Risk Analysis Of Cervical Lesions Caused By Non-16/18 High-risk Human Papillomavirus Infection In Songjiang Area

ObjectiveCervical cancer is one of the most commonly diagnosed gynecological cancer,Persistent human papillomavirus(HPV)infection is the main cause of cervical cancer.There are more than 200 HPV genotypes discovered so far,among which HPV16 and18(16/18)are considered to be the most important pathogenic subtypes of cervical cancer.The new versions of the guidelines for the diagnosis and treatment of cervical cancer prepared by the American Society of Colposcopy and Cervical Pathology(ASCCP)and the Chinese Society of Eugenics Colposcopy and Cervical Pathology(CSCCP)clearly recommends that patients infected with HPV 16/18 should receive colposcopy cervical biopsy.For patients with non-type 16/18 HPV infection,the guidelines recommend further consideration of the results of liquid-based thin-layer cytology(TCT).If the TCT data is positive,a colposcopy biopsy is required,if it is negative,follow-up is recommended.In view of the high rate of misdiagnosis of TCT,in order to reduce the missed detection of high-grade cervical lesions caused by false negatives of TCT,it is necessary to pass colposcopy cervical biopsy for infections of non-16/18 HPV with high risk of disease.In this study,2,291 women who volunteered for colposcopy biopsy due to HPV-positive infection in Songjiang area were used as samples to explore the characteristics of HPV infection in the area,focusing on the pathogenic risk of different HPV types,and through analysis of non-16/18 high-risk types.The pathological results of colposcopy biopsy of HPV infection cases revealed non-16/18 HPV types with a higher risk of causing high-grade cervical lesions in the region.This is to improve the current cervical screening guidelines and provides a reference for developing more effective regional cervical cancer prevention and control screenings and even HPV vaccination strategy.MethodsA retrospective analysis of adult women who volunteered for cervical cancer screening at the South Campus of Shanghai First People's Hospital from December2016 to June 2019.According to the HPV and TCT screening results of the patients,they were informed of the relevant risks.Some HPV infected patients(a total of 2291cases)voluntarily requested a further examination of colposcopy cervical biopsy(taken samples of suspected lesions)after informed consent.Combined with TCT and pathological results of cervical biopsy,the infection characteristics and risk of non-16/ 18 high-risk HPV in the local population were analyzed.ResultsAmong the population with HPV positive infection,the proportion of single infection is 62.51%(the single infection rates ranked from high to low as following:HPV16,HPV52,HPV18,HPV53,HPV58,HPV33,HPV51,HPV56,HPV31,others),and the proportion of multiple infections 37.49%,of which non-16/18 high-risk HPV infections accounted for 68.22% of the total infections,more than twice the HPV16/18 infection rate;HPV16/18 multiple infection has the most powerful ability to cause cervical cancer and high-grade intraepithelial neoplasia,followed by HPV16,HPV58,HPV18,HPV51,HPV56,HPV66,HPV52,HPV68,HPV53 and HPV31;In patients with high-grade cervical intraepithelial lesions and cervical cancer,non-16/18 high-risk HPV infections accounted for 50.84%(single infection 28.57%,multiple infections 22.27%),and the single HPV infections were ranked as: HPV16 >HPV52 > HPV18 = HPV58 > HPV51 > HPV53 = HPV56 > Others;in patients with non-16/18 type HPV infection and high-grade cervical intraepithelial lesions and cervical cancer,the false negative rate of TCT is as high as 62.81%;ConclusionThe overall risk of non-16/18 high-risk HPV infections causing lesions above HSIL is equivalent to that of HPV16/18,which is much higher than the European and American regions or the world average.The ranking of HPV subtypes from high to low risk of high-grade cervical lesions caused by single type infection are: HPV16,HPV52,HPV18 and HPV58,HPV51,HPV53 and HPV56,etc.Because of the high false negative rate of TCT,it is recommended to carry out colposcopy biopsy in patients with persistent infection of non-16/18 high-risk HPV subtypes such as 52,58,51,53,56.