J Korean Med Sci.  2007 Feb;22(1):99-104. 10.3346/jkms.2007.22.1.99.

Clinical Efficacy of Human Papillomavirus DNA Detection in Urine from Patients with Various Cervical Lesions

• Song ES
• Lee HJ
• Hwang TS

• KMID: 1713240
• DOI: http://doi.org/10.3346/jkms.2007.22.1.99

Abstract

A considerable number of adult Korean women avoid a Pap smear due to fear and discomfort of the pelvic examination. A reliable but noninvasive and comfortable screening method would considerably increase the participation rate. To evaluate the clinical efficacy of urine-based human papillomavirus (HPV) detection by oligonucleotide microarray, the results of HPV test from matched cervical swab specimens were compared. HPV DNA was detected in 70 of 100 cervical samples. HPV 16 was the most prevalent type (38/70), followed by types 18, 58, 52, 33, 35, 31, and 51. HPV DNA was identified in 47 of 90 urine samples. HPV 16 was the most prevalent type (30/45), followed by types 18, 52, 35, 51, 58, 33, and 56. The HPV detection rates of the cervical swabs increased in accordance with the severity of the cytologic and histologic diagnosis. The type specific agreement of HPV DNA tests between cervical swabs and urine was good in HPV 16 (kappa index=0.64 [95% CI: 0.50-0.79]), 18, 52, and 58 and fair in HPV 33 and 35. We propose that a urine HPV test is a valuable adjunctive method for a conventional Pap smear and can be used in population screening for cervical cancer in countries where it is difficult to obtain colposcopic specimens for cultural or religious reasons.

Keyword

DNA Probes, HPV; Oligonucleotide Microarray; Microarray Analysis; Cervical Swab; Vaginal Smears; Urine

MeSH Terms

Vaginal Smears
Uterine Cervical Neoplasms/*diagnosis
Papillomaviridae/genetics/*isolation & purification
Oligonucleotide Array Sequence Analysis
Middle Aged
Humans
Female
DNA, Viral/*urine
Cervical Intraepithelial Neoplasia/diagnosis
Aged
Adult

Figure

• 

  Fig. 1 Patterns of HPV typing by HPV oligonucleotide microarray. Each slide contains a pair of oligonucleotide probes of the 22 HPV genotypes. Image from a single HPV 16 infection (A), single HPV 18 infection (B), double HPV 16, 33 infection (C), and triple HPV 44, 59, 68 infection (D). A probe for beta-globin (BG) was used as an internal control.

Reference

1. An HJ, Cho NH, Lee SY, Kim IH, Lee C, Kim SJ, Mun MS, Kim SH, Jeong JK. Correlation of cervical carcinoma and precancerous lesions with human papillomavirus (HPV) genotypes detected with HPV DNA Chip microarray method. Cancer. 2003. 97:1672–1680.

2. Munoz N, Bosch FX, de Sanjose S, Herrero R, Castellsague X, Shah KV, Snijders PJ, Meijer CJ. International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003. 348:518–527.

3. Lee HP, Seo SS. The application of human papillomavirus testing to cervical cancer screening. Yonsei Med J. 2002. 43:763–768.

4. Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998. 338:423–428.

5. Rozendaal L, Walboomers JM, van der Linden JC, Voorhorst FJ, Kenemans P, Helmerhorst TJ, van Ballegooijen M, Meijer CJ. PCR-based high-risk HPV test in cervical cancer screening gives objective risk assessment of women with cytomorphologically normal cervical smears. Int J Cancer. 1996. 68:766–769.

6. Stanley MA. Human papillomavirus vaccines. Rev Med Virol. 2006. 16:139–149.

7. de Villiers EM. Human pathogenic papillomavirus types: an update. Curr Top Microbiol Immunol. 1994. 186:1–12.

8. Ackermann SP, Brackbill RM, Bewerse BA, Cheal NE, Sanderson LM. Cancer screening behaviors among U.S. women: breast cancer, 1987-1989, and cervical cancer, 1988-1989. MMWR CDC Surveill Summ. 1992. 41:17–25.

9. Anderson LM, May DS. Has the use of cervical, breast, and colorectal cancer screening increased in the United States? Am J Public Health. 1995. 85:840–842.

10. Breeze C, de Costa CM, Jagusch M. Do women in rural and remote areas need different guidelines for management of low-grade abnormalities found on cervical screening? Med J Aust. 2006. 184:307–308.

11. KMOHW (Korean Ministry of Health and Welfare). A study on the expansion of national cancer screening programme. 2004.

12. Coughlin SS, Uhler RJ, Hall HI, Briss PA. Nonadherence to breast and cervical cancer screening: what are the linkages to chronic disease risk? Prev Chronic Dis. 2004. 1:1–15.

13. Reddy DM, Wasserman SA. Patient anxiety during gynecologic examinations. Behavioral indicators. J Reprod Med. 1997. 42:631–636.

14. Prusty BK, Kumar A, Arora R, Batra S, Das BC. Human papillomavirus (HPV) DNA detection in self-collected urine. Int J Gynaecol Obstet. 2005. 90:223–227.

15. Jacobson DL, Womack SD, Peralta L, Zenilman JM, Feroli K, Maehr J, Daniel RW, Shah KV. Concordance of human papillomavirus in the cervix and urine among inner city adolescents. Pediatr Infect Dis J. 2000. 19:722–728.

16. Vossler JL, Forbes BA, Adelson MD. Evaluation of the polymerase chain reaction for the detection of human papillomavirus from urine. J Med Virol. 1995. 45:354–360.

17. Song ES, Koh SH, Song YS, Kim SR, Hwang SO, Park JH, Koh SK, Im MW, Lee BI, Lee WY. The report of the results of HPV oligonucleotide microarray tested on the first voided urine of patients of CIN and cervix cancer. Korean J Obstet gynecol. 2003. 46:2139–2145.

18. Hwang TS, Jeong JK, Park M, Han HS, Choi HK, Park TS. Detection and typing of HPV genotypes in various cervical lesions by HPV oligonucleotide microarray. Gynecol Oncol. 2003. 90:51–56.

19. Maclure M, Willett WC. Misinterpretation and misuse of the kappa statistic. Am J Epidemiol. 1987. 126:161–169.

20. KMOHW (Korean Ministry of Health and Welfare). Overview of Cancer Control Programs in Korea. 2004.

21. Wright TC Jr, Denny L, Kuhn L, Pollack A, Lorincz A. HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer. JAMA. 2000. 283:81–86.

22. Crotchfelt KA, Welsh LE, DeBonville D, Rosenstraus M, Quinn TC. Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in genitourinary specimens from men and women by a coamplification PCR assay. J Clin Microbiol. 1997. 35:1536–1540.

23. Stanczuk GA, Kay P, Allan B, Chirara M, Tswana SA, Bergstrom S, Sibanda EN, Williamson AL. Detection of human papillomavirus in urine and cervical swabs from patients with invasive cervical cancer. J Med Virol. 2003. 71:110–114.

24. Brinkman JA, Jones WE, Gaffga AM, Sanders JA, Chatuvedi AK, Slavinsky J III, Clayton JL, Dumestre J, Hagensee ME. Dectection of human papillomavirus DNA in urine specimens from human immunodeficiency virus-positive women. J Clin Microbiol. 2002. 40:3155–3161.

25. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977. 33:159–174.

26. Fahey MT, Irwig L, Macaskill P. Meta-analysis of Pap test accuracy. Am J Epidemiol. 1995. 141:680–689.