Document Detail

Six-year regression and progression of cervical lesions of different human papillomavirus viral loads in varied histological diagnoses.
MedLine Citation:
PMID:  23455757     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study aims to evaluate human papillomavirus (HPV) viral loads as a biomarker for triage into colposcopy and cervical intraepithelial neoplasia grade 2 (CIN2) therapy to reduce the colposcopy referral rate and CIN2 overtreatment in low-resource settings.
METHODS: In 1999, 1997 women aged 35 to 45 years in Shanxi, China, received 6 cervical screenings with pathological confirmation. In 2005, 1461 histologically normal women, 99 with CIN grade 1 (CIN1), and 30 with CIN2 or worse (CIN2+) were rescreened in a follow-up study. Human papillomavirus was detected by Hybrid Capture 2. Viral load, estimated by the ratio of relative light units to standard positive control (RLU/PC), was categorized into 4 groups: negative (<1.0), low (≥1.0, <10.0), moderate (≥10.0, <100.0), and high (≥100.0). We estimated the cumulative incidence of CIN2+ by viral load subgroups and calculated adjusted hazard ratios for CIN2+ using Cox proportional hazards regression.
RESULTS: Cumulative incidence of CIN2+ increased with baseline HPV viral loads among normal women and women with CIN1 at baseline (P(-trend) < 0.001). Repeat moderate-high viral load was associated with the highest risk for CIN2+ (adjusted hazard ratio, 188.8; 95% confidence interval, 41.2-864.1). Raising the ratio of relative light units to standard positive control cutoff from 1.0 to 10.0 for colposcopy greatly reduced the referral rate from 18.1% to 12.9%. It also increased the specificity (84.8% vs 90.4%), the positive predictive value (22.5% vs 28.9%), and the positive likelihood ratio (6.4 vs 8.9), yet with loss of sensitivity by 12% (97.6% vs 85.7%). Among women with CIN2 at baseline, 56% regressed to normal, 24% regressed to CIN1, 4% remained CIN2, and 16% progressed to CIN grade 3 or worse.
CONCLUSIONS: Locales using HPV testing as the primary screening method and lacking high-quality cytology-based screening should consider viral load as an alternative to colposcopy triage for women older than 35 years. Viral loads may also predict CIN2 progression until additional biomarkers become available.
Shao-Ming Wang; Danny Colombara; Ju-Fang Shi; Fang-Hui Zhao; Jing Li; Feng Chen; Wen Chen; Shu-Min Li; Xun Zhang; Qin-Jing Pan; Jerome L Belinson; Jennifer S Smith; You-Lin Qiao
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  International journal of gynecological cancer : official journal of the International Gynecological Cancer Society     Volume:  23     ISSN:  1525-1438     ISO Abbreviation:  Int. J. Gynecol. Cancer     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-24     Completed Date:  2014-02-03     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  9111626     Medline TA:  Int J Gynecol Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  716-23     Citation Subset:  IM    
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MeSH Terms
Biological Markers
Cervical Intraepithelial Neoplasia / diagnosis,  pathology,  virology*
Cervix Uteri / pathology*,  virology
Disease Progression
Mass Screening
Middle Aged
Remission, Spontaneous
Socioeconomic Factors
Uterine Cervical Neoplasms / diagnosis,  pathology,  virology*
Viral Load*
Grant Support
R24 TW007988/TW/FIC NIH HHS; R24 TW007988/TW/FIC NIH HHS; R25 CA094880/CA/NCI NIH HHS; R25 CA94880/CA/NCI NIH HHS
Reg. No./Substance:
0/Biological Markers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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