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Standard Infection and Co-infection with Human Papillomavirus of the Brazilian Northeast: Cervical Samples from Women with Low and High Grade Squamous Intraepithelial Lesion and Squamous Cell Carcinoma
Abstracts included thirty cases (81.1%) of LSIL, three cases (8.1%) of high grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 2 (HSIL/ CIN 2), and four cases (10.8%) of high grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 3 (HSIL/CIN 3). One case of adenocarcinoma in situ (AIS) was also noted in association with LSIL. Conclusion: In our small practice-based study of negative Pap tests with follow-up biopsy results, we did not uncover any high-grade lesions that were HPV negative. However, the findings are limited by sampling bias. Most cytology negative, HPV positive women had negative or low grade findings on follow-up biopsies. Overall, the findings support current recommendations for the management of co-testing results.
64 Standard Infection and Co-infection with Human Papillomavirus of the Brazilian Northeast: Cervical Samples from Women with Low and High Grade Squamous Intraepithelial Lesion and Squamous Cell Carcinoma Jacinto da Costa Silva Neto, Antonio Freitas, PhD, Giwellington Albuquerque, MSc, Dafne Quixabeira, Esp Federal University of Pernambuco, Brazil Introduction: Infection with human papillomavirus (HPV) is a necessary condition for the development of cervical lesions. In Brazil the government started a vaccination campaign in 2014 for all girls aged 11 to 13 years. In 2015 the program will be girls between 9 and 11 years old, and in 2016 it will be all girls from nine years using the quadrivalent vaccine (HPV6, 11, 16 and 18). Materials and Methods: For this study samples were collected with endocervical brushes and stored in liquid preservative of DNA solution. The detection was performed by polymerase chain reaction (PCR) by using consensus primers (MY09 / 10), followed by sequencing of positive samples and MasterMix and primers specific for HPV in cases of coinfections. Results: We analyzed 1198 samples of women living in the Brazilian Northeast states with diagnoses as follows: 41.23% LSIL, HSIL 43.60% and 15.17% squamous cell carcinoma. HPV 16 was the most frequent followed by HPV 31, 18, 33 and 35. In some areas we identified HPV 58 (14.41%), HPV 18 as low frequency (<1%). Also were found HPV 39 and 52 (2.70%). HPV 6 (low-risk) was the most frequent followed by HPV 11, but in some areas HPV 70 was the most prevalent followed by HPV 61 (4.5%). Various associations between low and high-risk viruses were found, the most frequent being HPV16 / 33 co-infection, followed by 16/31, 16/31/ 33 to high-risk. Conclusion: The pattern of infection in Northeastern Brazil is composed mainly by HPV 16, 31, 18, 33 and 35. In certain areas this sequence is modified with the addition of HPV 58, 39 and 52. For cervical cancer in this region, 20.3% of women are infected with HPV genotypes that are not part of the immunization coverage. 65 The Sensitivity of Pap Cytology and HPV Testing to Detect Cervical Cancer: Prior Testing Results in 178 Patients with Invasive Cervical Cancer at a Large General Hospital in China Haiyan Liang, MD, PhD1, Christopher Griffith, MD, PhD2, Li Ma, MD1, Bin Ling, MD, PhD1, Dingqing Feng, MD, PhD1, Zaibo Li, MD, PhD3, Chengquan Zhao, MD4 1 China-Japan Fridship Hospital, Beijing, China; 2 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; 3 Ohio State University Medical Center, Columbus, Ohio;
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Magee Womens Hospital/University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Introduction: Prior screening results in women diagnosed with cervical carcinoma are only reported in the literature in small numbers. We wish to examine a larger number of prior testing results in women with cervical carcinoma from China to better understand the strengths and weaknesses of Pap cytology and human papillomavirus (HPV) testing. Materials and Methods: 178 patients including 143 squamous cell carcinomas (SCC), 29 adenocarcinomas, and 6 adenosquamous carcinomas had hrHPV testing results and/or Pap test result during the preceding year and were therefore included in this study at China-Japan Friendship Hospital, Beijing, China, from January 2009 to December 2014. Pap cytology was performed using one of the two methods-ThinPrep and SurePath, and HPV testing was done with mostly HC2. Results: 82.0% of women were symptomatic at presentation with vaginal bleeding or abnormal vaginal discharge, 2.2% with abdominal pain, 6.2% with routine examination, and 9.6% with unknown cause. The average time period between the tests and histological diagnosis of cervical cancer was 1.4 months for hrHPV testing, 1.9 months for Pap test. HPV testing was negative in 9.8% of women (Table 1) and Pap cytology had a higher rate of false negative results at 16.7% (Table 2). Adenocarcinoma showed a higher negative testing rate than SCC with both cytology and HPV testing. Only 1 of 78 (1.3%) patients having both tests showed a double negative result (Table 3). Conclusion: Both Pap cytology and HPV testing have surprisingly high rates of prior negative results in women with cervical carcinoma. When testing is performed using both methods, the greatest number of cervical carcinomas can be detected. These results should also be considered when making screening recommendations with the understanding that HPV testing alone will miss at least a proportion of women with incident cervical carcinoma.
64 Standard Infection and Co-infection with Human Papillomavirus of the Brazilian Northeast: Cervical Samples from Women with Low and High Grade Squamous Intraepithelial Lesion and Squamous Cell Carcinoma Jacinto da Costa Silva Neto, Antonio Freitas, PhD, Giwellington Albuquerque, MSc, Dafne Quixabeira, Esp Federal University of Pernambuco, Brazil Introduction: Infection with human papillomavirus (HPV) is a necessary condition for the development of cervical lesions. In Brazil the government started a vaccination campaign in 2014 for all girls aged 11 to 13 years. In 2015 the program will be girls between 9 and 11 years old, and in 2016 it will be all girls from nine years using the quadrivalent vaccine (HPV6, 11, 16 and 18). Materials and Methods: For this study samples were collected with endocervical brushes and stored in liquid preservative of DNA solution. The detection was performed by polymerase chain reaction (PCR) by using consensus primers (MY09 / 10), followed by sequencing of positive samples and MasterMix and primers specific for HPV in cases of coinfections. Results: We analyzed 1198 samples of women living in the Brazilian Northeast states with diagnoses as follows: 41.23% LSIL, HSIL 43.60% and 15.17% squamous cell carcinoma. HPV 16 was the most frequent followed by HPV 31, 18, 33 and 35. In some areas we identified HPV 58 (14.41%), HPV 18 as low frequency (<1%). Also were found HPV 39 and 52 (2.70%). HPV 6 (low-risk) was the most frequent followed by HPV 11, but in some areas HPV 70 was the most prevalent followed by HPV 61 (4.5%). Various associations between low and high-risk viruses were found, the most frequent being HPV16 / 33 co-infection, followed by 16/31, 16/31/ 33 to high-risk. Conclusion: The pattern of infection in Northeastern Brazil is composed mainly by HPV 16, 31, 18, 33 and 35. In certain areas this sequence is modified with the addition of HPV 58, 39 and 52. For cervical cancer in this region, 20.3% of women are infected with HPV genotypes that are not part of the immunization coverage. 65 The Sensitivity of Pap Cytology and HPV Testing to Detect Cervical Cancer: Prior Testing Results in 178 Patients with Invasive Cervical Cancer at a Large General Hospital in China Haiyan Liang, MD, PhD1, Christopher Griffith, MD, PhD2, Li Ma, MD1, Bin Ling, MD, PhD1, Dingqing Feng, MD, PhD1, Zaibo Li, MD, PhD3, Chengquan Zhao, MD4 1 China-Japan Fridship Hospital, Beijing, China; 2 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; 3 Ohio State University Medical Center, Columbus, Ohio;
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Magee Womens Hospital/University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Introduction: Prior screening results in women diagnosed with cervical carcinoma are only reported in the literature in small numbers. We wish to examine a larger number of prior testing results in women with cervical carcinoma from China to better understand the strengths and weaknesses of Pap cytology and human papillomavirus (HPV) testing. Materials and Methods: 178 patients including 143 squamous cell carcinomas (SCC), 29 adenocarcinomas, and 6 adenosquamous carcinomas had hrHPV testing results and/or Pap test result during the preceding year and were therefore included in this study at China-Japan Friendship Hospital, Beijing, China, from January 2009 to December 2014. Pap cytology was performed using one of the two methods-ThinPrep and SurePath, and HPV testing was done with mostly HC2. Results: 82.0% of women were symptomatic at presentation with vaginal bleeding or abnormal vaginal discharge, 2.2% with abdominal pain, 6.2% with routine examination, and 9.6% with unknown cause. The average time period between the tests and histological diagnosis of cervical cancer was 1.4 months for hrHPV testing, 1.9 months for Pap test. HPV testing was negative in 9.8% of women (Table 1) and Pap cytology had a higher rate of false negative results at 16.7% (Table 2). Adenocarcinoma showed a higher negative testing rate than SCC with both cytology and HPV testing. Only 1 of 78 (1.3%) patients having both tests showed a double negative result (Table 3). Conclusion: Both Pap cytology and HPV testing have surprisingly high rates of prior negative results in women with cervical carcinoma. When testing is performed using both methods, the greatest number of cervical carcinomas can be detected. These results should also be considered when making screening recommendations with the understanding that HPV testing alone will miss at least a proportion of women with incident cervical carcinoma.