title: Genotyping for Human Papillomavirus (HPV) 16/18/52/58 Has a Higher Performance than HPV16/18 Genotyping in Triaging Women with Positive High-risk HPV Test in Northern Thailand.
abstract: BACKGROUND
  Testing for high-risk human papillomavirus DNA (HPV test) has gained increasing acceptance as an alternative method to cytology in cervical cancer screening. Compared to cytology, HPV test has a higher sensitivity for the detection of histologic high-grade squamous intraepithelial lesion or worse (HSIL+), but this could lead to a large colposcopy burden. Genotyping for HPV16/18 has been recommended in triaging HPV-positive women. This study was aimed to evaluate the screening performance of HPV testing and the role of genotyping triage in Northern Thailand.
  
  
  METHODS
  A population-based cervical screening program was performed in Chiang Mai (Northern Thailand) using cytology (conventional Pap test) and HPV test (Hybrid Capture 2). Women who had abnormal cytology or were HPV-positive were referred for colposcopy. Cervical samples from these women were genotyped using the Linear Array assay.
  
  
  RESULTS
  Of 5,456 women, 2.0% had abnormal Pap test results and 6.5% tested positive with Hybrid Capture 2. Of 5,433 women eligible for analysis, 355 with any positive test had histologic confirmation and 57 of these had histologic HSIL+. The sensitivity for histologic HSIL+ detection was 64.9% for Pap test and 100% for Hybrid Capture 2, but the ratio of colposcopy per detection of each HSIL+ was more than two-fold higher with Hybrid Capture 2 than Pap test (5.9 versus 2.8). Genotyping results were available in 316 samples. HPV52, HPV16, and HPV58 were the three most common genotypes among women with histologic HSIL+. Performance of genotyping triage using HPV16/18/52/58 was superior to that of HPV16/18, with a higher sensitivity (85.7% versus 28.6%) and negative predictive value (94.2% versus 83.9%).
  
  
  CONCLUSIONS
  In Northern Thailand, HPV testing with genotyping triage shows better screening performance than cervical cytology alone. In this region, the addition of genotyping for HPV52/58 to HPV16/18 is deemed necessary in triaging women with positive HPV test.
authors.affiliation: Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Surapan
authors.initials: S
authors.lastname: Khunamornpong
authors.affiliation: Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Jongkolnee
authors.initials: J
authors.lastname: Settakorn
authors.affiliation: Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Kornkanok
authors.initials: K
authors.lastname: Sukpan
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Prapaporn
authors.initials: P
authors.lastname: Suprasert
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Jatupol
authors.initials: J
authors.lastname: Srisomboon
authors.affiliation: Boromarajonani College of Nursing, Khon Kaen, Thailand.
authors.forename: Suthida
authors.initials: S
authors.lastname: Intaraphet
authors.affiliation: Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Sumalee
authors.initials: S
authors.lastname: Siriaunkgul
mesh_terms: D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000145:classification* / Q000235:genetics*; D003127:Colposcopy; D003430:Cross-Sectional Studies; D003584:Cytological Techniques; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D005260:Female; D005838:Genotype; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D058889:Molecular Typing / Q000592:standards; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D011159:Population Surveillance; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013785:Thailand / Q000453:epidemiology; D014218:Triage; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology