Clinical validation of the PCR-reverse dot blot human papillomavirus genotyping test in cervical lesions from Chinese women in the Fujian province: a hospital-based population study

Abstract

Objective: To determine the clinical significance of the polymerase chain reaction (PCR)-reverse dot blot (RDB) human papillomavirus (HPV) genotyping assay in cervical cancer screening.

Methods: A total of 10,442 women attending the Fujian Provincial Maternity and Children's Health Hospital were evaluated using the liquid-based cytology (thinprep cytologic test [TCT]) and the PCR-RDB HPV test. Women with HPV infection and/or abnormal cytology were referred for colposcopy and biopsy. For HPV DNA sequencing, 120 specimens were randomly selected. Pathological diagnosis was used as the gold standard.

Results: Using the PCR-RDB HPV test, overall HPV prevalence was 20.57% (2,148/10,442) and that of high-risk (HR)-HPV infection was 18.68% (1,951/10,442). There was 99.2% concordance between HPV PCR-RDB testing and sequencing. In this studied population, the most common HR-HPV types were HPV-16, -52, -58, -18, -53, -33, and -51, rank from high to low. HPV-16, -18, -58, -59, and -33 were the top 5 prevalent genotypes in cervical cancer but HPV-16, -18, -59, -45, and -33 were the top 5 highest risk factors for cancer (odds ratio [OR]=34.964, 7.278, 6.728, 6.101, and 3.658; all p<0.05, respectively). Among 10,442 cases, 1,278 had abnormal cytology results, of which, the HR-HPV positivity rate was 83.02% (1,061/1,278). To screen for cervical cancer by PCR-RDB HPV testing, when using CIN2+, CIN3+, and cancer as observed endpoints, the sensitivity was 90.43%, 92.61%, and 94.78% and the negative predictive value (NPV) was 99.06%, 99.42%, and 99.78%, respectively. PCR-RDB HPV and TCT co-testing achieved the highest sensitivity and NPV.

Conclusion: For cervical cancer screening, the PCR-RDB HPV test can provide a reliable and sensitive clinical reference.

Keywords: Cancer Screening; Cell Biology; Genotype; Histology; Papillomaviridae.

Fig. 1

Prevalence of different HPV genotype infections. (A) HPV-16 is most prevalent genotype in HPV-positive women. (B) The HR-HPV infection rate showed a bimodal trend, and the rates of different age groups were statistically significant (χ²=272.740; p<0.001). Top 5 most frequent HPV genotypes in (C) NILM patients; (D) LSIL (CIN1) patients; (E) HSIL patients (CIN2 and CIN3); and (F) cervical cancer. Orange bar in (C-F) is the cumulative cases of HPV genotypes. CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; HR-HPV, high-risk human papillomavirus; HSIL, high-grade squamous intraepithelial lesion; LSIL, low-grade squamous intraepithelial lesion; NILM, negative for intraepithelial lesion or malignancy.

Fig. 2

Age-related distribution of HPV infection. Top 5 most frequent HPV genotypes in different age groups of (A) NILM patients; (B) LSIL (CIN1) patients; (C) HSIL patients (CIN2 and CIN3); and (D) cervical cancer. CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; HSIL, high-grade squamous intraepithelial lesion; LSIL, low-grade squamous intraepithelial lesion; NILM, negative for intraepithelial lesion or malignancy.

Fig. 3

Cumulative occurred risk of HR-HPV genotype for cervical lesions. Cumulative occurred risk of each HPV genotype: in patients with (A) a pathologically diagnosed CIN1; (B) CIN2; (C) CIN3; and (D) invasive cervical cancer. Orange bar represents statistically significant (p<0.05) green bar represents not statistically significant (p>0.05). CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; HR-HPV, high-risk human papillomavirus.