HPV Genotyping of Biopsy-Proven Low Grade Dysplasia of Vulva Potential Implication for HPV Vaccination
J Baqai, W Lykes, MN Qureshi, L Bloom, BD Benstein, N Zafar. QDX Lab, Cranford, NJ; UTHSC, Memphis, TN
Background: Reports indicate around 8 million women in US have already received at least one of three-part HPV vaccine Gardasil since 2006. Speculation is rife for the protective role of Gardasil against HPV-induced vulvar dysplasia/squamous cell carcinoma.
Design: In this prospective pilot study over 1 year, women from a vulvar surveillance clinic in Memphis were recruited. Lesions with clinical suspicion of vulvar dysplasia were vigorously brushed prior to biopsy. Brushings were collected in PreserveCyte fluid for HPV-typing through a PCR assay, using a family of primers designated PGMY09/11 that amplify highly conserved L1 region of the HPV genome, known to infect the genital tract. Biopsied tissue was routinely processed through formalin fixation and stained with Hematoxylin and Eosin. Histology and PCR results were then correlated.
Results: Thirty-one lesions from 25 women, ranging in age from 19-65 years, which were reported as VIN1/condyloma at histology, with adequate brush sampling for HPV genotyping, qualified for assessment. Presence of HPV was confirmed in 25/31 lesions (80.7%). In a majority (n=14, 45.2%) of lesions, single HPV-type was present. In 2 (6.5%) lesions, 2 different HPV-types were present and in 9 (29%) lesions, 3 or more HPV types were detected. HPV type-6 was present in 9 (29%) lesions- as single virus type in 4/9 lesions. HPV-11 was identified in only 1 lesion, present as a single virus type. HPV-16 was present in 2 lesions, with 2 or more other HPV-types. HPV-18 was not identified in any sample. Other types included HPV-61 (n=4), HPV-62 (n=3), HPV-83 (n=3), unknown types (n=3), HPV-53 (n=2) and HPV types-32, -33, -52, -54, -58, -66, -67, -72, -LVX160 in single lesions.
Conclusions: In this pilot study useful trends were observed. HPV was not isolated in all cases of low grade vulvar dysplasia (19.4% in this study). Low grade vulvar dysplasia generally harbored a single HPV type (47.6% in this study), though in a significant percentage of cases (29% in this study), 3 or more HPV types were present. HPV-6 was the most common virus type in low grade vulvar dysplasia but large number of low grade lesions (67.7% in this study) did not carry HPV types 6/11. HPV type 16/18 was infrequently identified in low grade vulvar dysplasia. These trends indicate that the currently available vaccine Gardasil may not be fully protective against low grade vulvar dysplasia.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 141, Monday Morning