HUMAN PAPILLOMA VIRUS IN THE ABNORMAL SQUAMOUS CELLS AND MILDY DYSKARYOTIC CELLS
Background. A persistent infection with high-risk genotypes of human papilloma viruses (HPV) represents the most important etiologic factor for the development of cervical cancer, the second most frequent cancer in women in Slovenia as well as elsewhere in the world. In the detection of precancerous lesions the cervical Papanicolaou (Pap) smear screening is used in Slovenia and worldwide. Management of patients with repeat abnormal smears (Pap II) represents a great and complex clinical and public health problem; repeat cytologic examinations are the routine procedure in many countries, also in Slovenia, although the sensitivity of Pap smear testing in the detection of cervical intraepithelial neoplasms (CIN) II and III is relatively low. In cases of abnormal squamous cells and mildly dyskaryotic cells the presence of infections with high-risk HPV genotypes is being increasingly used as a complementary method to Pap smear testing.
Methods and patients. In the study we enrolled 148 women who within two years had three subsequent Pap II smears (abnormal squamous cells or mildly dyskaryotic cells). The prevalence of HPV infections was determined using three molecular tests: Hybrid Capture II (HCII) (Digene Corporation, Gaithersburg, USA) and two variants of polymerase chain reaction (PCR-PGMY11/PGMY09 and PCR-CPI/CPIIG). HPV genotypes were determined using the method of enzyme restriction of PCR products multiplied by group-specific oligonucleotid primers PGMY11/PGMY09.
Results. HPV infection was detected in 25.7% of women. In women aged ≤ 30 years a statistically significantly higher incidence of HPV infections was found (37.8%) than in women aged ≥ 30 years (20.4%). In women aged ≤ 30 years most frequent infections, and also equally distributed, were the ones with high-risk genotypes HPV 16 and HPV 73 and with a potentially high-risk genotype HPV 26. In women aged ≥ 30 years most frequent infections, and also equally distributed, were the ones with high-risk genotypes HPV 16 and with a potentially high-risk genotype HPV 53. The results of the three chosen molecular methods for the detection of HPV infections matched in 93.2%.
Conclusions. Our findings show that repeat Pap smears as the method of follow-up and detection of precancerous lesions do not provide relevant results due to low prevalence of HPV infections in Slovenia, which indirectly indicates low sensitivity and specificity of Pap smear testing. In the detection of HPV infections, molecular methods are thus sensitive screening tests to be used complementary to cytologic tests in women with abnormal squamous cells or mildly dyskaryotic cells.
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