It is demonstrated that all cervicovaginal squamous cell carcinomas are associated with HPV infection. Based on this evidence, the new international guidelines recommend HPV-DNA testing as the main primary screening method to filter those patients who may present pre-malignant lesions and need to go through further explorations. However, a subset of high-grade squamous intraepithelial lesions is found in women with negative HPV testing.
Our objective with this study is to report the patients in our base data with HPV-DNA negative test and high-grade squamous intraepithelial lesions (HSIL). HPV subtype and histolgy of the biopsy specimens are reported and taken into account for the final results.
A retrospective review of the cases identified as citology-positive and HPV-negative testing over a 36 month period at a tertiary care gynecologic center. Two types of testing were compared, enzyme-linked immunosorbent assay (ELISA) detection versus polymerase chain reaction (PCR) of the virus.
A total of 1043 cases (740 patients) meeting the study criteria were selected. 10 patients with high-grade lesions and negative ELISA detection were identified (representing 1.35%), of whom 8 had high risk HPV detected with PCR study (80% of the selected cases).
Of the ten selected patients one of them presented a biopsy positive for vaginal intraepithelial neoplasia (VaIN). The PCR test presented a coinfection with HPV 42 subtype (low risk) and 73 subtype (high risk).
Considering the oher nine cervical displasias, three of them presented a biopsy positive for squamous cell carcinoma, with PCR testing positive for HPV subtypes 52, 31, and 73 (high risk subtypes).
As we know, co-testing with the combination of Pap cytology and HPV DNA testing (HPV 16/18) is the preferred cervical cancer screening method for women between 30-65 years old. This combined method has a 5.5% false negative rate in most of the studies.
If we compare the most important international studies with our data we present a lower rate of false negative results using an ELISA testing combined with Pap cytology, and we can overcome this low rate if we complement the testing with a PCR study in the cases of discrepancy between both testings.
We consider that these cases are the ones that could have a grater benefit with the co-testing screening versus an HPV testing alone, as we would be able to compare the citology results with the DNA testing so as to avoid the loss of control and study of those patients with high grade lesions and negative HPV testing.