Human Papillomavirus Laboratory Testing: the Changing Paradigm

Abstract

SUMMARYHigh-risk human papillomaviruses (HPVs) cause essentially all cervical cancers, most anal and oropharyngeal cancers, and some vaginal, vulvar, and penile cancers. Improved understanding of the pathogenesis of infection and the availability of newer tests are changing the approach to screening and diagnosis. Molecular tests to detect DNA from the most common high-risk HPVs are FDA approved for use in conjunction with cytology in cervical cancer screening programs. More-specific tests that detect RNA from high-risk HPV types are now also available. The use of molecular tests as the primary screening tests is being adopted in some areas. Genotyping to identify HPV16 and -18 has a recommended role in triaging patients for colposcopy who are high-risk HPV positive but have normal cytology. There are currently no recommended screening methods for anal, vulvar, vaginal, penile, or oropharyngeal HPV infections. HPV testing has limited utility in patients at high risk for anal cancer, but p16 immunohistochemistry is recommended to clarify lesions in tissue biopsy specimens that show moderate dysplasia or precancer mimics. HPV testing is recommended for oropharyngeal squamous cell tumors as a prognostic indicator. Ongoing research will help to improve the content of future guidelines for screening and diagnostic testing.

Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all‐cause mortality: Results from head and neck 5000, a prospective observational cohort of people with head and neck cancer

“…Moreover, HPV16 E6 antibodies have also been shown to be independent favourable prognostic factors in OPCs 49, 50. Some HPV‐related OPCs are mediated by other HPV genotypes, including HPV18 (1–8% of OPCs), and less commonly HPV33, −35, −56 and −67 51. We only considered HPV16 in the current analysis because 69% of the 1,910 participants with OPCs were HPV16 positive, compared to only 2% who were HPV18 positive.…”

Feasibility and Acceptability of Anal Self-Sampling for Human Papillomavirus Screening in HIV-Infected Patients

“…However, the high prevalence of high-risk HPV in at-risk populations targeted for screening and the high prevalence of anal HPV16 in HIV-positive individuals are clinical concerns, as it was recently highlighted for HIV-infected women [6]. In addition, high-risk HPV and particularly HPV16 were reported to be the strongest risk factors of progression to anal cancer in high-grade anal intraepithelial neoplasia [10,25,26,27]. The present study did not aim at studying the value of HPV detection in anal cancer screening, but assessed, at a more preliminary stage, the acceptability and accuracy of anal self-sampling.…”

“…However, only scarce data are available on the natural history of anal HPV infection and cancer [6]. Moreover, in high-grade anal intraepithelial neoplasia, high-risk HPV and particularly HPV16 were reported to be the strongest risk factors of progression to anal cancer [10]. Hence, high-risk HPV and especially HPV16 detection on anal swabs could be used to identify patients at high risk of anal cancer, which could trigger regular monitoring and procedures such as high-resolution anoscopy and biopsy [11,12].…”

High-Risk Human Papillomavirus in Oral Cancer: Clinical Implications

“…The primers for the PCR-based assays constitute either MY09/ MY11 or GP5+/GP6+ regions with specificity of 91.19-92.76% and sensitivity of 87.14-100% [26,35] HPV types and formalin-fixed tissues are not usable; the specificity and sensitivity are comparable to HPV DNA PCR tests [36]. p16 is a cellular correlate of increased E6 and E7 expression in HPV-positive cancers and immunohistochemical detection of p16 is an inexpensive and standard technique for clinical assessment of HPV status irrespective of the HPV type.…”