Colposcopic and histopathologic evaluation of women with HPV persistence exiting an organized screening program

2020

Preprint

Background: During 2013 and 2016 the Region of Skåne, Sweden, started to analyse human papillomavirus (HPV) and cytology in postmenopausal women 60-65 years of age. Our aim was to evaluate high-risk (HR) HPV mRNA testing for the triage of HPV DNA positive postmenopausal women with normal cytology. Methods: A total of 271 women, 60-65 years of age, underwent liquid based cytology (LBC) and HPV testing by using the HR-HPV DNA MGP-PCR-Luminex assay. HR-HPV DNA-positive women with normal cytology underwent complimentary HPV mRNA testing (Aptima, Hologic Inc.). Over a period of 49 months (SD 11.0) the women received regular follow-up at intervals of 12-18 months. Women with abnormal cytology and/or a positive HR-HPV DNA and/or mRNA result at two subsequent visits were scheduled for colposcopy and clinical examination. Results: Over the surveillance period, 3.6% (10/271) of the HR-HPV DNA positive women developed histologically confirmed high-grade squamous intraepithelial lesions (HSILs) or worse. The cumulative incidence rates (CIR) were 29.7% (CI 24.8-30.1) for HSIL or worse among HPV mRNA-positive women at enrolment (39.5% 107/271) and 0% among HPV mRNA negative women (60.5%, 164/271), (p=0.002). Conclusions : Postmenopausal women with normal cytology along with the presence of HR-HPV mRNA are at increased risk for development of severe cervical dysplasia, in contrast to those women with negative HR-HPV mRNA. The HR-HPV mRNA APTIMA assay detecting 14 HR-HPV types may be a useful triage method among HPV DNA positive postmenopausal women with normal cytology.

Section: Resultssupporting

confidence: 89%

14-type HPV mRNA test in triage of HPV DNA positive postmenopausal women with normal cytology

2020

Preprint

“…The overall clearance rate in our cohort was 70.1% (190/271) and 137 (72%) healed their HR-HPV infection within the first twelve months. Those data are comparable to the results of other studies reporting clearance rates of about 40% in older women within an average time span of four months (4,10,19). The data of recent studies indicate that the long-term protective effect of a negative HPV mRNA result is comparable to that of negative HPV-DNA test (15,20,21).…”

Section: Discussionsupporting

confidence: 87%

“…In our cohort of high-risk (HR) human papillomavirus (HPV) DNA positive postmenopausal women with normal cytology we found significantly increased risk for high-grade squamous intraepithelial lesions It is already shown in the literature that the HR-HPV testing is a safe screening option in postmenopausal women (10) as it increases the likelihood of identifying cervical precancer lesions while cytology alone is known to have a relatively low sensitivity in this age group (3,11). Accordingly, we could also observe in our series a certain discrepancy of about 20 % between LBC results and the corresponding histological findings.…”

Section: Discussionmentioning

confidence: 64%

“…Postmenopausal women represent a special patient group, as they tend to have a higher risk for persistent HR-HPV infections than younger individuals, who have a higher acquisition frequency but also a faster clearance rate (16,17). Furthermore a type-specific HR-HPV persistence, especially for HR-HPV types 16, 18 and 31 appears to be associated with the future development of cervical precancer or worse in this age group (10). It is of clinical importance to distinguish between those individuals with active viral replication who are at risk to develop cervical precancer lesions and those with latent HR-HPV infections lacking any clinical significance.…”

Section: Discussionmentioning

confidence: 99%

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Increased risk for development of severe cervical dysplasia among postmenopausal women with normal cytology and presence of HPV mRNA

2020

Preprint

Background: During 2013 and 2016 the Region of Skåne, Sweden, started to analyse human papillomavirus (HPV) and cytology in postmenopausal women 60-65 years of age. Our aim was to evaluate if the presence of high-risk (HR) HPV mRNA could predict the development of cervical abnormalities among HR-HPV DNA positive women with normal cytology. Methods: A total of 271 women, 60-65 years of age, underwent liquid based cytology (LBC) and HPV testing by using the HR-HPV DNA MGP-PCR-Luminex assay. HR-HPV DNA-positive women with normal cytology underwent complimentary HPV mRNA testing (Aptima, Hologic). Over a period of 49 months (SD 11.0) the women received regular follow-up at intervals of 12-18 months. Women with abnormal cytology and/or a positive HR-HPV result at two subsequent visits were scheduled for colposcopy and clinical examination. Results: Over the surveillance period, 3.6% (10/271) of the HR-HPV DNA positive women developed histologically confirmed high-grade squamous intraepithelial lesions (HSILs) or worse and 13.3% (36/271) were diagnosed with cervical atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSILs). The cumulative incidence rates (CIR) were 29.7% (CI 24.8-30.1) for HSIL or worse among HPV mRNA-positive women at enrolment (39.4% 107/271) and 0% among HPV mRNA negative women (60.5%, 164/271), (p=0.002). The corresponding CIRs for ASCUS and LSIL was 59.9% (95% CI 59.3-66.2) and 26.1% (95 %CI 16.5-35.9), (p=0.001). Conclusions : Postmenopausal women with normal cytology along with presence of HR-HPV mRNA are at increased risk for development of severe cervical dysplasia, in contrast to those women with negative HR-HPV mRNA.

“…It is already shown in the literature that the HR-HPV testing is a safe screening option in postmenopausal women 11 as it increases the likelihood of identifying cervical precancer lesions while cytology alone is known to have a relatively low sensitivity in this age group 3 , 12 .…”

Section: Discussionmentioning

confidence: 99%

14-type HPV mRNA test in triage of HPV DNA positive postmenopausal women with normal cytology

2020

Preprint

Background: During 2013 and 2016 the Region of Skåne, Sweden, started to analyse human papillomavirus (HPV) and cytology in postmenopausal women 60-65 years of age. Our aim was to evaluate high-risk (HR) HPV mRNA testing for the triage of HPV DNA positive postmenopausal women with normal cytology.Methods: A total of 271 women, 60-65 years of age, underwent liquid based cytology (LBC) and HPV testing by using the HR-HPV DNA MGP-PCR-Luminex assay. HR-HPV DNA-positive women with normal cytology underwent complimentary HPV mRNA testing (Aptima, Hologic Inc.). Over a period of 49 months (SD 11.0) the women received regular follow-up at intervals of 12-18 months. Women with abnormal cytology and/or a positive HR-HPV DNA and/or mRNA result at two subsequent visits were scheduled for colposcopy and clinical examination. Results: Over the surveillance period, 3.6% (10/271) of the HR-HPV DNA positive women developed histologically confirmed high-grade squamous intraepithelial lesions (HSILs) or worse. The cumulative incidence rates (CIR) were 29.7% (CI 24.8-30.1) for HSIL or worse among HPV mRNA-positive women at enrolment (39.5% 107/271) and 0% among HPV mRNA negative women (60.5%, 164/271), (p=0.002). Conclusions: Postmenopausal women with normal cytology along with the presence of HR-HPV mRNA are at increased risk for development of severe cervical dysplasia, in contrast to those women with negative HR-HPV mRNA. The HR-HPV mRNA APTIMA assay detecting 14 HR-HPV types may be a useful triage method among HPV DNA positive postmenopausal women with normal cytology.