Abstract

Objective: This study aims to evaluate the diagnostic value of high-risk human papillomavirus (HR-HPV) positivity—particularly HPV type 16—together with cytological findings and colposcopic assessment in detecting cervical intraepithelial neoplasia (CIN) and cervical cancer.

Materials and Methods: We retrospectively analyzed 781 women who underwent colposcopic examination at a tertiary healthcare center between January 2020 and April 2024. HPV DNA results and cytological evaluations prior to colposcopy were reviewed. Histopathological outcomes from cervical biopsy, endocervical curettage (ECC), and probe curettage (P/C) were examined. Multivariate logistic regression was used to determine the predictors of CIN 2 or more severe lesions.

Results: HPV type 16 was found to be a significant independent predictor of CIN2+ lesions, with an odds ratio of 22.36 (p=0.002) compared to HPV-negative individuals. The model demonstrated statistical significance, and the area under the curve (AUC) was calculated as 0.679, indicating moderate diagnostic performance. Other HPV genotypes and unknown HPV status also showed a significant association with higher-grade lesions.

Conclusion: HR-HPV, and particularly HPV 16, is strongly associated with the presence of advanced cervical lesions. Women testing positive for HPV 16 should undergo close surveillance and timely colposcopic evaluation by specialists to enable early diagnosis and prevent progression to invasive cervical cancer.

Keywords: HPV 16, cervical cancer, colposcopy, CIN2+, precancerous lesion

Copyright and license

Copyright © 2025 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Özbilgeç S, Akkuş F, Şener R, Dönmez EE, Serin EC, Acar A. HPV status and colposcopy: key predictors in cervical cancer and precancerous lesion diagnosis. Northwestern Med J. 2025;5(4):201-8. https://doi.org/10.54307/2025.NWMJ.162

References

  1. Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023; 11(2): e197-206. https://doi.org/10.1016/S2214-109X(22)00501-0
  2. Li M, Du X, Lu M, et al. Prevalence characteristics of single and multiple HPV infections in women with cervical cancer and precancerous lesions in Beijing, China. J Med Virol. 2019; 91(3): 473-81. https://doi.org/10.1002/jmv.25331
  3. Lin S, Gao K, Gu S, et al. Worldwide trends in cervical cancer incidence and mortality, with predictions for the next 15 years. Cancer. 2021; 127(21): 4030-9. https://doi.org/10.1002/cncr.33795
  4. Shami S, Coombs J. Cervical cancer screening guidelines: An update. JAAPA. 2021; 34(9): 21-4. https://doi.org/10.1097/01.JAA.0000769656.60157.95
  5. Awolude OA, Oyerinde SO, Ayeni AO, Adewole IF. Human papillomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: test-of-concept study in Ibadan, Nigeria. Pan Afr Med J. 2021; 40: 48. https://doi.org/10.11604/pamj.2021.40.48.28628
  6. Zhao H, He Y, Fan B, Wang Y, Wu YM. Human papillomavirus E6E7 mRNA and TERC lncRNA in situ detection in cervical scraped cells and cervical disease progression assessment. Virol J. 2022; 19(1): 18. https://doi.org/10.1186/s12985-021-01696-9
  7. Dong A, Xu B, Wang Z, Miao X. Survival-related DLEU1 is associated with HPV infection status and serves as a biomarker in HPV-infected cervical cancer. Mol Med Rep. 2022; 25(3): 77. https://doi.org/10.3892/mmr.2022.12593
  8. Lyu Y, Ding L, Gao T, et al. Influencing Factors of High-Risk Human Papillomavirus Infection and DNA Load According to the Severity of Cervical Lesions in Female Coal Mine Workers of China. J Cancer. 2019; 10(23): 5764-9. https://doi.org/10.7150/jca.29034
  9. Horn J, Denecke A, Luyten A, et al. Reduction of cervical cancer incidence within a primary HPV screening pilot project (WOLPHSCREEN) in Wolfsburg, Germany. Br J Cancer. 2019; 120(10): 1015-22. https://doi.org/10.1038/s41416-019-0453-2
  10. Jary A, Teguete I, Sidibé Y, et al. Prevalence of cervical HPV infection, sexually transmitted infections and associated antimicrobial resistance in women attending cervical cancer screening in Mali. Int J Infect Dis. 2021; 108: 610-6. https://doi.org/10.1016/j.ijid.2021.06.024
  11. Hu H, Zhao J, Yu W, et al. Human papillomavirus DNA, HPV L1 capsid protein and p16(INK4a) protein as markers to predict cervical lesion progression. Arch Gynecol Obstet. 2019; 299(1): 141-9. https://doi.org/10.1007/s00404-018-4931-1
  12. Bedell SL, Goldstein LS, Goldstein AR, Goldstein AT. Cervical Cancer Screening: Past, Present, and Future. Sex Med Rev. 2020; 8(1): 28-37. https://doi.org/10.1016/j.sxmr.2019.09.005
  13. Chen L, Dong B, Zhang Q, et al. HR-HPV viral load quality detection provide more accurate prediction for residual lesions after treatment: a prospective cohort study in patients with high-grade squamous lesions or worse. Med Oncol. 2020; 37(5): 37. https://doi.org/10.1007/s12032-020-01363-z
  14. Sargent A, Fletcher S, Bray K, Kitchener HC, Crosbie EJ. Cross-sectional study of HPV testing in self-sampled urine and comparison with matched vaginal and cervical samples in women attending colposcopy for the management of abnormal cervical screening. BMJ Open. 2019; 9(4): e025388. https://doi.org/10.1136/bmjopen-2018-025388
  15. Gunes AC, Ozgul N, Turkyılmaz M, et al. Evaluation of colposcopy after the addition of human papillomavirus testing to the Turkish cervical cancer screening program. Cancer Med. 2023; 12(24): 21751-60. https://doi.org/10.1002/cam4.6740
  16. Hernández-López R, Lorincz AT, Torres-Ibarra L, et al. Methylation estimates the risk of precancer in HPV-infected women with discrepant results between cytology and HPV16/18 genotyping. Clin Epigenetics. 2019; 11(1): 140. https://doi.org/10.1186/s13148-019-0743-9
  17. Okunade KS. Human papillomavirus and cervical cancer. J Obstet Gynaecol. 2020; 40(5): 602-8. https://doi.org/10.1080/01443615.2019.1634030
  18. Santesso N, Mustafa RA, Schünemann HJ, et al. World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer. Int J Gynaecol Obstet. 2016; 132(3): 252-8. https://doi.org/10.1016/j.ijgo.2015.07.038
  19. Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020; 70(5): 321-46. https://doi.org/10.3322/caac.21628
  20. McCluggage WG, Judge MJ, Alvarado-Cabrero I, et al. Data Set for the Reporting of Carcinomas of the Cervix: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol. 2018; 37(3): 205-28. https://doi.org/10.1097/PGP.0000000000000412
  21. Wang P, Gao D, Yu X, Zhu G. Value of high‑risk human papillomavirus detection combined with colposcopy in the diagnosis of cervical cancer and precancerous lesions. Oncol Lett. 2024; 27(4): 185. https://doi.org/10.3892/ol.2024.14318
  22. Salvadó A, Miralpeix E, Solé-Sedeno JM, et al. Predictor factors for conservative management of cervical intraepithelial neoplasia grade 2: Cytology and HPV genotyping. Gynecol Oncol. 2021; 162(3): 569-74. https://doi.org/10.1016/j.ygyno.2021.06.019
  23. Tian R, Cui Z, He D, et al. Risk stratification of cervical lesions using capture sequencing and machine learning method based on HPV and human integrated genomic profiles. Carcinogenesis. 2019; 40(10): 1220-8. https://doi.org/10.1093/carcin/bgz094
  24. Quint W, Jenkins D, Molijn A, et al. One virus, one lesion--individual components of CIN lesions contain a specific HPV type. J Pathol. 2012; 227(1): 62-71. https://doi.org/10.1002/path.3970
  25. Wittenborn J, Weikert L, Hangarter B, Stickeler E, Maurer J. The use of micro RNA in the early detection of cervical intraepithelial neoplasia. Carcinogenesis. 2020; 41(12): 1781-9. https://doi.org/10.1093/carcin/bgaa046
  26. Luo Q, Lang L, Han N, Liang L, Shen L, Zhang H. Prevalence and genotype distribution of high-risk human papillomavirus infection among women with cervical cytological abnormalities in Chongqing, China, 2014-2020. Diagn Cytopathol. 2021; 49(12): 1237-43. https://doi.org/10.1002/dc.24891
  27. Painter H, Erlinger A, Simon B, Morroni C, Ramogola-Masire D, Luckett R. Impact of cervicitis on performance of cervical cancer screening using HRHPV testing and visual evaluation in women living with HIV in Botswana. Int J Gynaecol Obstet. 2020; 151(1): 144-6. https://doi.org/10.1002/ijgo.13235
  28. Liu G, Sharma M, Tan N, Barnabas RV. HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer. AIDS. 2018; 32(6): 795-808. https://doi.org/10.1097/QAD.0000000000001765
  29. Vodicka EL, Chung MH, Zimmermann MR, et al. Estimating the costs of HIV clinic integrated versus non-integrated treatment of pre-cancerous cervical lesions and costs of cervical cancer treatment in Kenya. PLoS One. 2019; 14(6): e0217331. https://doi.org/10.1371/journal.pone.0217331
  30. Husaiyin S, Han L, Wang L, et al. Factors associated with high-risk HPV infection and cervical cancer screening methods among rural Uyghur women aged > 30 years in Xinjiang. BMC Cancer. 2018; 18(1): 1162. https://doi.org/10.1186/s12885-018-5083-1
  31. Garza-Rodríguez ML, Oyervides-Muñoz MA, Pérez-Maya AA, et al. Analysis of HPV Integrations in Mexican Pre-Tumoral Cervical Lesions Reveal Centromere-Enriched Breakpoints and Abundant Unspecific HPV Regions. Int J Mol Sci. 2021; 22(6): 3242. https://doi.org/10.3390/ijms22063242
  32. Dong B, Chen L, Lin W, et al. Cost-effectiveness and accuracy of cervical cancer screening with a high-risk HPV genotyping assay vs a nongenotyping assay in China: an observational cohort study. Cancer Cell Int. 2020; 20: 421. https://doi.org/10.1186/s12935-020-01512-4
  33. Ferrera A, Valladares W, Cabrera Y, et al. Performance of an HPV 16/18 E6 oncoprotein test for detection of cervical precancer and cancer. Int J Cancer. 2019; 145(8): 2042-50. https://doi.org/10.1002/ijc.32156
  34. Suwanthananon C, Inthasorn P. A comparison of the associations of Reid Colposcopic Index and Swede Score with cervical histology. J Obstet Gynaecol Res. 2020; 46(4): 618-24. https://doi.org/10.1111/jog.14200