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HPV 16 and HPV 18 genotyping triage in young women with borderline cytology or mild dyskaryosis: effect of age on genotype‐specific risk of high‐grade CIN
Author(s) -
McKenna M.,
McMenamin M.,
McDowell A.
Publication year - 2016
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12316
Subject(s) - colposcopy , medicine , cervical intraepithelial neoplasia , triage , genotyping , gynecology , cytology , obstetrics , population , genotype , relative risk , cervical cancer , human papillomavirus , cancer , pathology , environmental health , confidence interval , biology , emergency medicine , biochemistry , gene
Objective Human papillomavirus ( HPV ) triage of borderline cytology or mild dyskaryosis is limited by the higher prevalence of HPV in women with these findings relative to those with high‐grade cervical intraepithelial neoplasia (≥ CIN 2). This is particularly relevant in young women in whom HPV prevalence is discernible. In a previous analysis of HPV triage and colposcopy outcomes in Northern Ireland, we revealed a substantial amount of prevalent high‐grade disease in women below 30 years of age. We explored the role of genotyping for HPV 16/ HPV 18 in this population by assessing the risk of high‐grade lesions associated with these genotypes and the effect of age on type‐specific risk. Methods Of the 866 women eligible for HPV triage, those who tested positive for HPV were referred to colposcopy. The relative risk of ≥ CIN 2 for HPV 16, HPV 18 and non‐ HPV 16/18 high‐risk genotype positivity was determined for cobas ® HPV Test‐positive results. Results The relative risk of high‐grade CIN was significantly greater in women infected with HPV 16 and/or HPV 18 compared with non‐ HPV 16/18 infections, regardless of age (2.23 and 0.45, respectively). In women under 30 years of age, HPV 16‐associated risk of ≥ CIN 2 was significantly greater than that of HPV 18 and the non‐ HPV 16/18 genotypes (1.74 versus 1.03 and 0.58, respectively). In women aged ≥30 years, HPV 18 infection presented the greatest risk of ≥ CIN 2 (3.03). The relative risk of ≥ CIN 2 associated with non‐ HPV 16/18 genotypes was lower (range, 0.32–0.58) for both age groups. Conclusion This analysis demonstrates the value of genotyping for HPV 16/ HPV 18 and age stratification to improve the specificity of HPV triage and to tailor management relative to the risk of high‐grade CIN and cancer.