using biotinylated DNA probes

In situ hybridization (ISH) for human papillomavirus (HPV)-6, -11, -16, -18, and -31 DNA was performed on 615 formalin-fixed paraffin-embedded cervical biopsies using biotinylated DNA probes. Results were obtained from 584 samples with 266 (45.5%) containing HPV-DNA sequences. Ninety percent of condyloma acuminatum specimens were positive for HPV-DNA with 18 of 19 positive cases containing HPV-6 or -11 DNA. The detection rate of HPV in cervical intraepithelial neoplasia (CIN) lesions was 50.6% (239 of 472), while only 8 of 91 (8.9%) cervical biopsies considered to be histologically normal or with minimal dysplasia contained HPV-DNA as demonstrated by ISH. The prevalence of HPV-16, -18, and/or -31 DNA increased with the severity of the lesions, with 20 of 20 (100%) positive CIN-III lesions containing these viral types compared with 102 of 157 (65.0%) positive CIN-I lesions. ISH with biotinylated DNA probes appears helpful in identifying lesions containing higher risk viral strains.     

Prevalence of human papillomavirus DNA in cervical tissue. Retrospective analysis of 855 cervical biopsies

The histopathologic features of 855 cervical biopsies were correlated with the presence of human papillomavirus DNA using in situ hybridization (ISH) with biotin labeled type specific probes for Human Papilloma Virus (HPV) types 6, 11, 16, 18, 31, 33 and 51. HPV-DNA was found in 18% (13/72) of cervical intraeptihelial neoplasia I (CIN I), 30% (35/115) of CIN II, 28% (57(206) of CIN III, in 84% (21/25) of flat condyloma and in 13% (15/112) of normal cervical tissue. HPV DNA was detectable in 11% (5/46) of cervical adenocarcinoma and in 21% (59/279) of squamous cell carcinoma (SCC) of the cervix. High risk HPV types were identified more often than low risk HPV types in CIN I, CIN II, CIN III and SCC. HPV type 16/18 predominates over HPV type 31/33/51 in CIN I, flat condyloma and in SCC. The prevalence of HPV was strongly associated with the grade of differentiation of SCC. It was identified in 59% (23/39) of well differentiated SCC, in 18% (25/142) of moderately differentiated and in 11% (11/98) of poorly differentiated SCC. Received: 29 March 1996 / Accepted: 15. August 1996     

Non-isotopic in situ hybridization of HPV types in cervical intraepithelial lesions in patients with AIDS

Human papilloma viruses (HPVs), particularly types 16 and 18 have a key role in the development of preneoplastic and neoplastic lesions of the uterine cervix. We studied, by non isotopic in situ hybridization using probes to HPV 6, 11, 16 and 18, cervical biopsies from AIDS patients with condilomata or cervical intraepithelial neoplasia. There were 32 biopsies which showed low-grade cervical intraepithelial neoplasia (Lo-CIN); 5 biopsies showed high-grade cervical intraepithelial neoplasia (Hi-CIN). Of 32 Lo-CIN biopsies, 18 (56.3%) were positive for HPV; 7 for HPV 6 and/or 11 (21.9%), 11 for HPV 16 and/or 18 (34.4%) and one for HPV 6 and 18. Of 5 Hi-CIN biopsies 3 were positive for HPV: one for HPV 6 and 2 for HPV 16 or 18. The total positivity was 56.8% (21/37). This result was similar to those obtained by various other authors studying the general population. Received: 28 January 1998 / Accepted: 7 April 1998     

Serologic response to human papillomavirus 16 among Australian women with high-grade cervical intraepithelial neoplasia

This study evaluated the detection of human papillomavirus (HPV) 16 antibody in HPV 16-associated cervical intraepithelial neoplasia (CIN) in Australian women. Seroreactivity to HPV 16 L1 virus-like particles was assessed in patients with CIN 2 (n= 169) and CIN 3 (n= 229) lesions previously tested for the presence of HPV DNA. Seropositivity was significantly commoner in women with HPV 16 DNA-positive lesions (98/184) than in women with no HPV DNA in the lesion (15/47) or with HPV of types other than 16 in the lesion (43/167) (P= 0.0004). In addition, seropositivity was observed in 33% (55/169) of women with CIN 2 and 46% (106/229) of women with CIN 3, in keeping with the lower fraction of CIN 2 (57/169) than CIN 3 (127/229) biopsies positive for HPV 16 DNA. HPV 16 seropositivity is most common in women with HPV 16-associated CIN, but many patients with HPV-associated CIN 3 are seronegative, and HPV 16 seropositivity is common in women with CIN associated with other HPV types. Overall, HPV 16 serology is a poor predictor of presence of HPV 16-associated CIN 3 in patient population studied.     

Human papillomavirus DNA in situ hybridization may be used for the quality control of genital tract biopsies

Biopsies of human papillomavirus (HPV)-related lesions of the lower female genital tract were studied using in situ hybridization for HPV DNA. The probes included HPV types 6, 11, 16, 18, 31, 33, 35, 41, 43, 44, 45, 51, 52, and 56. In cervical intraepithelial neoplasia (CIN) 1 lesions, 64 of 70 (91%) of formalin-fixed tissues were HPV DNA-positive; in vulvar condylomata, 34 of 36 (94%) were positive. Only two of 52 (4%) of the lesions diagnosed as equivocal for CIN 1 or condyloma were positive. Higher-grade CIN and vulvar intraepithelial neoplasia lesions had a lower rate of HPV DNA positivity. It is suggested that in situ hybridization may be used as a quality control procedure for the histologic diagnosis of HPV-related lesions.     

Altered expression of filaggrin in human papillomavirus (HPV) lesions of the uterine cervix

Summary A series of 64 punch biopsies collected from women prospectively followed-up for cervical Human papillomavirus (HPV) infections (with and without CIN), and 38 control biopsies (normal epithelia, and classical CIN) were analysed for expression of filaggrin (a histidine-rich protein constituent of keratohyalin granules) using the ABC technique and polyclonal antibody. HPV typing was completed using the in situ hybridization technique with DNA probes for HPV 6, 11, 16, 18 and 31. Three patterns of filaggrin distribution were differentiated: pattern I, all layers above the basal cells stained irregularly, and pattern III, scattered superficial cells stained positive. There was a significant difference between HPV-noCIN and HPV-CIN lesions in their filaggrin patterns, pattern I being present in the majority (77.7%) of HPV-noCIN lesions, as contrasted to HPV-CIN lesions, where pattern III was the predominant one (43.5%), followed by pattern II (32.6%). In HPV-CIN CIN as well as in CIN lesions, pattern I was inversely related to the grade of CIN, being entirely absent in HPV-CIN III and CIN III. A significant difference exists between CIN and HPV-CIN lesions, concerning the presence of pattern III (4.3% and 43.5%, respectively,P< 0.001). The difference was less dramatic with regard to pattern I (30.4% and 21.7%, respectively,P< 0.05). In the lesions containing HPV 6, 11 or 31 DNA, filaggrin distribution was shown to be more close to that of the normal epithelium (I 36.7%, and II 34.7%), while in the HPV 16 and 18-infected cases, pattern III was the predominant one (46.7%). The assessment of filaggrin pattern in HPV lesions might be of help in evaluating the severity of the disturbance of keratinocyte differentiation induced by the progression of HPV infections.     

Oral contraceptives and human papillomavirus infection in cervical intraepithelial neoplasia

Summary We report about 142 patients from whom colposcopically directed cervical punch biopsies were taken which showed condylomatous lesions with or without cervical intraepithelial neoplasia (CIN). Fiftysix (39.4%) of these women used oral contraceptives (OC) for at least two years before examination. We used DNA in situ hybridization on all biopsies for detection of human papillomavirus (HPV)-DNA. Among OC users a significant trend towards higher HPV infection rates in high grade CIN (odds ratio 2.9,P<0.05) was found, whereas non-users of oral contraceptives had the highest HPV infection rate in condylomatous lesions without CIN (odds ratio 0.5,P<0.05). Thus in OC users HPV infection was about 24 times more likely in CIN III as in condyloma, whilest among non-users the trend was the other way round (7-fold likelyhood of HPV positivity in condyloma compared to CIN III). Other known risk factors for cervical carcinoma did not influence HPV infection rates in either group.     

Detection and quantitation of human papillomavirus type 16, 18 and 52 DNA in the peripheral blood of cervical cancer patients

OBJECTIVE: To prospectively evaluate the feasibility of detecting human papillomavirus (HPV) type 16, 18 and 52 DNA in the peripheral blood of patients with cervical cancer using real-time polymerase chain reaction (PCR) and to determine its prognostic importance. METHODS: Blood and cervical swab specimens from 135 consecutive patients with 60 invasive cervical cancers, 10 microinvasions, 20 cervical intraepithelial neoplasias (CIN) III, 10 CIN II, 10 CIN I and 25 controls were collected and examined for HPV type 16, 18 and 52 DNA using real-time PCR to investigate the prevalence and viral load of HPV DNA at the time of diagnosis and during follow-up in patients with positive blood samples. RESULTS: Of the 60 patients with invasive cervical cancer, 27% had positive test results for HPV DNA in blood samples in contrast to 0% of patients with microinvasions, CIN III, CIN II, CIN I and normal controls. The DNA detection rates of viral subtypes in blood samples of cervical cancer patients were 5% for HPV-16, 16.7% for HPV-18, 8.3% for HPV-52, 1.7% for both HPV-16 and HPV-18 and 1.7% for both HPV-18 and HPV-52, while the detection rates in cervical swab specimens were 36.2% for HPV-16, 15.5% for HPV-18 and 17.2% for HPV-52. During follow-up, 8 of 10 cervical cancer patients with viral DNA detected in blood within 3 months after treatment had recurrence, and a high percentage (87.5%, 7/8) of this recurrence involved distant metastases. CONCLUSIONS: In this study, real-time PCR detected HPV-16, -18 or -52 DNA in the peripheral blood of more than one-fourth of invasive cervical cancer patients. The association between risk of cancer recurrence and the amount of viral DNA detected in blood among cervical cancer patients after treatment is intriguing and deserves further investigation.     

Detection and typing of HPV genotypes in various cervical lesions by HPV oligonucleotide microarray

OBJECTIVES: This study was conducted to evaluate a clinical efficacy of human papillomavirus (HPV) oligonucleotide microarray (Biomedlab Co., Seoul, South Korea) for the detection of HPVs in various cervical lesions. RESULTS: HPV DNAs from 234 patients were analysed by two methods. Among those, 212 patients were classified into 5 groups according to the histologic diagnosis: chronic cervicitis, cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, and invasive cervical carcinoma. PCR-RFLP could detect 7 types of high-risk HPVs (HPV 16/18/31/33/35/52/58) and HPV microarray could detect 15 types of high-risk HPVs (HPV 16/18/31/33/35/39/45/51/52/56/58/59/66/68/69) and 7 types of low-risk HPVs (HPV 6/11/34/40/42/43/44).HPV genotyping by HPV oligonucleotide microarray revealed that HPV16 was the most frequent type (30.2%) in all specimens tested and was significantly more frequent in CIN III and invasive carcinomas than other lesions. METHODS: HPV DNAs were detected in 158 and 174 of the 234 cervical samples by PCR-RFLP and HPV microarray, respectively. The correlation between the two methods was good in detecting HPVs in general (kappa index = 0.69) and HPVs 31 and 52 (kappa index = 0.70 and 0.70, respectively) and excellent in detecting HPVs 16, 18, 33, 35, and 58 (kappa index = 0.90, 0.88, 0.92, 0.77, and 0.84, respectively). Double HPV infection was detected in 10 cases and one triple infection was detected. By combining cytology and HPV testing, the sensitivity was improved to 87.5, 95.5, 96.1, and 97.2% in CIN I, CIN II, CIN III, and carcinoma, respectively. CONCLUSIONS: This results suggest that HPV oligonucleotide microarray is a highly comparable method to the previously used PCR-RFLP method for the detection of HPVs in cervical specimens. Genetic informations for HPV infection in cervical specimens may offer new strategies in manipulating the patients harboring cervical intraepithelial neoplasia and cervical carcinoma.     

Prevalence of human papillomavirus genomes in tissues from the lower genital tract as detected by molecular in situ hybridization.

Incidence cases of human papillomavirus (HPV)-related disease of the lower anogenital tract were prospectively collected and submitted to RNA-DNA in situ hybridization, which allows a direct correlation between morphology and the presence of viral DNA. The overall HPV detection rate in condylomata and intraepithelial or invasive neoplasia varied for the different genital areas: cervix (64%), vagina (56%), vestibule (59%), vulva (50%), and penis (42%). HPVs 6/11 were associated with condylomata, whereas HPV 16 was associated with intraepithelial and invasive neoplasia. Not a single case of intraepithelial or invasive neoplasia contained HPV 6/11, which supports the notion of the oncogenic potential of HPV 16. Condylomata were positive for HPV 16 only when adjacent to HPV 16-positive cervical intraepithelial neoplasias (CINs). The amount of viral DNA (copy number) was low in invasive cancers, intermediate in intraepithelial neoplasia, and conspicuously high in condylomata. In biopsies (n = 142) taken from lesions suggestive of subclinical papillomavirus infection on the basis of minor colposcopic and histologic abnormalities, HPV DNA was not detectable. Histologically normal tissue (n = 210) adjacent to condyloma, CIN, or cancer, and thus potential carrier of latent HPV infection, also proved negative for HPV DNA by in situ hybridization. The inability to detect viral DNA by in situ hybridization in tissues diagnosed as subclinically or latently infected may have been due to limited sensitivity of the hybridization method applied in this study.