Sharmila A. Pimple (India)
Tata Memorial Hospital Preventive OncologyPresenter of 1 Presentation
ACCURACY OF HUMAN PAPILLOMAVIRUS VIRAL LOAD QUANTIFICATION FOR TRIAGING HIGH RISK (HR)-HPV-POSITIVE WOMEN (ID 607)
Abstract
Introduction
INTRODUCTION :Primary high risk human papillomavirus (HR-HPV) screening is being widely adopted in national programs for cervical cancer screening. However since majority of the HPV infections are transient, most suitable triage strategies for the HR-HPVpositive women are still being explored. This study evaluated the association between HR-HPV viral load and cervical intraepithelial neoplasia (CIN) lesions and its potential for triage after primary HPV screening.
Methods
METHODS: We conducted a retrospective review of 229 HPV positive women in the age group of 30-60, who underwent primary screening for HR HPV DNA testbetween January 2017 to December 2018 at the tertiary cancer centre. HR HPVwas detected by Hybrid Capture 2 assay and viral load was measured by the ratio of relative light units to standard positive control (RLU/CO).Histopathology established the pathological grades of CIN.The clinical performance to detect CIN 2 and above lesions (CIN2+) at different viral load cut-off values was calculated.
Results
RESULTS :The prevalence ofCIN2+ among HPV positive women was 30.6 % (70/229).The mean RLU/CO values for histopathology grades ofnegative CIN, CIN 1, CIN 2, CIN 3, and invasive cancer were 330.65, 610.72, 694.35, 910.85 and 778.39 respectively. The severity of cervical lesions increased with the increasing viral load(P < 0.001).The algorithm using RLU/CO value cut offs at >=10, >=100, and>= 1000 for detecting CIN 2+ lesions had sensitivity of 0.91 (0.82 - 0.97), 0.73(0.61 - 0.83) and 0.33 (0.22 - 0.45)and specificity of 0.26 (0.19 - 0.33), 0.56 (0.48 - 0.64) and 0.86 (0.79 - 0.91) respectively. Increasing the cut-point of the HC2 viral load assay improved the specificity and decreased the false positive ratesat the cost of loss in sensitivity.
Conclusions
CONCLUSIONS: Increase in the HR-HPV viral load increases the risk of cervical cancer and precancerous lesions. Quantifying viral load can be effectively utilised for strengthening cervical screening programs.