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Human papiloma virus testing in the cervix of high-risk women: A hospital-based clinicopathological, colposcopic, and cytogenetic study

Subhash Bhardwaj, Farooq Ahmed Wani, Altaf Bandy.

Abstract
Background: The role of human papillomavirus (HPV) in the etiopathogenesis of precancerous and cancerous lesions of the cervix has been proven beyond doubt. Uterine cervix is a privileged organ being accessible and easily examined for lesions that can be extirpated in noninvasive stage, thus affecting a complete cure. Many different modalities for early detection of cervical lesions have been adopted, the most cost-effective being the Pap smear (Papanicolaou test). HPV DNA hybrid capture assays can be specifically used for detection of HPV DNA.

Objectives: The purpose of this study was to estimate HPV positivity in high-risk women and to evaluate its relationship with age, parity, and other risk factors. Besides, it was carried out to evaluate the results of cytology, colposcopy, histopathology and HPV hybridization in early detection of cervical carcinoma, and to evaluate each parameter in the present setup.

Materials and Methods: This was a hospital-based prospective study carried out from April 2006 to March 2007. Two hundred prospective patients were enrolled to study HPV positivity among high-risk women. Pap smears were taken and microscopically studied according to the Bethesda System 1988. Patients with atypical squamous cell of undeterminate significance (ASCUS) were then subjected to hybrid capture HPV test. Colposcopy examination and colposcopically-directed biopsies were taken in all the cases.

Results: Most of the patients with lesions suggestive of HPV belonged to younger age group (2130 years), and there was a significant increase in epithelial abnormalities with advancing age (p < 0.05). Inflammatory smears were seen in 70 patients (35%); 40 patients (20%) reported as ASCUS were subjected to High Risk Capture II assay (for HPV 16, 18, 45, 56, 58) and high-risk HPV DNA was found in 20 (50%) of the patients. The sensitivity of cytology was only 61%, histopathology could detect 24 (12%) additional cases of dysplasia compared to cytology, indicating a low sensitivity of Pap smear. Colposcopy correlated well with histopathology with a comparatively high sensitivity (80%).

Conclusion: We conclude that cytology will continue to be a major screening method for detection of cervical lesions due to its low cost and easy availability. We also conclude that HPV DNA testing is a very sensitive and highly reproducible test but cannot be used as a mass screening procedure due to its expensive nature and its inaccessibility to the common masses.

Key words: Human Papillomavirus; Cervical Cancer; Pap Smear, Colposcopy



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