Biomedical subjects

T C Wright

Publications and source records attributed to T C Wright.

At least 55 records · Page 3Linked to original sources

PubMed1997

Adenocarcinoma of the cervix. Expression and clinical significance of estrogen and progesterone receptors.

BACKGROUND: Although hormone receptor status is an important prognostic indicator in adenocarcinoma of the breast and the endometrium, few studies have investigated the expression and clinical significance of estrogen receptor (ER) and progesterone receptor (PgR) in adenocarcinoma of the cervix. METHODS: ER and PgR expression were determined using an immunohistochemical method in 84 cervical adenocarcinomas. Clinical features and outcome were determined by chart review. RESULTS: ER was identified in 17 of the 84 cases (20%). ER positivity was most frequently detected in mucinous adenocarcinoma of the endocervical type (in 11 of 48 cases) and endometrioid adenocarcinoma (in 4 of 10 cases). PgR was identified in 23 of the 84 cases (27%). PgR positivity was also most frequently detected in mucinous adenocarcinoma of the endocervical type (in 15 of 48 cases) and endometrioid adenocarcinoma (in 6 of 10 cases). Mucinous adenocarcinoma of the intestinal type (five cases), glassy cell carcinoma (two cases), and clear cell adenocarcinoma (two cases) were uniformly negative for both ER and PgR. No association was detected between International Federation of Gynecology and Obstetrics stage and receptor status, but there was a somewhat lower frequency of ER positivity in poorly differentiated tumors (P = 0.07). No association was detected between PgR status and disease free survival. Similarly, no association between ER status and overall survival was observed. Although ER positive tumors may be associated with longer disease free survival than ER negative tumors, this difference did not reach statistical significance in this study (P = 0.06). CONCLUSIONS: ER and PgR positivity were found in 20% and 27%, respectively, of primary cervical adenocarcinomas. However, receptor status was not significantly associated with either overall survival or disease free survival.

Adenocarcinoma↗

PubMed1997

Measuring cervical ectopy: direct visual assessment versus computerized planimetry.

OBJECTIVE: Cervical ectopy has been identified as a possible risk factor for heterosexual transmission of human immunodeficiency virus. To accurately assess the importance of cervical ectopy, methods for measuring ectopy with precision need to be developed. The objective of this study was to evaluate the reliability of two methods of measuring cervical ectopy: direct visual assessment and computerized planimetry. STUDY DESIGN: Cervical photographs of 85 women without cervical disease were assessed for cervical ectopy by three raters using direct visual assessment and a computer planimetry method. Agreement between the two methods, among the three raters, and among measurements by each rater over time was calculated with use of intraclass correlation coefficients, where 1.0 represents perfect agreement and 0 represents no agreement except by chance. RESULTS: The intraclass correlation coefficient among the three raters (interrater agreement) was 0.58 for direct visual assessment without application of acetic acid to the cervix compared with 0.72 for direct visual assessment with acetic acid and 0.82 for computerized planimetry with acetic acid. The intraclass correlation coefficient among measurements by each rater over time (intrarater agreement) was 0.66 for direct visual assessment without acetic acid compared with 0.77 for direct visual assessment and 0.83 for computerized planimetry after application of acetic acid. When acetic acid was used, the intraclass correlation coefficient between the two methods was 0.69. CONCLUSIONS: Computerized planimetry of cervical photographs may provide the most consistent estimate of the percent of ectopy. However, if time and resources make the use of computer planimetry difficult, direct visual assessment after application of 5% acetic acid appears to provide comparable estimates.

Cervix Uteri↗

PubMed1997

Increased prevalence of vulvovaginal condyloma and vulvar intraepithelial neoplasia in women infected with the human immunodeficiency virus.

OBJECTIVE: To compare the prevalence of human papillomavirus (HPV)-associated vulvovaginal lesions in human immunodeficiency virus (HIV)-positive and HIV-negative women. METHODS: For this cross-sectional study, all participants received a complete gynecologic examination including colposcopic evaluation and a structured interview about sociodemographic characteristics and risk factors for vulvovaginal disease. In addition, HPV DNA was assayed for in cervicovaginal lavages using polymerase chain reaction. RESULTS: Vulvar and/or vaginal condyloma acuminata were detected in 22 of 396 (5.6%) HIV-positive and in 3 of 375 (0.8%) HIV-negative women (odds ratio [OR] 7.3, P < .001). High-grade vulvar intraepithelial neoplasia (VIN) was present in two of the HIV-positive and none of the HIV-negative women. Human immunodeficiency virus-positive women with condyloma or VIN were significantly more likely to have cervical intraepithelial neoplasia (33%) than those without vulvovaginal lesions (17%) (OR 2.9, 95% confidence interval [CI] 1.1, 74). In multivariate logistic regression analysis, both HIV seropositivity (adjusted OR 5.3, 95% CI 1.3, 35.3) and HPV infection (adjusted OR 6.1, 95% CI 1.7, 39.4) were associated with vulvovaginal condyloma. CONCLUSION: The prevalence of vulvovaginal condyloma was increased in HIV-positive women even when controlling for HPV infection. Human papillomavirus-associated disease was more likely to be multicentric and involve the vulva, vagina, and cervix in HIV-positive than HIV-negative women. Detection of high-grade VIN in two of the HIV-positive women suggests that they may also be at risk for developing invasive vulvar carcinoma.

AIDS-Related Opportunistic Infections↗

PubMed1996

Association between human papillomavirus type and clonal status of cervical squamous intraepithelial lesions.

BACKGROUND: Lesions that are histologically classified as precursors of cervical cancer, which are often referred to as squamous intraepithelial lesions (SILs), represent a heterogeneous clinical entity that can be associated with many different types of human papillomaviruses (HPVs) and have a variable biologic behavior. Approximately one half of low-grade SILs behave as non-neoplastic, productive viral lesions that frequently regress spontaneously, whereas the other half behave as neoplasms and either persist or progress to a histologically higher grade lesion. Identification of biomarkers that reliably differentiate those low-grade SILs with the properties of a non-neoplastic viral infection from those with the properties of neoplasia would provide a more rational basis for decisions about disease management. Since monoclonality is a hallmark of neoplasia irrespective or organ site, clonal status might represent one such biomarker. PURPOSE: To better understand the pathobiology of SILs, we analyzed the clonality of low-grade and high-grade SILs and compared their clonal status with their associated HPV types. METHODS: One hundred forty formalin-fixed, paraffin-embedded cervical biospy and loop electrosurgical specimens, originally diagnosed as SILs, were obtained from the pathology archives of both the Columbia-Presbyterian Medical Center and Kyto Diagnostics in New York. Clonality was determined with the use of a polymerase chain reaction (PCR) based method that detects nonrandom X-chromosome inactivation. This PCR-method amplifies a polymorphic region of the androgen receptor gene that is flanked by several differentially methylated enzyme sites. The same tissue was also analyzed for HPV DNA with the use of PCR and both L1 and E6 "consensus" primers. RESULTS: All 25 evaluable cases of high-grade SILs were determined to be monoclonal. Although 54 (68%) of 79 evaluable low-grade SILs were monoclonal, 25 (32%) of 79 low-grade SILs were polyclonal. A strong association was observed between HPV type and clonal status, with a total of 71 (47 low-grade and 24 high-grade) SILs determined to be monoclonal and containing HPV types 16, 18, 31, 33, 35, 39, 45, 56, 58, or 65. In contrast, 22 (92%) of the 24 low-grade SILs that contained another type of HPV were polyclonal (Fisher's exact test, two-sided, P</-.001). CONCLUSIONS: Our findings suggest that the histopathologic entity termed low-grade SIL consists of two different types of lesions that are biologically distinct. One lesion is monoclonal and is associated with HPV types 16, 18, 31, 33, 35, 39, 45, 56, 58, or 65. The second types of low-grade SIL is polyclonal and is associated with other types of HPV.

Alleles↗

PubMed1996

Invasive vulvar carcinoma in two women infected with human immunodeficiency virus.

This report presents two HIV-infected women who developed invasive squamous cell carcinoma of the vulva. One patient was diagnosed with Stage II vulvar cancer 4 years after surgical excision of VIN. This patient underwent a hemivulvectomy and external-beam radiation therapy, but has subsequently developed recurrent vulvar cancer. The other patient was diagnosed with stage IV invasive vulvar cancer 1 year after the diagnosis of VIN and died of invasive vulvar cancer 11 months later. VIN should be considered a serious condition in HIV-infected women and clinicians should be careful to examine the vulva and perianal region in all HIV-infected women.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Significance of mild cytologic atypia in women infected with human immunodeficiency virus.

OBJECTIVE: To determine the prevalence of cervical intraepithelial neoplasia (CIN) in women who are infected with human immunodeficiency virus (HIV) and who have mild cytologic atypia. METHODS: As part of an ongoing, prospective study of cervical disease in HIV-infected women, Papanicolaou smears were analyzed cross-sectionally for the diagnosis of mild cytologic atypia. RESULTS: Mild cytologic atypia was diagnosed in 112 (25%) of the 453 HIV-infected women enrolled in this study, compared with 36 (9%) of the 401 HIV-uninfected women (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.2-5.1; P < .001). Mild cytologic atypia was diagnosed more frequently in HIV-infected women with lower CD4+ T-lymphocyte counts (chi2 for trend, P = .015) and in those with a history of an abnormal Papanicolaou smear or treatment for cervical disease (OR 3.0, 95% CI 1.2-7.6; P = .008). Coexistent CIN was detected by colposcopically directed biopsy in 42 (38%) of the 112 HIV-infected women with mild cytologic atypia, compared with five (14%) of the 36 HIV-uninfected women (OR 3.7, 95% CI 1.3-11.9; P = .008). Severe inflammation with associated epithelial reparative atypia was diagnosed in 90 (20%) of the HIV-infected women and in 87 (22%) of the HIV-uninfected women. Coexistent CIN was detected in 12% of the HIV-infected women with severe inflammation and associated epithelial reparative atypia, compared with 2% of the HIV-uninfected women with this cytologic diagnosis (OR 5.9, 95% CI 1.2-23; P = .01). CONCLUSION: Mild cytologic atypia, a frequent diagnosis on Papanicolaou smears from HIV-infected women, is associated with CIN. We recommend that all HIV-infected women with mild cytologic atypia be referred for colposcopy.

Adult↗

PubMed1996

Characteristics of menstruation in women infected with human immunodeficiency virus.

OBJECTIVE: To determine the characteristics of menstruation in women infected with human immunodeficiency virus (HIV) and the impact of immunosuppression on menstruation in HIV-infected women. METHODS: In this cross-sectional study, 197 HIV-infected and 189 HIV-uninfected women were interviewed about menstruation and abnormal vaginal bleeding during the previous 12 months. Information was also obtained about CD4+ T-lymphocyte levels of HIV-infected women and other factors, including drug use and weight loss, that might affect menstruation. RESULTS: The number and duration of menses in HIV-infected women were not significantly different from those of uninfected women. During a 12-month period, 154 (78%) of 197 HIV-infected women and 150 (80%) of 188 uninfected women had 10-14 menses (P = .74). The proportions of women in the two groups with intermenstrual bleeding, postcoital bleeding, or no bleeding were also similar. In HIV-infected women, menstruation and the prevalence of abnormal vaginal bleeding were not significantly different by CD4+ T-lymphocyte level. By multiple logistic regression analysis, neither HIV infection nor CD4+ T-lymphocyte level less than 200 cells/microL was associated with intermenstrual bleeding, postcoital bleeding, or no bleeding. CONCLUSION: The results of this study suggest that neither HIV infection nor immunosuppression has a clinically relevant effect on menstruation or other vaginal bleeding. Most HIV-infected women menstruate about every 25-35 days, suggesting monthly ovulation and an intact hypothalamic-pituitary-ovarian axis.

Adult↗

PubMed1996

Anogenital papillomavirus infection and neoplasia in immunodeficient women.

This article reviews the impact of infection with human immunodeficiency virus (HIV) on HPV infections and HPV-associated lesions of the female anogenital tract. Studies investigating HPV infections in HIV-seropositive women are presented as well as the possibility that HIV can influence HPV expression directly through molecular interactions between viral genes and indirectly through immunosuppression. Studies linking HIV infection to invasive cervical cancer and cervical intraepithelial neoplasia are reviewed; recommended protocols for cervical cancer screening in HIV-seropositive women for cervical disease also are presented.

Adolescent↗

PubMed1996

Diagnostic performance of Hybrid Capture human papillomavirus deoxyribonucleic acid assay combined with liquid-based cytologic study.

OBJECTIVE: Our purpose was to determine the diagnostic performance of human papillomavirus deoxyribonucleic acid testing when performed on liquid-based (Thin-prep) cytologic samples. STUDY DESIGN: Thin-prep cytologic study, human papillomavirus deoxyribonucleic acid assay with probes for high oncogenic risk human papillomavirus types (16, 18, 31, 33, 35, 45, 51, 52, and 56), and cervical biopsies on women referred to colposcopy for an abnormal Papanicolaou smear were performed. RESULTS: Of the 364 patients, 186 (51.6%) had a low-grade squamous intraepithelial lesion or worse by histologic diagnosis. Human papillomavirus deoxyribonucleic acid quantitation was correlated with a histologic diagnosis of squamous intraepithelial lesion (p < 0.0001) and the morphologic severity (p < 0.01). The combination of Thin-prep cytologic study and human papillomavirus deoxyribonucleic acid testing correctly identified 87.7% of histologic low-grade lesions and 95.1% of the women with high grade lesions and invasive cancer (p < 0.01). CONCLUSIONS: A liquid-based cytologic system provides adequate material for concomitant human papillomavirus testing. Addition of human papillomavirus testing to Thin-prep cytologic study provides significant gains in diagnostic accuracy over either cytologic study or human papillomavirus deoxyribonucleic acid testing alone.

Adolescent↗

PubMed1996

Prevalence of anal human papillomavirus infection and anal cytologic abnormalities in HIV-seropositive women.

OBJECTIVE: To determine the prevalence of anal human papillomavirus (HPV) infections and anal cytologic abnormalities in HIV-seropositive and HIV-seronegative women. DESIGN: This cross-sectional study of a cohort of women with known HIV serostatus involved a standardized interview and a gynecologic examination, including a cytologic evaluation of the cervix and anus. Anal swabs were tested for HPV DNA using the Hybrid Capture assay. SETTING: Two HIV/AIDS clinics, a sexually transmitted disease clinic, a methadone clinic and women enrolled in a study of HIV heterosexual transmission in the greater New York City metropolitan area. PATIENTS: One hundred and two HIV-seropositive and 96 HIV-seronegative women were selected from an ongoing study of the gynecologic manifestations of HIV infection. MAIN OUTCOME MEASURES: Detection of anal HPV DNA and anal cytologic abnormalities. RESULTS: Anal cytologic abnormalities were detected in 27 (26%) of the 102 HIV-seropositive women and in six (7%) of 96 HIV-seronegative women. Five (5%) of the anal smears from the HIV-seropositive women and one (1%) from the HIV-seronegative women had low-grade anal intra-epithelial neoplasia. The remainder of the anal cytologic abnormalities were classified as mild squamous cytologic atypia. HPV DNA was detected in 30 (29%) of 102 HIV-seropositive and two (2%) of 96 HIV-seronegative women. Of the 33 patients with anal cytologic abnormalities, 19 (58%) had anal HPV DNA detected as compared to 13 (8%) of 160 women without cytologic abnormalities (P < 0.001). In a multivariate logistic regression analysis, HIV-seropositivity was found to be an independent risk factor for both anal HPV infection and anal cytologic abnormalities and the strength of the association was greater in women with lower CD4+ T-lymphocyte counts. CONCLUSION: The prevalence of both anal cytologic abnormalities and anal HPV infection are significantly increased in HIV-seropositive women.

Adult↗

PubMed1996

Low prevalence of human papillomavirus infection of the cervix in renal transplant recipients.

BACKGROUND: An increased risk of anogenital tract malignancies has been noted among renal transplant recipients. A high prevalence of human papillomavirus (HPV) infection of the cervix in the female renal-transplant population has been assumed based on increasing evidence suggesting that HPV infection is the major risk factor for cervical intraepithelial neoplasia (CIN) and cervical cancer. It has been assumed that immunosuppression leads to either a reactivation of latent HPV or a reduction in the host's ability to contain a primary HPV infection, thereby increasing the risk of CIN and cervical cancer. The objective of this study was to evaluate the prevalence of human papillomavirus (HPV) infection in a population of iatrogenically immunosuppressed renal transplant recipients. METHODS: Twenty-one women were recruited from the renal transplant clinic at Presbyterian Hospital and underwent a gynaecological examination which included colposcopy, a Papanicolaou smear, and a cervicovaginal lavage. Lavage samples were analysed for HPV DNA using L1 consensus primers and the polymerase chain reaction (PCR). RESULTS: No cases of cervical intraepithelial neoplasia (CIN) were detected in this cohort of 21 immuno-suppressed renal transplant recipients. HPV DNA was detected in only a single patient. CONCLUSIONS: Our data suggests that HPV infection is not highly prevalent among older, cytologically normal renal transplant recipients, particularly those who are currently monogamous or not presently sexually active. This study suggests that recent sexual behaviours are more important than past behaviours as a determinant of HPV status in transplant recipients, and also suggests that education concerning the avoidance of high-risk sexual behaviour is an important part of the care of the female renal transplant recipient. Our data is consistent with previous work suggesting that the incidence of CIN is declining in transplant recipients, and it also suggests that the prevalence of HPV infection may be declining as well.

Adult↗

PubMed1996

A neglected lesbian health concern: cervical neoplasia.

Many health care providers believe that lesbian women do not need routine Papanicolaou smears. This erroneous assumption fails to recognize that the majority of lesbian women have had prior heterosexual relationships and thus may be at risk for developing cervical neoplasia. The following case report describes a lesbian woman who denied prior heterosexual intercourse but who developed cervical intraepithelial neoplasia grade 2 (CIN 2) associated with a high oncogenic risk human papillomavirus (HPV) type. Sexual contact with multiple lesbian partners who had previous heterosexual relationships likely explains her cervical disease.

Adult↗

PubMed1995

Molecular biology of cervical cancer and its precursors.

Cervical cancer develops from well-defined precursor lesions referred to as either cervical intraepithelial neoplasia or squamous intraepithelial lesions. It is now known that specific types of human papillomaviruses (HPV) are the principal etiologic agents for both cervical cancer and its precursors. The high-oncogenic-risk HPV types associated with invasive cervical cancer produce two oncoproteins, designated E6 and E7, which interact with endogenous cell cycle regulatory proteins, including p53 and Rb. The interaction of virally derived and endogenous cellular proteins converges in deregulation of cell cycle progression and appears to be critical for the development of cervical cancers. However, the development of cervical cancer is a multistep process that cannot be explained simply by infection with specific types of HPV. One additional event that appears to play a role in tumor progression is integration of HPV DNA into the host genome. Integration of HPV DNA frequently disrupts the E2 open reading frames, resulting in overexpression of the E6 and E7 oncoproteins and possibly causing genomic instability. Additional cofactors and mutational events may be important in the pathogenesis of invasive cervical cancers and may include chromosomal rearrangements, loss of constitutional heterozygosity, and proto-oncogene activation.

Cell Transformation, Viral↗

PubMed1995

Clear cell adenosquamous carcinoma of the cervix. An aggressive tumor associated with human papillomavirus-18.

BACKGROUND: It is well recognized that adenocarcinomas and adenosquamous carcinomas of the cervix are frequently associated with human papillomavirus (HPV)-16 or -18. However, few studies have investigated associations between histologic variants of these tumors and specific types of HPV. METHODS: Eleven cases of cervical adenosquamous carcinoma with an unusual histologic appearance were characterized using histochemical and immunohistochemical stains. Sections were tested for the presence of HPV DNA using the polymerase chain reaction (PCR) and type specific primers for HPV-16 and -18. Clinical outcome was determined from a chart review. RESULTS: All tumors were histologically characterized by the presence of sheets of cohesive cells with prominent cell borders and a vacuolated or clear cytoplasm containing large amounts of glycogen. All tumors had focal gland formation and stained positive with mucicarmine stain. Using PCR, HPV-18 DNA was identified in all cases. The youngest patient was 24 years old and the oldest 74 years (mean, 43 years). Eight (73%) of the 11 patients have developed recurrent disease with a mean follow-up until recurrence of 9.5 months (range, 3-22 months). Seven (64%) of the 11 patients have died of their cervical tumors. Of the five patients with Stage IB disease, three (60%) have died of their cervical tumors. CONCLUSIONS: A subset of invasive cervical adenosquamous carcinoma associated with HPV-18 that has a distinctive histologic appearance and an aggressive clinical course is described. The term "clear cell adenosquamous carcinoma" is proposed for this unique variant of invasive cervical carcinoma.

Adenocarcinoma, Clear Cell↗

PubMed1995

X chromosome inactivation and microsatellite instability in early and advanced bilateral ovarian carcinomas.

Ovarian carcinoma can arise synchronously from multiple independent sites and metastasize widely. Therefore, it is frequently unclear whether bilateral tumors represent two independent primaries or one primary and a metastasis. We have used X chromosome inactivation of the androgen receptor gene and microsatellite instability at four chromosomal loci to evaluate the clonal origin of 39 bilateral ovarian carcinomas. An identical monoclonal pattern was found bilaterally in all cases including 10 stage I bilateral ovarian carcinomas. Microsatellite alterations were identified in three cases, and in all three, identical alterations were present in tumor tissue from both ovaries. These results suggest that bilateral ovarian carcinomas evolve as unifocal neoplasias and that metastatic dissemination can occur early in the course of the disease.

Base Sequence↗

PubMed1995

Evaluation of the Hybrid Capture human papillomavirus deoxyribonucleic acid detection test.

OBJECTIVE: Our purpose was to evaluate the sensitivity and accuracy of a new, nonradioactive human papillomavirus deoxyribonucleic acid detection method. STUDY DESIGN: Cervical samples from 520 women were assayed for human papillomavirus deoxyribonucleic acid with both the Hybrid Capture test and polymerase chain reaction. RESULTS: Human papillomavirus deoxyribonucleic acid was detected with Hybrid Capture in 106 (42%) of 254 samples from women with no evidence of cervical intraepithelial neoplasia and 211 (79%) of 266 with cervical intraepithelial lesions or cervical cancer. There was a good correlation between Hybrid Capture and polymerase chain reaction. Hybrid Capture correctly identified 92% of samples found to contain a human papillomavirus type with a high or intermediate oncogenic risk with polymerase chain reaction. Although Hybrid Capture can quantify the amount of human papillomavirus deoxyribonucleic acid present in a sample, no correlation was observed between the relative amount of human papillomavirus deoxyribonucleic acid detected with Hybrid Capture and the grade of cervical lesion. CONCLUSION: The Hybrid Capture test is a sensitive and accurate method for identifying human papillomavirus types of high and intermediate oncogenic risk in clinical specimens.

Cervix Uteri↗

PubMed1995

Comparison of management algorithms for the evaluation of women with low-grade cytologic abnormalities.

OBJECTIVE: To present our clinical experience using a repeat Papanicolaou smear and human papillomavirus (HPV) DNA testing to evaluate patients with low-grade cytologic abnormalities. METHODS: We performed a retrospective chart review of women who were referred for the evaluation of a Papanicolaou smear and were diagnosed as having either atypical cells of undetermined clinical significance or a low-grade squamous intraepithelial lesion (SIL). All women included in this review had a repeat Papanicolaou smear, HPV DNA testing with the Hybrid Capture method, and a colposcopic examination. RESULTS: The sensitivity and specificity of the repeat Papanicolaou smear for detecting biopsy-confirmed cervical intraepithelial neoplasia (CIN) were 0.74 and 0.67, respectively, in the 398 women referred for a previous low-grade SIL or atypical Papanicolaou smear. The sensitivity and specificity of a HPV DNA test positive for "high oncogenic risk" HPV types were 0.73 and 0.66, respectively. Triage using a repeat Papanicolaou smear and an HPV DNA test in combination correctly identified 92% of the women with biopsy-proven CIN, but 71% of the women would have been referred for colposcopy with this form of triage. CONCLUSIONS: A repeat Papanicolaou smear combined with a HPV DNA test is a sensitive alternative to colposcopic evaluation for the detection of CIN in women referred for a previous low-grade abnormal Papanicolaou smear. However, because of the low specificity of this approach, it results in only modest cost reductions compared to the more standard triage of performing colposcopy at the first visit.

Algorithms↗

PubMed1995

A polymerase chain reaction-enzyme-linked immunosorbent assay method for detecting human papillomavirus in cervical carcinomas and high-grade cervical cancer precursors.

OBJECTIVE: To develop and evaluate a novel polymerase chain reaction (PCR)-enzyme-linked immunosorbent assay (ELISA)-based method for detecting high-oncogenic-risk human papillomaviruses (HPV). METHODS: An HPV assay based on PCR amplification of a region of the E6 open reading frame and ELISA detection of PCR products that specifically identify high-oncogenic-risk HPV types (eg, types 16, 18, 31, 33, 35, 39, 45, 56, 58, and 65) was developed. Dacron swabs were used to obtain samples from the cervices of 371 women referred for colposcopy. The swabs were analyzed using the PCR-ELISA method. The results of HPV DNA testing were then compared with the results of a repeat Papanicolaou smear and cervical biopsy obtained at the same visit. RESULTS: The sensitivity of the PCR-ELISA HPV test for detecting invasive cervical cancer or high-grade squamous intraepithelial lesions (SIL) was 90%. High-oncogenic-risk HPVs were detected in six of seven women with biopsy-confirmed invasive cervical cancer, 74 of 81 women with biopsy-confirmed high-grade SIL, 58 of 128 women with biopsy-confirmed low-grade SIL, and 46 of 155 women with no evidence of cervical disease by colposcopy and cervical biopsy. When used in conjunction with a repeat Papanicolaou test, 97% of the women with invasive cervical carcinoma and high-grade SIL lesions were identified. CONCLUSION: The PCR-ELISA-based HPV detection provides the potential for an automated, rapid, and sensitive test for cervical cancer and high-grade cervical lesions.

Base Sequence↗