RESUMO
Our aim was to investigate whether high-risk HPV (hrHPV) mRNA detection by PreTect HPV-Proofer can be used to stratify hrHPV DNA-positive women of different cytology classes for risk of high-grade cervical intraepithelial neoplasia or worse (cervical precancer or cancer, i.e., cervical intraepithelial neoplasia grade 2 or higher [≥ CIN2]). A total of 375 women participating in population-based screening, with a GP5+/6+-PCR hrHPV DNA-positive cervical scrape with normal cytology (n = 202), borderline or mild dyskaryosis (BMD) (n = 88), or moderate dyskaryosis or worse (>BMD) (n = 85), were enrolled. Cervical scrapes were additionally subjected to HPV16/18/31/33/45 E6/E7 mRNA analysis by PreTect HPV-Proofer (mRNA test). Referral and follow-up policies were based on cytology, hrHPV DNA, and mRNA testing. The primary study endpoint was the number of ≥CIN2 detected within 3 years of follow-up. The mRNA positivity increased with the severity of cytological abnormality, ranging from 32% (64/202) in hrHPV DNA-positive women with normal cytology to 47% (41/88) in BMD and 68% (58/85) in >BMD groups (P < 0.01). Women with ≥ CIN2 were more likely to test positive by mRNA test (63%) than women without evidence of ≥ CIN2 (32%; P < 0.01). A positive mRNA test result conferred an increased ≥ CIN2 risk in hrHPV DNA-positive women with normal cytology, i.e., 0.55 (95% confidence interval [95% CI], 0.34 to 0.76) in mRNA-positive versus 0.20 (95% CI, 0.07 to 0.33) in mRNA-negative women. In hrHPV DNA-positive women with BMD or >BMD, the result of the mRNA test did not influence the ≥ CIN2 risk. In conclusion, mRNA testing by PreTect HPV-Proofer might be of value to select hrHPV DNA-positive women with normal cytology in need of immediate referral for colposcopy.
Assuntos
Técnicas de Diagnóstico Molecular/métodos , Proteínas Oncogênicas Virais/biossíntese , Infecções por Papillomavirus/diagnóstico , RNA Mensageiro/análise , RNA Viral/análise , Neoplasias do Colo do Útero/diagnóstico , Virologia/métodos , Adulto , Idoso , Técnicas Citológicas/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Proteínas Oncogênicas Virais/genética , Infecções por Papillomavirus/virologia , RNA Mensageiro/genética , RNA Mensageiro/isolamento & purificação , RNA Viral/genética , RNA Viral/isolamento & purificação , Neoplasias do Colo do Útero/virologiaRESUMO
The availability and accessibility of healthcare to those unable to pay is deteriorating rapidly. One place this is clearly apparent is in our nation's capital, where extremes of poverty and wealth abound. In an effort to improve access to healthcare for the poor, homeless, and medically indigent in the Washington, DC, area, the Washington Archdiocese Health Care Network (AHCN) was formed in 1984 under the leadership of Card. James A. Hickey. The AHCN is a coordinating agency that refers people in need to physicians, physical therapy and rehabilitation services, and dentists who have agreed to volunteer their services to this vulnerable population. The formation, operation, and continuation of the AHCN are performed by five members of one steering committee on behalf of the hundreds of volunteers who make it work daily.