title: The Influence of Human Papillomavirus Genotypes on Visual Screening and Diagnosis of Cervical Precancer and Cancer.
abstract: OBJECTIVE
  To examine the influence of human papillomavirus (HPV) genotypes on the sensitivity of visual inspection with acetic acid (VIA) for screening, and colposcopy for diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe (CIN2+).
  
  
  METHODS
  Women aged 25 to 65 years from China (n = 7,541) were screened with 6 tests (careHPV and Hybrid Capture 2 on self- and clinician-collected specimens; HPV-16, HPV-18, HPV-45 E6 detection; and VIA). Biopsies from women with a diagnosis of CIN2+ underwent testing for 25 HPV genotypes using SPF10/LiPA. Human papillomavirus genotyping results were classified according to broad categories of cancer risk.
  
  
  RESULTS
  Among the 143 women with a diagnosis of CIN2+, the percentage who were HPV16 positive increased with increasing severity of diagnosis: 33.3% for CIN2 (n = 39), 69.1% for CIN3 (n = 94), and 90% for cancer (n = 10). There was a higher percentage of HPV-16 in women with abnormal colposcopic impression (p = .007) and positive VIA (p = .02) than normal colposcopy and negative VIA, respectively. Colposcopy and VIA were more sensitive to detect CIN2+ among HPV-16- and/or HPV-18-positive women than HPV-16-/HPV-18-negative women (67.4% vs 43.1%, p = .008, for colposcopy; and 53.3% vs 37.3%, p = .08, for VIA).
  
  
  CONCLUSIONS
  Human papillomavirus type 16 is related to more clear visual acetowhite changes in the epithelium. Therefore, we should expect a reduction of the performance of VIA for cervical cancer screening to identify women with CIN2+, and reduction of the performance of colposcopy to diagnose CIN2+, in vaccinated populations.
authors.affiliation: 1PATH, Seattle, WA; 2Department of Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; 3Department of Pathology, University of Virginia, Charlottesville, VA; and 4Global Cancer Initiative, Chestertown, MD.
authors.forename: Jose
authors.initials: J
authors.lastname: Jeronimo
authors.forename: Pooja
authors.initials: P
authors.lastname: Bansil
authors.forename: Melissa
authors.initials: M
authors.lastname: Valdez
authors.forename: Le-Ni
authors.initials: LN
authors.lastname: Kang
authors.forename: Fang-Hui
authors.initials: FH
authors.lastname: Zhao
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
authors.forename: Wen
authors.initials: W
authors.lastname: Chen
authors.forename: Xun
authors.initials: X
authors.lastname: Zhang
authors.forename: Proma
authors.initials: P
authors.lastname: Paul
authors.forename: Ping
authors.initials: P
authors.lastname: Bai
authors.forename: Roger
authors.initials: R
authors.lastname: Peck
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.forename: Mark H
authors.initials: MH
authors.lastname: Stoler
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D003127:Colposcopy; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005838:Genotype; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D006801:Humans; D007202:Indicators and Reagents; D008875:Middle Aged; D009367:Neoplasm Staging; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000235:genetics; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D014626:Vaginal Smears; D016387:Women's Health; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid