Factors Associated with Presence of Human Papillomavirus Infection among Women: Findings from New Cervical Cancer Screening in Kelantan, Malaysia

@#Introduction: Human papillomavirus (HPV) infection is known to cause cervical cancer worldwide. Recently, Malaysia introduced HPV DNA detection testing for cervical cancer screening program. However, knowledge regarding factors for HPV infection among women still limited. Thus, this study aimed to determine the prevalence and factors associated with HPV infection among women in Kelantan, a north-eastern state of Malaysia. Methods: This study used secondary data extracted from HPV DNA test registry book and HPV DNA laboratory request forms. Data on all Malaysian women aged 30 to 49 years old in 2019 reported in registry book were included. Simple random sampling was applied. All information from book and forms were collected using proforma and analysed using SPSS. The outcomes were categorised into HPV infection and non-HPV infection. The parameters related to factors associated with HPV infection were determined using multivariable logistic analysis. Results: The prevalence of HPV infection among women attending the new cervical screening was 8.4% (95% CI 6.4%, 10.3%). Those aged between 30 and 39 years old (AdjOR 2.09; 95% CI 1.16, 3.78, p=0.014), had 5 or more parities (AdjOR 2.82; 95% CI 1.58, 5.06, p<0.001) and hormonal contraception users (AdjOR 7.48; 95% CI 4.07, 13.76, p<0.001) were significantly associated with HPV infection. Conclusion: Overall, the prevalence of HPV infection from this study is comparable to the local and international studies. Age, number of parities and hormonal contraception users influence the HPV infection. This finding could help in designing more targeted screening for cervical cancer.

Riesgo de desarrollar LIE-AG en pacientes con tamizaje inicial positivo para VPH y citología cervicovaginal negativa en seguimiento hasta 10 años: revisión sistemática y metaanálisis / Risk of developing H-SIL in patients with initial positive screening for HPV and negative cervicovaginal cytology in follow-up up to 10 years: systematic review and meta-analysis

Resumen Introducción: El cáncer de cérvix es el segundo en frecuencia y el tercero en mortalidad; la infección por el virus del papiloma humano (VPH) está asociada al riesgo de cáncer; sin embargo, no se conoce el riesgo acumulado a 1, 2, 3, 5 y 10 años. Objetivo: Determinar el riesgo de las pacientes VPH positivo con evaluación inicial citológica negativa para desarrollar lesión intraepitelial de alto grado a lo largo del tiempo. Método: Se realizó una revisión sistemática de artículos en inglés y español de los últimos 20 años, usando las bases de datos PubMed, Cochrane, LILACS, ProQuest y Embase. Se incluyeron ensayos clínicos aleatorizados en los que se determinaba el estado VPH y se realizaba seguimiento con citología cervicovaginal a 1, 2, 3, 5 y 10 años en mujeres de 20-64 años. Resultados: Se incluyeron siete ensayos clínicos aleatorizados, con un total de 98.521 mujeres, de ellas 8820 VPH positivo y 89.701 VPH negativo al ingreso, seguidas hasta por 10 años con citología cervicovaginal, encontrando que la infección por VPH es un factor de riesgo para desarrollar lesiones intraepiteliales de alto grado a 2, 5 y 10 años, con un riesgo relativo de 110.94 (79.41-154.97), 83.65 (55.22-126.73) y 29.71 (5.72-154.33), respectivamente. Conclusiones: La infección por VPH es un factor de riesgo importante para el desarrollo de lesiones intraepiteliales de alto grado a 2, 5 y 10 años.

Abstract Introduction: Cervical cancer is the second in frequency and the third in mortality, infection by the human papillomavirus (HPV) is associated with the risk of increased cancer; however, the cumulative risk of 1, 2, 3, 5 and 10 years is not known. Objective: To determine the risk of HPV-positive patients with negative initial cytological evaluation for developing high-grade intraepithelial lesion over time. Method: A systematic review of articles in English and Spanish in the last 20 years was carried out, using the PubMed, Cochrane, LILACS, ProQuest and Embase databases. Randomized clinical trials were included in which HPV was performed and subsequent follow-up with cervicovaginal cytology at 1, 2, 3, 5 and 10 years in women aged 20-64 years. Results: Seven randomized clinical trials were included, a total of 98,521 women, 8820 with positive HPV and 89701 negative on admission and followed up for up to 10 years with cervicovaginal cytology. Finding that HPV infection is a risk factor for developing high-grade intraepithelial lesion at 2, 5 and 10 years with a relative risk of 110.94 (79.41-154.97), 83.65 (55.22- 126.73) and 29.71 (5.72-154.33), respectively. Conclusions: HPV infection is an important risk factor for the development of high-grade intraepithelial lesion at 2, 5 and 10 years.

Application and prospect of fecal DNA test in colorectal cancer screening / 中华胃肠外科杂志

Effective early screening and primary prevention is one of the major initiatives to decrease the morbidity and mortality of colorectal cancer in China. As a new non-invasive screening method for colorectal cancer in recent years, fecal DNA test detects colorectal cancer by analyzing gene mutations from intestinal tumor cells in the feces. The most widely used method among fecal DNA test is multi-target stoolDNA test (MT-sDNA). Many studies abroad on this emerging technique have been carried out to verify its high sensitivity, and it is gradually used in the clinic with continuous improvement and development of technology. Meanwhile, domestic MT-sDNA is still in the prototype stage, and more researches from Chinese population are needed. Compared with traditional screening methods, MT-sDNA technology has the advantages of non-invasiveness, painlessness and convenience. But its defects exist, such as high cost and low specificity. MT-sDNAis in accordance with precision medicine, and can largely make up for the shortcomings of traditional screening methods for colorectal cancer. It also holds a great promise for promoting the screening for colorectal cancer. This paper is aimed to discuss the application value of fecal DNA test by introducing its related researches at home and abroad,and summarizing its merits and demerits.

Evaluation of satisfaction with three different cervical cancer screening modalities: clinician-collected Pap test vs. HPV test by self-sampling vs. HPV test by urine sampling / 부인종양

OBJECTIVE: Human papillomavirus testing by self-sampling and urine sampling might be alternatives to Papanicolaou test (Pap test) for cervical cancer screening (CCS), and may increase compliance and adherence thereto. The present study aimed to explore satisfaction and preferences for cervical screening modalities among Korean women. METHODS: In total, 732 women aged between 20 and 69 years responded to a questionnaire designed to survey the women's perceived satisfaction for the 3 CCS modalities: clinician-collected Pap test, self-collected vaginal sampling (self-sampling) and urine sampling. RESULTS: Overall satisfaction was significantly higher with both the self-sampling and urine sampling than the clinician-collected Pap test (odds ratio [OR]=2.01; 95% confidence interval [CI]=1.48–3.00 and OR=2.47; 95% CI=1.75–3.48, respectively). Psychological distress, including embarrassment, pain, anxiety, discomfort, and stress, with self-sampling and urine sampling were significantly lower than that with the Pap test. 52% of participants reported preferences for self-sampling in the next screening round. CONCLUSIONS: Korean women were more likely to report satisfaction with alternative modalities (self-sampling and urine sampling) for CCS in comparison to the Pap test. This suggests that self-collected modalities may help with improving CCS uptake rates by eliminating burden related with the Pap test. However, further studies for test accuracy and cost-effective analysis of the alternative modalities should be conducted in order to apply CCS.

Cost analysis of different cervical cancer screening strategies in Mexico / Análisis de costos de distintas estrategias de tamizaje para cáncer cervical en México

Objective. To compare the costs and number of undetected cases of four cervical cancer screening strategies (CCSS) in Mexico. Materials and methods. We estimated the costs and outcomes of the following CCSS: a) conventional Papanicolaou smear (Pap) alone; b) high-risk human papilloma virus testing (HR-HPV) as primary screening with Pap as reflex triage; c) HR-HPV as primary screening with HPV-16/18 typing, liquid-based cytology (LBC) and immunostaining for p16/Ki67 testing as reflex triage, and d) co-testing with HR-HPV and LBC with HPV-16/18 typing and immunostaining for p16/Ki67 as reflex triage. The outcome of interest was high-grade cervical lesions or cervical cancer. Results. HR-HPV testing, HPV typing, LBC testing and immunostaining is the best alternative because it is the least expensive option with an acceptable number of missed cases. Conclusions. The opportunity costs of a poor quality CCSS is many false negatives. Combining multiple tests may be a more cost-effective way to screen for cervical cancer in Mexico.

Objetivo. Comparar los costos y los casos no detectados de cuatro estrategias de tamizaje de cáncer cervical (ETCC) en México. Material y métodos. Se estimaron los costos y resultados en salud de las siguientes ETCC: a) citología convencional como único procedimiento de tamizaje; b) detección de virus del papiloma humano de alto riesgo (VPH-AR) como tamizaje primario y citología convencional como procedimiento de triage; c) detección de VPH-AR como tamizaje primario y tipificación de VPH-16/18, citología en base líquida e inmunotinción para p16/Ki67 como procedimientos de triage, y d) evaluación conjunta con VPH-AR y citología en base líquida como tamizaje primario y tipificación de VPH-16/18 e inmunotinción para p16/Ki67 como procedimientos de triage. El resultado en salud analizado fueron los casos de neoplasia intraepitelial cervical (CIN 2/3) o cáncer cervical detectados. Resultados. La ETCC basada en la detección de VPH-AR como prueba primaria y seguida de la tipificación de VPH-16/18, la citología en base líquida y la inmunotinción para p16/Ki67 como procedimientos de triage es la mejor alternativa, ya que es la menos costosa y la que tuvo un nivel aceptable de casos perdidos. Conclusiones. El costo de oportunidad de una ETCC de mala calidad es un alto número de falsos negativos. La combinación seriada de varias pruebas de tamizaje y triage puede ser una alternativa costo-efectiva para la detección oportuna de cáncer cervical en México.

Comparison of the Digene HPV Genotyping LQ Test and the PANArray HPV Genotyping Chip for Detection of High-Risk or Probable High-Risk Human Papillomavirus Genotypes

BACKGROUND: We evaluated the performance of two different array-based techniques, a bead-based multiplex genotyping method (LQ; digene HPV Genotyping LQ Test, QIAGEN, Germany) and a DNA chip-based method using peptide nucleic acid probes (PANArray; PANArray HPV Genotyping Chip, Panagene, Korea), for detection of human papillomavirus (HPV) and genotyping of high-risk (HR) or probable high-risk (PHR) HPVs in healthy patients who visited a health-promotion center. METHODS: We obtained 508 unselected, consecutive cervicovaginal swab specimens. All specimens were examined by using the PANArray and LQ tests. All HPV-positive samples were then analyzed by multiplex PCR and direct sequencing. RESULTS: The LQ test detected 47 HPV-positive cases (9.3%) with HR or PHR genotypes and the PANArray test identified 36 cases (7.1%). When the results of LQ and PANArray were compared by using comprehensive genotyping (integrated interpretation of the results of LQ, PANArray, multiplex PCR, and direct sequencing) for the detection of HR or PHR genotypes, the kappa values were 0.44 and 0.30 for LQ and PANArray, respectively. In comparison to comprehensive genotyping, the LQ test yielded 53 (60.0%) concordant and 12 (13.5%) compatible results, and the PANArray yielded 36 (40.4%) concordant and three (3.4%) compatible results. CONCLUSIONS: The results of the LQ test had higher concordance and/or greater compatibility with those of comprehensive genotyping for the detection of HR or PHR genotypes than those of the PANArray test.

Stool DNA Testing for Colorectal Cancer: Development and Advances

Screening for colorectal cancer is one of the most effective public health interventions. Although colonoscopy is the preferred method in many settings, colonoscopy can miss lesions, interval neoplasms can arise after a normal colonoscopy, and some patients refuse to undergo colonoscopy. In the last decade, detection of neoplasia-associated genetic alterations in the stool has become feasible. First-generation stool DNA tests demonstrated better sensitivity for colorectal cancer than fecal occult blood tests. Improvements to stool DNA tests have made them more sensitive and less complex. The newer marker panels can detect colorectal cancer and even the majority of advanced adenomas, regardless of location in the colon. This review summarizes the development and advances to stool DNA testing for colorectal cancer.

Avaliação de métodos diagnósticos, morfológicos e biomoleculares em mulheres encaminhadas com citologia alterada / The diagnostic efficacy of morphologic and molecular methods in women with abnormal citology

Introdução: o câncer do colo uterino é a neoplasia mais frequente em mulheres de países em desenvolvimento. Doença causada pela infecção persistente com diferentes tipos de papilomavírus humano (HPV) classificados em baixo e alto risco, de acordo com o potencial oncogênico. Objetivo: em mulheres com diagnóstico citopatológico anormal por ocasião de exame de rastreamento do câncer cervical, encaminhadas por diferentes postos de atendimento do Sistema Único de Saúde para serviço universitário de referência e com diagnóstico definitivo de lesão intraepitelial de alto grau ou câncer cervical, avaliara eficácia diagnóstica de métodos morfológicos e biomoleculares utilizados de maneira isolada ou em associação; e a prevalência, estratificada em duasfaixas etárias, abaixo de 30 e igual ou superior a 30 anos, do HPV tipos 16, 18 e 45. Métodos: estudaram-se 167 mulheres encaminhadas ao Ambulatório de Patologia Cervical e Colposcopia do Hospital Universitário da Universidade Federal de Juiz de Fora, no período de novembro de 2002 e dezembro de 2003,com colo uterino íntegro, não grávidas e sem história de câncer no trato genital inferior. Coletaram-se, de todas as mulheres, amostras para estudo citológico,convencional e em meio líquido, e para os testes de DNA-HPV. Considerou-se como diagnóstico histopatológico final a avaliação mais grave dentre ospossíveis espécimes, biópsia, conização ou peça cirúrgica, que a paciente pudesse ter. Resultados: não há qualquer diferença no tocante à sensibilidade,ao valor preditivo positivo e negativo e à acurácia dentre os métodos diagnósticos estudados, porém a associação da citologia com o teste DNA-HPV tem menor especificidade que o exame citológico isolado, quer convencional ou em meio líquido. A prevalência do HPV 16, 18 e 45 cai de 88,9% para 50,0%nas mulheres com 30 anos ou mais (p = 0,02). Conclusão: nas mulheres encaminhadas ao ambulatório de PTGIC do HU-UFJF com colpocitologia alteradanão se justifica a realização de qualquer exame confirmatório, devendo realizar-se imediatamente a colposcopia para se ter o desfecho diagnóstico.

Introduction: cervical cancer is the most frequent neoplasia among the women of countries in development. Great part of these cases is caused by persistent infection with different types of human papilomavirus (HPV) classified as low and high risk, according to the risk of cervical cancer development. Objectives:based on women with abnormal cytology when screening for cervical cancer who were led from different units of the Public Health System to the reference university service and with a definite diagnosis of high cervical intraepithelial neoplasia or cancer, was to evaluate the diagnostic efficacy of morphologicand molecular methods used alone or together and the prevalence of HPV types 16, 18, 45, stratified into two age brackets. Methods: 167 women went to the Cervical Pathology and colposcopy clinic of the University Hospital of the Universidade Federal de Juiz de Fora, during the period from November 2002 to December 2003, with intact uterine cervix, not pregnant and without previous chemical and/or radiotherapy treatment for the inferior genital tract.Samples for cytology study were collected from all women, with conventional and liquid-based preparations, for CH2 for high risk virus, for DNA PAP andfor Probe Pack test. The worst histologic diagnosis among the possible histologic studies through biopsy, conization or cirurgic pieces was considered as "gold standard". Results: there is no difference regarding sensibility, positive predict value and negative predict value for all methods studied, However, the DNA PAP method has less specificities than the citology exam, either with conventional or based-liquid preparation. The prevalence of HPV 16, 18, 45 decreases from 88,9% to 50% in women of 30 years old or more, being this decrease statistically significant. Conclusion: in those women led to the PTGIC of the HUUFJF with abnormal cytology it is not necessary to repeat any tests, just colposcopy in order to reach the final diagnosis.

Detection of human papillomavirus type 16 and 18 by PCR in patients with cervical neoplasia / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the detection rate of human papillomavirus (HPV) DNA Test (type 16 and 18) and to investigate the clinical significance of HPV DNA test in patients with cervical neoplasia. METHODS: Of the 708 patients aged 21~83 years who had undergone both conventional Papanicolaou cervical cytologic test and HPV DNA test by polymerase chain reaction, 383 cases underwent histologic diagnoses. RESULTS: Of the 708 cytologic diagnoses, there were 11 positive HPV DNA test diagnoses in squamous cell carcinoma (SCC), 41 in high-grade squamous intraepithelial lesion (HSIL), 20 in low-grade squamous intraepithelial lesion (LSIL), 41 in atypical squamous cells (ASC), and 86 in negative cytology. Of the 383 histologic diagnoses, there were 24 positive HPV DNA test diagnoses in SCC, 42 in cervical intraepithelial neoplasia (CIN) 3, 12 in CIN 2, 12 in CIN 1, 7 in atypical change, and 45 in negative histology. Of the 239 patients with negative HPV DNA test, 28.5% cases showed histologic diagnoses of CIN 1 or worse lesion. Of the 46 patients with negative cytology and positive HPV DNA test, 50.0% cases showed histologic dianoses of CIN 1 or worse lesion. Pap cytology revealed sensitivity of 72.5%, specificity of 66.4%, and false negative rate of 27.5%, whereas HPV DNA test showed 57.5%, 76.7%, and 42.5%, respectively. CONCLUSION: This study confirmed that the primary standard Pap cytology and HPV DNA test were adjunctive. Also this study showed that physicians always should not overrate Pap cytology or HPV DNA test in managing the patient with cervical neoplasia. Combined test was a very effective diagnostic method for detecting cervical neoplasia.

Human papillomavirus test for prediction of recurrent and residual disease after treatment for cervical intraepithelial neoplasia / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate high-risk (HR) HPV DNA test to predict recurrence/residual disease in patients treated for CIN (cervical intraepithelial neoplasia). METHODS: Four hundred and fifty-two patients treated with LLETZ (large loop excision of the transformation zone) were followed by HR HPV DNA test, cytology and colposcopy. The sensitivity, specificity and diagnostic odds ratios in predicting recurrence/residual disease were compared to those of cytology and HPV DNA test. RESULTS: Fourteen patients (3.1 %) developed recurrent/residual disease, during follow up. Of these women, 7 were diagnosed at the time of recurrence with a CIN 1 lesion, 5 with a CIN 2 lesion, and 2 with a CIN 3 lesion. The sensitivity and specificity of the HPV DNA test were 92.9% (CI 68.5%, 98.7%) and 75.3% (71.1%, 79.1%). The sensitivity and specificity of the cytology were 71.4% (45.4%, 88.3%) and 92.5% (89.6%, 94.6%), respectively. The likelihood ratio of a positive and negative HPV DNA test were 3.77 (3.03, 4.69) and 0.09 (0.01, 0.63). And the likelihood ratio of a positive and negative cytology were 9.48 (5.95, 15.11) and 0.31 (0.13, 0.71). The accuracy of cytology and HPV DNA test were 94.7% and 78.3%. The sensitivity and specificity of the combination test (PAP and/or HPV DNA test) were 92.9% (68.5%, 98.7%) and 73.1% (68.7%, 77.0%). The likelihood ratio of a positive and negative combination test were 3.45 (2.79, 4.26) and 0.10 (0.01, 0.65). CONCLUSION: Cytology remains the base in the follow up after of CIN. HPV DNA test increase the sensitivity of cytology. Negative HPV test can rule out recurrent/residual disease.

The comparative evaluation of clinical screening in combined tests cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) II),cervicography for uterine cervical cancer / 부인종양

OBJECTIVE: Since the accuracy of Pap smear for cervical neoplasm has been questioned, a number of adjunctive tests have been developed. The purpose of this study was to evaluate which protocol is the most effective screening test among cervical cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) II) and cervicography. METHODS: We chose 252 patients who were underwent the biopsy among 829 patients who visited our hospital for cervical cancer screening test. These 252 patients were engaged in this study simultaneously. They underwent triple combined test [cervical cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) II), cervicography] and colposcopic-directed biopsy or biopsy on operation for diagnostic evaluation. RESULTS: The triple combined test showed a sensitivity of 96.0%, while double combined test [cervical cytology (ThinPrep(R))+cervicography] showed a sensitivity of 89.0%, the other double combined test [cervical cytology (ThinPrep(R))+HPV DNA test (Hybrid capture(R) II)] showed a sensitivity of 86.7%. Cervicography showed a specificity of 75.4% (highest among the single test), positive predictability of 89.8% (also highest). CONCLUSION: The sensitivity of cervical cytology was markedly improved by combination with HPV DNA test and cervicography. So the triple combined tests which improved the high false negative rate of cervical cytology may be a new effective method as a cervical cancer screening test, if the effectiveness could be confirmed by mass screening study.

Clinical Efficacy of Human Papillomavirus DNA test after Loop Electrosurgical Excision Procedure in Cervical Intraepithelial Neoplasia / 대한산부인과학회지

OBJECTIVE: The aim of this study was to analyze a relation between the recurrence of cervical intraepithelial neoplasia (CIN) and the detection of high-risk human papillomavirus (HPV) DNA after loop electrosurgical excision procedure (LEEP), and to evaluate the clinical efficacy of HPV DNA test by Hybrid Capture Assay as a predictor of the recurrence of CIN after LEEP. METHODS: From January 2000 through March 2003, the charts of 238 women diagnosed as CIN and treated with LEEP were reviewed retrospectively. HPV DNA test (Hybrid Capture System I) for high-risk HPV was performed in all patients before LEEP. They were followed up with Papanicolaou smears and HPV DNA tests at the interval of 3 months during the first 6 months and then at the interval of 6 months. The Chi-square test was used for the statistical analysis. RESULTS: The rate of detection of high-risk HPV declined chronologically after LEEP. A higher recurrence rate was noted in the HPV DNA positive group after LEEP, comparing with the negative group, at 3 months (54.5% in positive vs. 6.5% in negative; p<0.05), at 6 months (61.1% in positive vs. 5.4% in negative; p<0.05), at 12 months (50.0% in positive vs. 14.0% in negative; p<0.05), and at 18 months (50.0% in positive vs. 15.2% in negative; p<0.05). The negative predictive value was high at 3 months (93.5%), at 6 months (94.6%), at 12 months (86.0%), and at 18 months (84.6%). There were significant associations between the recurrence of CIN and positive resection margin except for glandular involvements. CONCLUSION: The detection of high-risk HPV is a risk factor for the presence of CIN after LEEP. HPV DNA test by Hybrid Capture Assay after LEEP may be useful marker for the negative prediction of recurrence of CIN after LEEP.

Resection margin status and HPV DNA test as predictor of residual lesion after cervical conization in the management of CIN 3 / 부인종양

OBJECTIVE: To identify resection margin status and HPV DNA test as predictive factors for residual lesion in the management of CIN3 with cervical conization. METHODS: A retrospective study was conducted on 96 patients with CIN3 who had been performed cervical conization (LEEP or CKC) between January 1999 and December 2003 at Soonchunhyang university Chunan hospital. Secondary conization or hysterectomy were performed in case of positive margin on cone specimen or negative margin with other hysterectomy indication. Resection margin status and pre conization HPV DNA test were compared with residual lesion on subsequent cone or hysterectomy specimen. RESULTS: Among 96 cases, 24 cases (15.6%) showed positive resection margin on cone specimen. Of 24 cases with positive resection margin, 2 cases were followed up without treatment, 2 cases were treated with secondary conization and 20 cases were treated with hysterectomy. Of 72 cases with negative resection margin, hysterectomy was performed due to other indication in 16 cases. Persistence of residual lesion in the secondary conization and hysterectomy specimens was significantly correlated with high risk HPV infection and positive resection margin status (p<0.05). CONCLUSION: Conization is good treatment modality of the management of CIN3. HPV DNA test and resection margin status are good predictor of residual lesion after cervical conization for the management of CIN 3. Therefore, when HPV positive and resection margin positive, secondary treatment is mandatory.

The diagnostic potential of maternal plasma in detecting fetal diseases by DNA test.

Conventionally, DNA based investigations for fetal diseases are done by chorionic villous sampling and amniocentesis. Both are invasive techniques. Recently, molecular diagnosis has also been made possible in early pregnancy from maternal blood which is noninvasive and advantageous. Most of the researches have tried to identify the Y chromosome marker(s) to detect a male fetus and paternally inherited allele. This is currently helpful to detect a very few genetic disorders including Rh D status in Rh negative women in early pregnancy and preeclampsia a few weeks preceding the clinical onset. This is a potential area for prenatal diagnosis in future.

Identification of High Risk Group of HPV associated with Cervical Cancer in Korean Women / 대한산부인과학회잡지

OBJECTIVE: To identify genital HPV types and high risk group of HPV associated with cervical cancer in Korean women. METHODS: Both Pap test and HPV-DNA test using PCR assay were performed as screening test for cervical cancer in this clinic. When patients were positive in HPV-DNA test, HPV genotyping using sequencing method and cervical biopsy were performed. RESULTS: Frequent age group of HPV infection was 40 yrs (34.3%) and prevalence of HPV infection was 9.8%. Twenty-three types of HPV were detected. HPV 16 and 58 were detected in invasive cancer. HPV 16, 31, 33, 45, and 58 were detected in HSIL. HPV 6, 11, 18, 53, 59, and 66 were detected in LSIL. HPV 16 was most commonly detected in HSIL and invasive cancer. CONCLUSION: HPV 16, 31, 33, 45, and 58 are included in high risk group of HPV in Korean women. It may be very effective in early detection of cervical cancer to classify HPV types included in high risk group of cervical cancer in Korean women and to perform cervical biopsy in the patients who have high risk types of HPV infection.

Identification of High Risk Group of HPV associated with Cervical Cancer in Korean Women / 대한산부인과학회잡지

OBJECTIVE: To identify genital HPV types and high risk group of HPV associated with cervical cancer in Korean women. METHODS: Both Pap test and HPV-DNA test using PCR assay were performed as screening test for cervical cancer in this clinic. When patients were positive in HPV-DNA test, HPV genotyping using sequencing method and cervical biopsy were performed. RESULTS: Frequent age group of HPV infection was 40 yrs (34.3%) and prevalence of HPV infection was 9.8%. Twenty-three types of HPV were detected. HPV 16 and 58 were detected in invasive cancer. HPV 16, 31, 33, 45, and 58 were detected in HSIL. HPV 6, 11, 18, 53, 59, and 66 were detected in LSIL. HPV 16 was most commonly detected in HSIL and invasive cancer. CONCLUSION: HPV 16, 31, 33, 45, and 58 are included in high risk group of HPV in Korean women. It may be very effective in early detection of cervical cancer to classify HPV types included in high risk group of cervical cancer in Korean women and to perform cervical biopsy in the patients who have high risk types of HPV infection.

Cervicography and HPV DNA Testing as Triage Criteria for Women with Abnormal Pap Smear by Primary Care Clinicians / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to determine the predictive values of cervicography and HPV DNA test for histologic CIN diagnoses among women with abnormal cervical cytology so as to use as an intermediate triage criteria by primary care clinicians. METHODS: All 129 patients with abnormal cervical cancer screening tests underwent simultaneous or consecutive cervicography, HPV DNA test, colposcopically directed punch biopsy and/or LEEP. The results of single or combination screening tests were compared with final histopathologic findings. 71 among 129 patients were referred from other clinics, and remainders from mine between July 2000 and June 2001. RESULTS: Sensitivity/Specificity/PPV/NPV/Efficiency and FPR/FNR of single or combination tests were calculated. Following results were obtained. 1) Sensitivity : Triple combined test was 100%, double combined test by cytologic test plus either cervicography or HPV DNA test (97.8%), cytologic test (94.6%), HPV DNA test (88.4%), and cervicography (56.0%) followed. 2) Specificity : Cervicography was 61.1%, HPV DNA test (45.9%), cytologic test (30.6%), double combined test by cytologic test plus HPV DNA test (22.9%), double combined test by cytologic test plus cervicography (8.3%), and triple combined test (7.9%) followed. 3) PPV : No statistically significant differences were shown among single, double and triple combined tests, and it ranged between 72.2% and 80.8%. 4) NPV : Triple combined test was 100%, double combined test by cytologic test plus HPV DNA test (80.0%), HPV DNA test (68.0%), double combined test by cytologic test plus cervicography (60.0%), and cervicography (34.9%) followed. 5) Efficiency : Larger than 70% of efficiency in all screening methods (either single or combined) except single cervicography (57.4%). 6) FPR : Triple combined test was 92.1%, double combined test by cytologic test plus cervicography (91.7%), double combined test by cytologic test plus HPV DNA test (78.4%), cytologic test (69.4%), HPV DNA test (54.1%), and cervicography (38.9%) followed. 7) FNR : Cervicography was 44.1%, HPV DNA test (8.7%), cytologic test (5.4%), double combined test by cytologic test plus cervicography (2.2%), double combined test by cytologic test plus HPV DNA test (1.1%), and triple combined test (0%) followed. CONCLUSION: Even though the optimal clinical management of cervical cytologic abnormality remains still problematic, this study demonstrates that additional HPV DNA test and/or cervicography have much value in predicting histologic CIN diagnoses. Primary care clinicians can easily perform these tests at their clinics as an intermediate triage criteria to prevent overreferral for colposcopy without compromising the detection of significant disease underlying cytologic atypia.

Korean National Recommendation Guidelines on Screening and Surveillance for Early Detection of Colorectal Cancers

Colorecal cancer undergo relatively long preneoplastic processes before being invasive. Fecal occult blood test (FOBT) has been a useful tool to detect the advanced colorectal cancers with cost-effectiveness. However, the patient’s compliance to FOBT was poor because of low sensitivity and annual sampling. The sigmoidoscopy and colonoscopy have the ten-year preventive effect for the advanced cancer. Recently the DNA stool test for detection of mutations has showed excellent sensitivity and specificity. It has several adventages such as collection of samples and automated analysis. Virtual colonoscopy, especially CT colonograpy, can be a viable option for the colorecal cancer screening. In November 2001, the Korean Society of Coloproctology (KSCP) and the Natinal Cancer Center (NCC) developed the guidelines on screening and surveillance for early detection of colorectal cancers in Korea. Average-risk men and women should start colonoscopic examination with a 10-year interval at the age of 50. Individuals with increased risk such as those with a family or personal history of colorectal cancer or colorectal adenomas, or family history of familial adenomatous polyposis, hereditary non-polyposis colorectal cancer should consult their surveillance to the specialty-physicians. The ideal screening tools may change by age.

Three ways in detection of HPV infection of cervical squamous epithelial cells / 解放军医学杂志

Objective To investigate the efficiency of three methods to detect HPV infection of desquamated cervical epithelial cells and the relationship between methods and TCT.Methods hC2 method was used in disconnecting the HPV DNA chain in the samples to hybrid captures,and examine the 13 types of HPV which were highly related to cervical carcinoma.Q-PCR was first used to extract HPV DNA of samples and expanded nucleotide to be examined on Q-PCR to obtain results directly.MPHC was used to extract HPV DNA and to amplify nucleotide.The products was added to micro-well plate to proceed hybridization,and enzyme label was added,and results were studied in the enzyme labelling apparatus.The results of the latter two methods were the same as hC2.hC2 matched Q-PCR was used to examine 260 eases of desquamated cells from HPV infection against 200 cases of desquamated cells from HPV infection,and the results were compared by using MPHC matching examination.Results 1.With three methods,HPV infection was found to be 100% in all the abnormal cervical squamous epithelial cells.2.The sensitivity of the methods,howerer,was different.The QFCR and MPHC had higher positive rate than hC2.Positive HPV infection rate with Q-PCR and MPHC was the same as that of hC2 in the majority of cases,as in a few cases,it was positive with Q-PCR and MPHC but negative with hC2 alone False positive rate was 2% in MPHC.Conclusion HPV testing combined with the TCT routine is the best screening program for detecting cervical cancer and precursor of cervical careinoma.

The Prevalence of HPV Infection in General Population of Korea and Efficacy of HPV DNA Test as an Adjunctive Screening of Cervical Cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Our study was performed to assess prevalence of HPV infections in general female population of Korea and efficacy of HPV DNA test as an adjunctive screening of cervical cancer. MATERIALS AND METHODS: From January 2000 to December 2000, a total 689 patients who had undergone Pap smear and HPV DNA test using Hybrid Capture System-II were included in this study. High risk types of HPV included 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68. We performed colposcopic biopsy on 203 patients. RESULTS: High-risk oncogenic HPV infections were found in the 19.4% of the investigated patients. The sensitivity and negative predictive value of Pap smear alone in identifying the lesions more severe than CIN 2 was 72.2% and 83.2%, respectively. The combination of Pap smear and high risk HPV testing increased to 96.3% and 95.3%, respectively. CONCLUSIONS: The prevalence of HPV infection in general population was 19.4%. The use of HPV DNA testing significantly improved the sensitivity or negative predictive value of the diagnosis of high grade CIN or cancer. Thus, we suggest HPV DNA testing appears to be a needed adjunct to the Pap smear and a combined screening test offers the possibility of greater detection or longer screening intervals, which will be able to reduce the overall cost of the screening program.