title: HPV16 and HPV18 genotyping triage in young women with borderline cytology or mild dyskaryosis: effect of age on genotype-specific risk of high-grade CIN.
abstract: OBJECTIVE
  Human papillomavirus (HPV) triage of borderline cytology or mild dyskaryosis is limited by the higher prevalence of HPV in women with these findings relative to those with high-grade cervical intraepithelial neoplasia (≥CIN2). This is particularly relevant in young women in whom HPV prevalence is discernible. In a previous analysis of HPV triage and colposcopy outcomes in Northern Ireland, we revealed a substantial amount of prevalent high-grade disease in women below 30 years of age. We explored the role of genotyping for HPV16/HPV18 in this population by assessing the risk of high-grade lesions associated with these genotypes and the effect of age on type-specific risk.
  
  
  METHODS
  Of the 866 women eligible for HPV triage, those who tested positive for HPV were referred to colposcopy. The relative risk of ≥CIN2 for HPV16, HPV18 and non-HPV16/18 high-risk genotype positivity was determined for cobas(®) HPV Test-positive results.
  
  
  RESULTS
  The relative risk of high-grade CIN was significantly greater in women infected with HPV16 and/or HPV18 compared with non-HPV16/18 infections, regardless of age (2.23 and 0.45, respectively). In women under 30 years of age, HPV16-associated risk of ≥CIN2 was significantly greater than that of HPV18 and the non-HPV16/18 genotypes (1.74 versus 1.03 and 0.58, respectively). In women aged ≥30 years, HPV18 infection presented the greatest risk of ≥CIN2 (3.03). The relative risk of ≥CIN2 associated with non-HPV16/18 genotypes was lower (range, 0.32-0.58) for both age groups.
  
  
  CONCLUSIONS
  This analysis demonstrates the value of genotyping for HPV16/HPV18 and age stratification to improve the specificity of HPV triage and to tailor management relative to the risk of high-grade CIN and cancer.
authors.affiliation: Cytopathology Department, Altnagelvin Hospital, Londonderry, UK.
authors.forename: M
authors.initials: M
authors.lastname: McKenna
authors.affiliation: Cytopathology Department, Altnagelvin Hospital, Londonderry, UK.
authors.forename: M
authors.initials: M
authors.lastname: McMenamin
authors.affiliation: Northern Ireland Centre for Stratified Medicine, Ulster University, Londonderry, UK.
authors.forename: A
authors.initials: A
authors.lastname: McDowell
mesh_terms: D000328:Adult; D005260:Female; D005838:Genotype; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D052161:Human papillomavirus 18 / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D006801:Humans; D060787:Neoplasm Grading; D009660:Northern Ireland; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000821:virology; D012307:Risk Factors; D014218:Triage; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000821:virology
keywords: cervical abnormalities; genotyping; human papillomavirus; triage; young women