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Serial quantitation of HPV‐16 in the smears of women with mild and moderate dyskaryosis
Author(s) -
Flannelly G.,
Jiang G.,
Anderson D.,
Melvin W.,
Mann E.,
Kitchener Henry
Publication year - 1995
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.1890470103
Subject(s) - cervical intraepithelial neoplasia , medicine , gynecology , cytology , obstetrics , population , colposcopy , cervical screening , prospective cohort study , cervical cancer , pathology , cancer , environmental health
The aim of this study was to examine the efficacy of semi‐quantitative polymerase chain reaction ( PCR ) testing in cervical smears as an adjunct to cytological surveillance in a cohort of women with mild or moderate dyskaryosis. The study population comprised a group of 62 women who underwent twelve months of cytological and col‐poscopic surveillance as part of a larger randomised prospective study of women with mild and moderate dyskaryosis. Semi‐quantitative PCR for HPV‐16 DNA was carried out on the initial and twelve month study smears before a large loop excision of the transformation zone (LLETZ) was carried out. Smears from a control population which comprised 167 women without a history of abnormal cervical cytology who were attending family planning and general practitioner clinics for routine cervical smears were tested similarly. The presence of high or intermediate levels of HPV‐16 DNA on both the initial and twelve month study smear was positively associated with the identification of cervical intraepithelial neoplasia (CIN) grades II or III in the LLETZ specimen (P=0.01). While the combination of HPV‐16 DNA testing with cytology on a repeat cervical smear improved the selection of women with underlying CIN II/III, there was still a false negative rate of 53%. Twenty‐nine women had ‘low risk’ levels of HPV‐16 DNA and mild dyskaryosis or less on both repeat smears indicating suitability for surveillance, but in fact 34% of them had CIN II/III. This study supports the finding reported previously of an association between high and intermediate levels of HPV‐16 DNA and CIN II/III. This suggests that semi‐quantitative PCR may be a useful adjunct to cytology for selecting those women with mildly abnormal smears who would benefit most from colposcopy. A significant fluctuation in the levels of HPV‐16 DNA was not detected when repeated smears were studied, suggesting that serial estimations of HPV‐16 levels would add little to cytological examination for the subsequent surveillance of women considered to be at low risk of CIN II/III. © 1995 Wiley‐Liss, Inc.