The impact of HPV type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme: a two centre observational study

Ami Munro, Colette Gillespie, Seonaidh Cotton, Camille Busby-Earle, Kimberley Kavanagh, Kate Cuschieri, Heather Cubie, Chris Robertson, Louise Smart, Kevin Pollock, Catherine Moore, Timothy Palmer, Margaret E Cruickshank

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective
To determine if HPV immunisation has affected the prevalence of HPV genotypes and colposcopic features of CIN in young women referred for colposcopy.

Design
A two-centre observational study including vaccinated and unvaccinated women.

Setting
Colposcopy clinics serving two health regions in Scotland, UK.

Population
361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening.

Methods
Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16,18,31,33 and 45. Demographic data, cytology and histology results and colposcopic features were recorded. Chi squared analysis was conducted to identify associations between vaccine status, HPV genotypes and colposcopic features.

Main outcome measures
Colposcopic features, HPV genotypes, mRNA expression and cervical histology.

Results
The prevalence of HPV 16 was significantly lower in the vaccinated (8.6%) compared with the unvaccinated (46.7%) group (p=0.001). The number of cases of cervical intraepithelial neoplasia 2 or more (CIN2+) was significantly lower in vaccinated women (p=0.006).HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+ from 74% (unvaccinated) to 66.7% (vaccinated).

Conclusions
In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in vaccinated women is at the lower acceptable level of the UK national cervical screening programme guidelines.
LanguageEnglish
JournalBJOG: An International Journal of Obstetrics and Gynaecology
DOIs
Publication statusAccepted/In press - 11 Jan 2017

Fingerprint

Colposcopy
Observational Studies
Immunization
Vaccines
Human papillomavirus 16
Cell Biology
Papillomavirus Vaccines
Genotype
Histology
Human papillomavirus 18
Messenger RNA
Cervical Intraepithelial Neoplasia
Scotland
Vaccination
Demography
Guidelines
DNA
Health
Infection

Keywords

  • human papillomavirus
  • immunisation
  • vaccine
  • genotypes
  • colposcopy
  • cervical samples
  • cervical intraepithelial neoplasia
  • abnormal cytology
  • cervical screening
  • HPV
  • HPV vaccine
  • HPV genotyping
  • CIN

Cite this

Munro, Ami ; Gillespie, Colette ; Cotton, Seonaidh ; Busby-Earle, Camille ; Kavanagh, Kimberley ; Cuschieri, Kate ; Cubie, Heather ; Robertson, Chris ; Smart, Louise ; Pollock, Kevin ; Moore, Catherine ; Palmer, Timothy ; Cruickshank, Margaret E. / The impact of HPV type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme : a two centre observational study. In: BJOG: An International Journal of Obstetrics and Gynaecology . 2017.
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abstract = "ObjectiveTo determine if HPV immunisation has affected the prevalence of HPV genotypes and colposcopic features of CIN in young women referred for colposcopy.DesignA two-centre observational study including vaccinated and unvaccinated women.SettingColposcopy clinics serving two health regions in Scotland, UK.Population361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening. MethodsCervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16,18,31,33 and 45. Demographic data, cytology and histology results and colposcopic features were recorded. Chi squared analysis was conducted to identify associations between vaccine status, HPV genotypes and colposcopic features.Main outcome measuresColposcopic features, HPV genotypes, mRNA expression and cervical histology. ResultsThe prevalence of HPV 16 was significantly lower in the vaccinated (8.6{\%}) compared with the unvaccinated (46.7{\%}) group (p=0.001). The number of cases of cervical intraepithelial neoplasia 2 or more (CIN2+) was significantly lower in vaccinated women (p=0.006).HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+ from 74{\%} (unvaccinated) to 66.7{\%} (vaccinated).ConclusionsIn this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in vaccinated women is at the lower acceptable level of the UK national cervical screening programme guidelines.",
keywords = "human papillomavirus, immunisation, vaccine, genotypes, colposcopy, cervical samples, cervical intraepithelial neoplasia, abnormal cytology, cervical screening, HPV, HPV vaccine, HPV genotyping, CIN",
author = "Ami Munro and Colette Gillespie and Seonaidh Cotton and Camille Busby-Earle and Kimberley Kavanagh and Kate Cuschieri and Heather Cubie and Chris Robertson and Louise Smart and Kevin Pollock and Catherine Moore and Timothy Palmer and Cruickshank, {Margaret E}",
note = "This is the peer reviewed version of the following article: Munro, A., Gillespie, C., Cotton, S., Busby-Earle, C., Kavanagh, K., Cuschieri, K., ... Cruickshank, M. E. (2017). The impact of HPV type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme: a two centre observational study. BJOG: An International Journal of Obstetrics and Gynaecology, which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving",
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The impact of HPV type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme : a two centre observational study. / Munro, Ami; Gillespie, Colette; Cotton, Seonaidh; Busby-Earle, Camille; Kavanagh, Kimberley; Cuschieri, Kate; Cubie, Heather; Robertson, Chris; Smart, Louise; Pollock, Kevin; Moore, Catherine; Palmer, Timothy; Cruickshank, Margaret E.

In: BJOG: An International Journal of Obstetrics and Gynaecology , 11.01.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact of HPV type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme

T2 - BJOG: An International Journal of Obstetrics and Gynaecology

AU - Munro, Ami

AU - Gillespie, Colette

AU - Cotton, Seonaidh

AU - Busby-Earle, Camille

AU - Kavanagh, Kimberley

AU - Cuschieri, Kate

AU - Cubie, Heather

AU - Robertson, Chris

AU - Smart, Louise

AU - Pollock, Kevin

AU - Moore, Catherine

AU - Palmer, Timothy

AU - Cruickshank, Margaret E

N1 - This is the peer reviewed version of the following article: Munro, A., Gillespie, C., Cotton, S., Busby-Earle, C., Kavanagh, K., Cuschieri, K., ... Cruickshank, M. E. (2017). The impact of HPV type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme: a two centre observational study. BJOG: An International Journal of Obstetrics and Gynaecology, which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving

PY - 2017/1/11

Y1 - 2017/1/11

N2 - ObjectiveTo determine if HPV immunisation has affected the prevalence of HPV genotypes and colposcopic features of CIN in young women referred for colposcopy.DesignA two-centre observational study including vaccinated and unvaccinated women.SettingColposcopy clinics serving two health regions in Scotland, UK.Population361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening. MethodsCervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16,18,31,33 and 45. Demographic data, cytology and histology results and colposcopic features were recorded. Chi squared analysis was conducted to identify associations between vaccine status, HPV genotypes and colposcopic features.Main outcome measuresColposcopic features, HPV genotypes, mRNA expression and cervical histology. ResultsThe prevalence of HPV 16 was significantly lower in the vaccinated (8.6%) compared with the unvaccinated (46.7%) group (p=0.001). The number of cases of cervical intraepithelial neoplasia 2 or more (CIN2+) was significantly lower in vaccinated women (p=0.006).HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+ from 74% (unvaccinated) to 66.7% (vaccinated).ConclusionsIn this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in vaccinated women is at the lower acceptable level of the UK national cervical screening programme guidelines.

AB - ObjectiveTo determine if HPV immunisation has affected the prevalence of HPV genotypes and colposcopic features of CIN in young women referred for colposcopy.DesignA two-centre observational study including vaccinated and unvaccinated women.SettingColposcopy clinics serving two health regions in Scotland, UK.Population361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening. MethodsCervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16,18,31,33 and 45. Demographic data, cytology and histology results and colposcopic features were recorded. Chi squared analysis was conducted to identify associations between vaccine status, HPV genotypes and colposcopic features.Main outcome measuresColposcopic features, HPV genotypes, mRNA expression and cervical histology. ResultsThe prevalence of HPV 16 was significantly lower in the vaccinated (8.6%) compared with the unvaccinated (46.7%) group (p=0.001). The number of cases of cervical intraepithelial neoplasia 2 or more (CIN2+) was significantly lower in vaccinated women (p=0.006).HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+ from 74% (unvaccinated) to 66.7% (vaccinated).ConclusionsIn this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in vaccinated women is at the lower acceptable level of the UK national cervical screening programme guidelines.

KW - human papillomavirus

KW - immunisation

KW - vaccine

KW - genotypes

KW - colposcopy

KW - cervical samples

KW - cervical intraepithelial neoplasia

KW - abnormal cytology

KW - cervical screening

KW - HPV

KW - HPV vaccine

KW - HPV genotyping

KW - CIN

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DO - 10.1111/1471-0528.14563

M3 - Article

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

ER -