Revisiting the objectives: risk markers for cervical cancers (excluding HPV triage)
Tuesday, December 4, 2018
Clinical Session
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CS 03
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8:15 AM
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9:45 AM
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Revisiting the objectives: risk markers for cervical cancers (excluding HPV triage)
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Aud. III / IV
HPV based screening is slowly but steadily replacing cytology as the primary cervical screening test. It offers much higher sensitivity but lower specificity, largely due to transient infections with minimal progressive potential, so that some form of immediate triage on the same specimen is desirable to better identify those women who are most in need of direct referral to colposcopy. Where good cytology is available one option is reflex cytology. When this shows high grade changes, immediate referral for colposcopy is warranted, but lower grade cytological abnormalities still carry a high false positive rate - even for HPV positive women. A range of newer tests are now under evaluation to try to improve discrimination. Of these some form of HPV genotyping has been most fully investigated, but usually this has been limited to types 16 and 18. There is emerging evidence that fuller typing provides useful additional information and that types 31 and especially 33 carry a much higher risk that other types, and that types 39,56,59,66 and 68 carry lower risk, and could usefully be designated as ‘intermediate risk’ types. Types 18 and 45 do not have a high PPV for CIN2+, but are more related to invasive cancer and lesions in the endocervical canal often missed on colposcopy, and deserve a different management. Tests for p16INK4 also look promising and detect more high grades lesions with a similar PPV to HPV16 genotyping. Recent evidence also supports a role for methylation testing of both human and viral genes and measures of viral load also appear to add information about the likelihood of a high-grade precursor lesion. Tests of E6 and E7 protein levels continue to be evaluated in a range of settings.
A similar need for good triage tests arises when the initial test is a self-taken cervical or urine sample, where use of cytology based tests is no longer effective.
8:15 AM
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CS 03-01
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Genotyping / p16
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N.
Nicolas
WENTZENSEN
8:30 AM
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CS 03-02
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Methylation
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A.
Attila
LORINCZ
8:45 AM
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CS 03-03
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E6-E7
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A.
Andreas
KAUFMANN
9:00 AM
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CS 03-04
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Sequencing
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L.
Lisa
MIRABELLO
9:15 AM
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CS 03-05
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VALidation of Human papillomavirus assays and collection DEvices for HPV testing on Self-samples and urine samples (the VALHUDES study)
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E.
Eliana
Peeters
9:30 AM
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CS 03-06
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Discussion
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