Korean J Obstet Gynecol.  2011 Aug;54(8):435-440. 10.5468/KJOG.2011.54.8.435.

High risk type human papillomavirus indicates increasing high grade intraepithelial lesion incidence in cytological low grade squamous intraepithelial lesion patients

• Park YH
• Rhim CC
• Kim SJ
• Kang JB
• Jang PR
• Kim HB
• Lee KY
• Park CE
• Jo Y
• Rho ES
• Lee YW
• Yang SC
• Choi SR

• KMID: 2274063
• DOI: http://doi.org/10.5468/KJOG.2011.54.8.435

Abstract

OBJECTIVE
Human papillomavirus (HPV) is known as the causal agent of cervical cancer. The Papanicolaou smear is the most popular screening tool for cervical cancer. Some cytological low grade squamous intraepithelial lesions (LSILs) are in the developmental stage of high grade intraepithelial lesions (HSILs) and cervical cancer metaphases. Our purpose is to disclose the significance of high risk type (HRT) HPV in LSIL.
METHODS
Documentation of 200 cases of cone biopsy at Hallym University Sacred Heart Hospital from February 2006 to February 2008 was reviewed retrospectively. HPV typing with DNA microarray results were found in 20 of the LSIL patients. Chi-square and student-t tests were used in the statistical analysis.
RESULTS
In the cytological LSIL patients, HRT-HPV positive patients were 16/20 (80%) and one low risk type (LRT) HPV positive patient was 1/20 (5%). In the cytological LSIL patients, postoperative pathological diagnoses were cervical intraepithelial neoplasia 1 (CIN 1) 16/26 (61.5%), CIN2 2/26 (7.7%), CIN3 5/26 (19.2%), carcinoma in situ 1/26 (3.8%). Among the 16 HRT-HPV positive patients, there were six that were above HSIL 6/16 (37.5%) in pathologic diagnoses. In the HRT-HPV negative 10 cytologic LSIL patients, there were two that were above HSIL 2/10 (20%) in pathologic diagnoses. HRT-HPV prevalences were not significantly different between LSIL and HSIL.
CONCLUSION
In HRT-HPV positive LSIL, the risk of HSIL or cancer of the cervix seems to be increasing. The HPV test is helpful in LSIL patient strategies and should be done in LSIL patients in order to discriminate between the nature and prognosis of cytological LSIL.

Keyword

Human papillomavirus; Low grade squamous intraepithelial lesion

MeSH Terms

Biopsy
Carcinoma in Situ
Cervical Intraepithelial Neoplasia
Heart
Humans
Incidence
Mass Screening
Metaphase
Oligonucleotide Array Sequence Analysis
Prevalence
Prognosis
Retrospective Studies
Uterine Cervical Neoplasms
Vaginal Smears

Figure

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  Fig. 1 The age and pathologic distribution of cone biopsies. HSILs are most frequent in the fifth decade. LSIL, low grade squamous intraepithelial lesion; HSIL, high grade squamous intraepithelial lesion.

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  Fig. 2 High risk HPV type positivity in all pathologic diagnosis of cone biopsies. High risk type HPVs are similar in prevalence among LSIL (78.9%), HSIL (74.7%) and cancer (76.9%) groups (P=0.877). LSIL, low grade squamous intraepithelial lesion, HSIL, high grade squamous intraepithelial lesion; HPV, human papillomavirus.

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  Fig. 3 High risk HPV positivity according to the cytologic diagnoses of patients. LSIL, low grade squamous intraepithelial lesion; HSIL, high grade squamous intraepithelial lesion; ASCUS, atypical squamous cells of undetermined significance; ASC-H, atypical squamous cells cannot exclude HSIL; HPV, human papillomavirus.

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  Fig. 4 Histologic diagnoses in cytologic LSIL patients. The cytologic LSILs were pathological LSIL in biopsies (61.5%). The cytologic LSILs were histologic HSIL in 8/26 (30.7%). Vertical axis represents ratio (%) of every categories in cytologic LSILs. LSIL, low grade squamous intraepithelial lesion; HSIL, high grade squamous intraepithelial lesion; CIN, cervical intraepithelial lesion; CIS, carcinoma in situ.

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  Fig. 5 High risk type HPVs in cytological LSILs are probably related to increasing histological HSIL. (A) 80% of high risk HPV positive cytologic LSILs were histologic HSIL. 5% of low risk HPV positive cytologic LSILs were histologic HSIL. The vertical axis represents ratio of each categories in LSIL patients. (B) High risk HPV positive cytologic LSIL patients were higher than other groups-over all cytologic LSIL and high risk HPV negative cytologic LSIL patients. The vertical axis represents ration of every categories in LSIL patients. LSIL, low grade squamous intraepithelial lesion; HPV, human papillomavirus.

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