title: Can human papillomavirus (HPV) genotyping classify non-16/18 high-risk HPV infection by risk stratification?
abstract: OBJECTIVE
  Infection with high-risk genotypes of human papillomavirus (HR-HPV) is the major cause of invasive cervical cancers. HPV-16 and HPV-18 are known to be responsible for two-thirds of all invasive cervical carcinomas, followed by HPV-45, -31, and -33. Current guidelines only differentiate HPV-16/18 (+) by recommending direct colposcopy for treatment. We tried to evaluate whether there are differences in risk among 12 non-16/18 HR-HPV genotypes in this study.
  
  
  METHODS
  The pathology archive database records of 1,102 consecutive gynecologic patients, who had results for cervical cytology and histology and for HPV testing, as determined by HPV 9G DNA chip, were reviewed.
  
  
  RESULTS
  Among the 1,102 patients, 346 were non-16/18 HR-HPV (+) and 231 were HPV-16/18 (+). We calculated the odds ratios for ≥cervical intraepithelial neoplasia 2 (CIN 2) of 14 groups of each HR-HPV genotype compared with a group of HR-HPV (-) patients. Based on the odds ratio of each genotype, we divided patients with non-16/18 HR-HPV genotypes (+) into two groups: HPV-31/33/35/45/52/58 (+) and HPV-39/51/56/59/66/68 (+). The age-adjusted odds ratios for ≥CIN 2 of the HPV-31/33/35/45/52/58 (+) and HPV-39/51/56/59/66/68 (+) groups compared with a HR-HPV (-) group were 11.9 (95% CI, 7.6 to 18.8; p<0.001) and 2.4 (95% CI, 1.4 to 4.3; p<0.001), respectively, while that of the HPV-16/18 (+) group was 18.1 (95% CI, 11.6 to 28.3; p=0.003).
  
  
  CONCLUSIONS
  The 12 non-16/18 HR-HPV genotypes can be further categorized (HPV-31/33/35/45/52/58 vs. HPV-39/51/56/59/66/68) by risk stratification. The HPV-31/33/35/45/52/58 genotypes might need more aggressive action. Large scale clinical trials or cohort studies are necessary to confirm our suggestion.
authors.affiliation: Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yeoun Eun
authors.identifier: http://orcid.org/0000-0002-9408-0085
authors.initials: YE
authors.lastname: Sung
authors.affiliation: Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Eun Young
authors.identifier: http://orcid.org/0000-0003-1189-3310
authors.initials: EY
authors.lastname: Ki
authors.affiliation: Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Youn Soo
authors.identifier: http://orcid.org/0000-0002-1653-6315
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Soo Young
authors.identifier: http://orcid.org/0000-0001-6563-2293
authors.initials: SY
authors.lastname: Hur
authors.affiliation: Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea. klee@catholic.ac.kr.
authors.forename: Ahwon
authors.identifier: http://orcid.org/0000-0002-2523-9531
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. jspark@catholic.ac.kr.
authors.forename: Jong Sup
authors.identifier: http://orcid.org/0000-0003-4086-4885
authors.initials: JS
authors.lastname: Park
mesh_terms: D000328:Adult; D003127:Colposcopy; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005838:Genotype; D052162:Human papillomavirus 16 / Q000235:genetics; D052161:Human papillomavirus 18 / Q000235:genetics; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000821:virology*; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000821:virology*
chemical_list: D004279:DNA, Viral
keywords: Cervical Intraepithelial Neoplasia; Human Papillomavirus DNA Tests; Papillomavirus Infections; Uterine Cervical Neoplasms