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Low-Risk Human Papillomavirus Types in Cervical Intraepithelial Neoplasia 2–3 and in Invasive Cervical Cancer Patients

Siegler, Efraim MD1,2; Reichman, Yael MD2; Kugelman, Nir MD1,2; Mackuli, Lena MD1; Lavie, Ofer MD1,2; Ostrovsky, Ludmila MD1; Shaked-Mishan, Pninint PhD3; Segev, Yakir MD1,2

Journal of Lower Genital Tract Disease: October 2019 - Volume 23 - Issue 4 - p 248–252
doi: 10.1097/LGT.0000000000000486
Original Research Articles: Cervix and HPV

Objectives A total of 95% to 99% of patients with invasive cervical cancer (CC) are infected with human papillomavirus (HPV). The aim of the study was to evaluate the incidence of low-risk HPV (LR-HPV) types among women with cervical intraepithelial neoplasia (CIN 2–3) and CC.

Materials and Methods We conducted a nested cohort study of patients diagnosed with CIN 2–3 or CC. Inclusion criteria were diagnosis of CIN 2–3 or CC and HPV-DNA testing from the cervix.

Results During the study period, we collected clinical data on 608 women of whom 402 were with CIN 2–3 and 206 with diagnosis of CC. When examining 14 high-risk HPV (HR-HPV) types, patients with CIN 2–3, 90.3% were found positive to at least one type of HR-HPV, 89.8% from CC patients were found positive to at least one type of HR-HPV. A total of 4.5% of patients with CIN 2–3 and 3.9% of those with CC were positive to only one LR-HPV or to some of a few LR-HPV types. Among 5.2% with CIN 2–3 and 6.3% of those with CC, no HPV types were detected.

Conclusions The prevalence of the LR-HPV in high-grade squamous intraepithelial lesion cervical lesions is low but is expected to increase in the future because of the expected decrease in CC caused by HPV types that are included in the bi-, quadri-, and nanovalent vaccine. The CIN 2–3 and CC patients with LR-HPV types and with negative HPV, challenge HPV screening sensitivity, which is based on a limited number of HR-HPV types.

1Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel

2Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

3Clinical Serology and Virology Laboratory, Carmel Medical Center, Haifa, Israel

Correspondence to: Nir Kugelman, MD, Department of Obstetrics & Gynecology, Carmel Medical Center, 7 Michal St, Haifa, Israel. E-mail:

The authors have declared they have no conflicts of interest.

The study protocol was approved by the ethics board of Carmel Medical Center, Haifa, Israel (Protocol Number CMC 88-0069).

E.S., Y.R., and Y.S. are the equally contributing authors.

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology