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Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e3182472947
Basic Science

Prevalence of Human Papillomavirus Types in Invasive Vulvar Cancers and Vulvar Intraepithelial Neoplasia 3 in the United States Before Vaccine Introduction

Gargano, Julia W. PhD1,2; Wilkinson, Edward J. MD3; Unger, Elizabeth R. PhD, MD2; Steinau, Martin PhD2; Watson, Meg MPH4; Huang, Youjie DrPH, MD5; Copeland, Glenn MBA6; Cozen, Wendy DO, MPH7; Goodman, Marc T. PhD, MPH8; Hopenhayn, Claudia PhD, MPH9; Lynch, Charles F. PhD, MD10; Hernandez, Brenda Y. PhD8; Peters, Edward S. ScD, DMD11; Saber, Maria Sibug MD7; Lyu, Christopher W. MPA12; Sands, Lauren A. BA2; Saraiya, Mona MD, MPH5

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Objective: The study aimed to determine the baseline prevalence of human papillomavirus (HPV) types in invasive vulvar cancer (IVC) and vulvar intraepithelial neoplasia 3 (VIN 3) cases using data from 7 US cancer registries.

Materials and Methods: Registries identified eligible cases diagnosed in 1994 to 2005 and requested pathology laboratories to prepare 1 representative block for HPV testing on those selected. Hematoxylin-eosin–stained sections preceding and following those used for extraction were reviewed to confirm representation. Human papillomavirus was detected using L1 consensus polymerase chain reaction (PCR) with PGMY9/11 primers and type-specific hybridization, with retesting of samples with negative and inadequate results with SPF10 primers. For IVC, the confirmatory hematoxylin-eosin slides were re-evaluated to determine histological type. Descriptive analyses were performed to examine distributions of HPV by histology and other factors.

Results: Human papillomavirus was detected in 121/176 (68.8%) cases of IVC and 66/68 (97.1%) cases of VIN 3 (p < .0001). Patients with IVC and VIN 3 differed by median age (70 vs 55 y, p = .003). Human papillomavirus 16 was present in 48.6% of IVC cases and 80.9% of VIN 3 cases; other high-risk HPV was present in 19.2% of IVC cases and 13.2% of VIN 3 cases. Prevalence of HPV differed by squamous cell carcinoma histological subtype (p < .0001) as follows: keratinizing, 49.1% (n = 55); nonkeratinizing, 85.7% (n = 14), basaloid, 92.3% (n = 14), warty 78.2% (n = 55), and mixed warty/basaloid, 100% (n = 7).

Conclusions: Nearly all cases of VIN 3 and two thirds of IVC cases were positive for high-risk HPV. Prevalence of HPV ranged from 49.1% to 100% across squamous cell carcinoma histological subtypes. Given the high prevalence of HPV in IVC and VIN 3 cases, prophylactic vaccines have the potential to decrease the incidence of vulvar neoplasia.

©2012The American Society for Colposcopy and Cervical Pathology


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