Human papillomavirus (HPV) is the most important pathogenetic factor of intraepithelial neoplasias of the lower genital tract. HPV-DNA and mRNA tests are applied for the management of epithelial dysplasias. The aims of this multicentric retrospective study were to compare the 2 molecular tests before the onset of metachronous intraepithelial lesions and to analyze the different characteristics between synchronous and metachronous lesions and their relationship to the pathologic mechanisms.
The study concerns 55 cases of multiple intraepithelial neoplasias of the lower genital tract. Clinical features of patients with synchronous and metachronous lesions were analyzed. During a 3-year follow-up, HPV-DNA and mRNA tests were performed every 6 months after treatment of the initial lesion. HPV-DNA and mRNA results were analyzed 12 and 6 months before, at time of the onset of the metachronous lesion, and 6 months after its treatment.
We observed 31 synchronous lesions and 24 metachronous lesions. Immunodeficiency and multiple genotypes were associated with the synchronous lesions (p = .04 and p = .02, respectively). During the follow-up, positive DNA and mRNA tests increased before the appearance of the metachronous lesion and decreased 6 months after; mRNA test was significantly better than the DNA test 6 months before the appearance of the lesion (p = .04) and at the time of its appearance (p = .02).
Our results support the hypothesis that a positive HPV-mRNA test could be a marker of persistent infection and a risk factor for the onset of metachronous lesions.
E6/E7 proteins could be a marker of persistent infections, thus HPV-mRNA test could prove itself to be a more precise predictor of metachronous lesions.
1Department of Gynecological, Obstetric and Urological Sciences, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy; 2Section of Gynecology, Academic Department of Biomedicine and Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy; 3Department of Gynaecologic Oncology, National Cancer Institute, Aviano, Italy; 4Department of Obstetrics and Gynaecology, Cristo Re Hospital, Rome, Italy; 5Department of Obstetrics and Gynaecology, San Carlo Hospital-IDI IRCCS, Rome, Italy; and 6Department of Clinical and Molecular Medicine, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
Reprint requests to: Antonio Frega, MD, Department of Gynecological, Obstetric and Urological Sciences, Sant’ Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy. E-mail: firstname.lastname@example.org
The authors have declared they have no conflicts of interest.