Can Type Specific HPV Testing Predict Persistence/Progression (PP) of Cervical Intraepithelial Neoplasia (CIN)?
GE Galliano, AE Walts, R Chan, S Bose. Cedars-Sinai Medical Center, Los Angeles, CA
Background: A diagnosis of CINI frequently results in low-yield expensive follow up for detection of high-grade CIN (HGCIN). There is a risk that persistent CINI lesions will progress to HGCIN but there is little information regarding whether HPV genotype analysis is predictive of progression. A cost effective method to predict persistence/progression (PP) based on the initial CINI in a small cervical biopsy (CBx) obtained at colposcopy could provide more individualized and cost effective follow up. A test utilizing Invader HPV reagents (Hologic, Inc, Bedford, MA) in a recently developed assay (Inv) uses three probe sets (A5/A6 detects HPV 51, 56, 66; A7 detects HPV 18, 39, 45, 59, 68; and A9 detects HPV 16,31, 33, 35, 52, 58) to identify high risk (HR) HPV DNA in cervical samplings. The A9 probe positive cases can be further analyzed to identify those that are HPV 16+. Our study was designed to assess the ability of Inv performed on CINI CBxs to predict PP and regressed (R) CIN.
Design: Thirty-nine cervical biopsies diagnosed as CINI were retrieved from our files and divided into two groups: PP and R. For purposes of this study, PP was defined as the presence of at least CINI for a minimum of six months. Patient age (17-62 yrs; mean 28.1; median 25) and length of follow up (6-43 mos; mean 14.3; median 11.5) were similar in both groups. CBxs from 10 additional women (5 CINIII and 5 negative) served as controls. After slides were reviewed and diagnoses confirmed, Inv and HPV16/18 typing were performed on formalin fixed paraffin embedded (FFPE) serial sections in accordance with manufacturer's recommendations. Eight (20%) of the CINI CBxs yielded insufficient DNA for Inv testing leaving 31 CINI CBxs (20 PP and 11 R) for study. HPV typing was correlated with follow up.
*Both CBxs were + for HPV 16 and HPV 18
|HRHPV +||HPV16 +||HPV18 +||HRHPV+ non16/18|
|Persistent/Progressed CINI (20)||16 (80%)||3 (19%)||0 (0%)||13 (81%)|
|Regressed CINI (11)||6 (54%)||0 (0%)||0(0%)||6 (100%)|
|Negative Controls (5)||0 (0%)||0 (0%)||0(0%)||0 (0%)|
|CINIII Controls (5)||4 (80%)||3 (60%)||2 (40%)*||1 (20%)|
Conclusions: HPV typing can be performed on FFPE CBxs. All patients with CINI CBxs that were HPV 16+ had PP CIN. The utility of HPV 16 testing to predict PP in CINI lesions merits further study.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 148, Monday Morning