ASSOCIATION BETWEEN TYPE OR NUMBER OF HPV INFECTIONS AND CYTOLOGICAL AND COLPOSCOPY-DIRECTED BIOPSY ANALYSIS OF CERVIX UTERI

Abstract

Aim: The association of high-risk (hHPV) genotypes with discordance between cytological and histopathological analysis of cervix uteri has been reported in a limited number of studies. We aimed to compare the cytological and histopathological analysis of cervix uteri and association of these with HPV genotypes and clinical factors in HPV-positive adult patients.

Materials and Methods: Patients who underwent cervical screening, HPV genotype analysis, and colposcopy-directed biopsy after cervical screening were included in this study. Patients were excluded when the time between the cytology screen and cervix uteri biopsy was longer than six months, patients were excluded. Smoking status, gravida, history of previous childbirth, route of previous delivery, and oral contraceptive [O.C.] or intrauterine device [I.U.D.] use were recorded from electronic and written patient files. Cytological findings were classified as negative for intraepithelial lesions or malignancy (NILM), atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LGSIL), and histopathological findings as benign, LGSIL, or high-grade squamous intraepithelial lesions (HGSIL). In the cytological analysis, HGSIL was not detected, and we omitted the atypia of the glandular cells. HPV-positive samples were typed using by Anyplex II 28 (Seegene;VR, Seoul, South Korea). We grouped the patients with positive for HPV 16 or 18 as Group I and those positive for other HPV types as Group II. The number of positive HPV types in each patient was assessed and analyzed. We defined it as under call if NLIM on cytology was changed to LGSIL,  or HGSIL, or ASCUS on cytology was changed to HGSIL on histopathological analysis. We analyzed the risk factors for undercall. If ASCUS cytology changed to a benign finding on biopsy, it was defined as a minor variance. If cytological and histopathological findings were consistent, or if ASCUS cytology was changed to LGSIL on biopsy, we defined it as an agreement. If LGSIL on cytology was changed to benign on histopathological analysis, it was defined as an: overcall.

Results: The median age of the patients was 36 (16-70) in Group I (n=29) and 33 (21-65) in Group II in Group II (n=38) (p=0.405). In Group I, HPV type 16 was detected in 23 patients and HPV type 18 in 10 patients, with both types detected in 4 patients. In Group II, more than one HPV type was detected in 29 patients. Of the patients with discordance between cytology and histopathology (n=25), undercall was detected in 19 patients. When compared with agreement, undercall was associated with Group I HPV genotypes (p=0.013), number of HPV types (p=0.018), history of normal spontaneous vaginal delivery (p=0.023), I.U.D. (p=0.036), or O.C. use (p=0.036). After adjustment for age, Group I HPV genotype (p=0.028, OR: 4.693) and multiple HPV types (p=0.029, OR: 20.587) predicted undercall.

Conclusion: We observed a relatively higher discordance ratio between cytological and histopathological results. Analysis of HPV 16 and 18 seems to be, important for reducing the possibility of undercalling. Besides, undercall was an important finding in those patients with other HPV types. This study aims to analyze the identication of multiple HPV genotypes predicted undercall.

Funding Statement: The study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data Access Statement: Research data are not publicly available due to privacy and ethical restrictions.

Conflict of Interest declaration: The author declare that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.

Author Contributions: The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.

Keywords: HPV, cervical dysplasia, cervix, cytology, colposcopy, biopsy.