Published: 2017-11-23

The use of HPV-DNA testing combined with Pap smear in detection of pre-invasive disease of the cervix

Fayrouz A. Nwesar, Tawfik Abdel Salam T., Marwa Hanafi M., Layla K. Younis, Ziad S. Abou-Zeid, Dalal M. N. Elkaffash


Background: Cancer cervix constitutes a major health problem worldwide. It is one of the most common female malignancy in both incidence and mortality. Cancer cervix has many risk factors, the most important one is persistent infection with one of HPV high risk types. Its morbidity and mortality can be reduced by frequent screening and early diagnosis. So that, several studies have been conducted in recent years in order to find better tests for screening for pre-invasive disease of the cervix and so early intervention and better prognosis. This study aimed to compare the sensitivity of Pap test and HPV DNA test as screening tests for pre-invasive disease of the cervix.

Methods: 100 females from those attending Alexandria University gynaecologic clinic for causes rather than cancer cervix were subjected to Pap smear and cervical swab for HPV-DNA testing at the same setting. Cases of HSIL or positive HPV were subjected to VIA test, colposcopy and cervical punch biopsy was taken if aceto-whitening of the cervix or any other abnormality was found. Cases with ASCUS or LSIL were re-smeared after 3-6 months, if persistent or progressive pathology, colposcopy and punch biopsy from acetowhite areas were taken.

Results: 21 cases (21%) were HPV positive and 66 cases (66%) were positive for intraepithelial lesions (37% ASCUS, 18% LSIL and 11% HSIL) with re-smearing there were 3 persistent ASCUS cases (8.1%) and 5 LSIL cases (27.78%). Colposcopy done, and biopsies were taken from 10 HSIL cases (90.1%), 5 LSIL (27.8%), 3 ASCUS (8.1%) and 10 HPV positive cases (62.5%). With significant relationship between colposcopic findings and HPV-DNA positivity and abnormal cytology. Biopsies were 18; 14 were CIN I and 4 were CIN II.

Conclusions: HPV-DNA positivity has positive association with HSIL. Pap smear is an easy cheap method for screening. HPV-DNA test is less sensitive than cytology as a method for screening.


Cancer cervix, HPV-DNA, Papanicolaou smear, Pre-invasive disease of the cervix, Screening of cancer cervix

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Ali-Risasi C, Verdonck K, Padalko E, Vanden Broeck D, Praet M. Prevalence and risk factors for cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of the Congo: a cross-sectional study. Infect Agent Cancer. 2015;10:20.

Bermudez A, Bhatla N, Leung E. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2015;131:88-95.

Abudukadeer A, Azam S, Mutailipu AZ, Qun L, Guilin G, Mijiti S. Knowledge and attitude of Uyghur women in Xinjiang province of China related to the prevention and early detection of cervical cancer. World J Surg Oncol. 2015;13:110:1-7.

Ibrahim AS, Khaled HM, Mikhail NNH, Baraka H, Kamel H. Cancer Incidence in Egypt: results of the national population-based cancer registry program. J Cancer Epidemiol. 2014:1-18.

Danaei G, Hoorn VS, Lopez AD, Murray CJ, Ezzati M. Causes of cancer in the world: comparative risk assessment of nine behavioral and environmental risk factors. Lancet. 2005;366(9499):1784-93.

Manga MM, Fowotade A, Abdullahi YM, El-Nafaty AU, Adamu DB, Pindiga HU, et al. Epidemiological patterns of cervical human papillomavirus infection among women presenting for cervical cancer screening in North-Eastern Nigeria. Infect Agent Cancer. 2015;10:39.

Bueno CT, da Silva DCM, Barcellos RB, da Silva J, Dos Santos CR, Menezes JE, et al. Association between cervical lesion grade and micronucleus frequency in the Papanicolaou test. Genet Mol Biol. 2014;37(3):496-9.

Anttila A, Ronco G, Clifford G, Bray F, Hakama M, Arbyn M, et al. Cervical cancer screening programmes and policies in 18 European countries. Br J Cancer. 2004;91:935-41.

Smith RA, Manassaram-Baptiste D, Brooks D, Cokkinides V, Doroshenk M, Saslow D, et al. Cancer screening in the United States, 2014: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2014;64(1):30-51.

Orang’o EO, Wachira J, Asirwa FC. Factors associated with uptake of visual inspection with acetic acid (VIA) for cervical cancer screening in Western Kenya. PloS On. 2016;11(6):1-12.

Jin XW, Lipold L, Foucher J. Cost-effectiveness of primary hpv testing, cytology and co-testing as cervical cancer screening for women above age 30 years. Gen Intern Med. 2016:1-7.

Davis M, Feldman S. Making Sense of cervical cancer screening guidelines and recommendations. Curr Treat Options Oncol. 2015;16(12):55.

Lee KR, Ashfaq R, Birdsong GG, Corkill ME, McIntosh KM, Inhorn SL. Comparison of conventional Papanicolaou smears and a fluid-based, thin-layer system for cervical cancer screening. Obstet Gynecol. 1997;90(2):278-84.

Ring M, Bolger N, O’Donnell M, Malkin A, Bermingham N, Akpan E, et al. Evaluation of liquid-based cytology in cervical screening of high-risk populations: a split study of colposcopy and genitourinary medicine populations. Cytopathol. 2002;13:152-9.

Saslow D, Solomon D, Lawson HW. American society for colposcopy and cervical pathology, and American Society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer. Ca Cancer J Clin. 2012;62:147-72.

Boehmer G, Wang L, Iftner A, Holz B, Haedicke J, von Wasielewski R, et al. A population-based observational study comparing Cervista and Hybrid Capture 2 methods: improved relative specificity of the Cervista assay by increasing its cut-off. BMC Infect Dis. 2014;14:674.

Hesselink AT, Berkhof J, van der Salm ML. Clinical validation of the HPV-Risk assay, a novel real-time pcr assay for detection of high-risk human papillomavirus dna by targeting the e7 region. J Clin Microbiol. 2014;52:890-6.

Ngou J, Gilham C, Omar T, Goumbri-Lompo O, Doutre S, Michelow P, et al. Comparison of analytical and clinical performances of the digene HC2 HPV DNA assay and the inno-lipa hpv genotyping assay for detecting high-risk hpv infection and cervical neoplasia among HIV-positive African Women. JAIDS. 2015;68(2):162-8.

Klinkhamer JP, Meerding WJ, Rosier PF. Liquid Based Cytology. Cancer Cytopathol. 2003;99:263-71.

Syrjänen S, Shabalova IP, Petrovichev N, Kozachenko VP, Zakharova T, Pajanidi J, et al. Human papillomavirus testing and conventional pap smear cytology as optional screening tools of women at different risks for cervical cancer in the countries of the former Soviet Union. J Low Genit Tract Dis. 2002;6:97-110.

Castle PE, Fetterman B, Poitras N, Lorey T. Five-Year experience of human papillomavirus DNA and Papanicolaou test cotesting. Obstet Gynecol. 2009;113(3):595-600.

Carozzi F, Visioli CB, Confortini M, Iossa A, Mantellini P, Burroni E, et al. hr-HPV testing in the follow-up of women with cytological abnormalities and negative colposcopy. Br J Cancer. 2013;109(7):1766-74.

Allameh T, Moghim S, Asadi-Zeidabadi M. A survey on the prevalence of high-risk subtypes of human papilloma virus among women with cervical neoplasia in Isfahan University of Medical Science. Arch Gynecol Obstet. 2011;284(6):1509-13.

An HJ, Cho NH, Lee SY, Kim IH, Lee C, Kim SJ, et al. Correlation of cervical carcinoma and precancerous lesions with human papillomavirus (HPV) genotypes detected with the HPV DNA chip microarray method. Cancer. 2003;97(7):1672-80.