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Human Papillomavirus Laboratory Testing: the Changing Paradigm.

Eileen M Burd1

  • 1Emory University School of Medicine, Department of Pathology and Laboratory Medicine, and Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA eburd@emory.edu.

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High-risk human papillomaviruses (HPVs) are linked to several cancers. New molecular tests for HPV DNA and RNA are improving screening and diagnosis, especially for cervical cancer.

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Area of Science:

  • Oncology
  • Virology
  • Molecular Diagnostics

Background:

  • High-risk human papillomaviruses (HPVs) are the primary cause of cervical cancers and contribute to other cancers like anal, oropharyngeal, vaginal, vulvar, and penile cancers.
  • Advances in understanding HPV pathogenesis and diagnostic technologies are transforming cancer screening and diagnosis protocols.

Purpose of the Study:

  • To review the current landscape of HPV testing in cancer screening and diagnosis.
  • To highlight the evolving role of molecular diagnostic tests, including DNA and RNA detection, in managing HPV-related cancers.
  • To discuss the current limitations and future directions for HPV screening and diagnostic methods.

Main Methods:

  • Review of FDA-approved molecular tests for high-risk HPV DNA detection used in cervical cancer screening.
  • Discussion of newer RNA-based HPV tests and their application.
  • Examination of HPV testing's role in triaging patients with abnormal cytology and its prognostic utility in oropharyngeal cancers.
  • Assessment of current screening gaps for non-cervical HPV-related cancers.

Main Results:

  • Molecular tests for high-risk HPV DNA are FDA-approved for adjunct use with cytology in cervical cancer screening.
  • RNA-based HPV tests offer increased specificity and are being considered for primary screening.
  • HPV genotyping for HPV16 and -18 is recommended for triaging HPV-positive patients with normal cytology.
  • p16 immunohistochemistry aids in evaluating suspicious lesions in anal cancer contexts.
  • HPV testing serves as a prognostic indicator for oropharyngeal squamous cell tumors.

Conclusions:

  • Molecular HPV testing, including DNA and RNA detection, is increasingly central to cervical cancer screening and diagnosis.
  • While effective for cervical cancer, standardized screening methods for other HPV-related cancers are still under development.
  • Ongoing research is crucial for refining guidelines and expanding the utility of HPV testing across various cancer types.