The prognostic value of HPV DNA testing has been widely assessed in cervical diseases, mainly premalignant lesions. A meta-analysis of patients with identified HPV infection showed a higher risk of cervical intraepithelial neoplasia (CIN) 1 and 2, and a higher risk of high-grade squamous intraepithelial lesions (HSIL) recurrence. The association with CIN 3, metastases or deaths was less clear. An analysis of 13 studies and 1,591 patients with the same assessment of HPV DNA and P16 protein status showed that used together, the risk of recurrence of cervical diseases, both HSIL and CIN grade lesions, was significantly higher in patients with HR HPV DNA and protein-positive cases than in patients with undetectable P16 using immunocytochemistry (ICC) (Kirn et al., 2009). Both HPV assessment methods have high sensitivity but limited reliability; therefore, the authors advised that their diagnostic use be limited to primary screening of high-risk patients. Most studies included participants with normal cytology, showing positive results in 0.2-0.9 % of women (Kirn et al., 2009).
This epidemiology review of studies on the relation between HPV DNA and the progression of cervical disease showed that positivity for HR-HPV is associated with development of CIN2/3 and a 5-fold increase in cancer risk (Laheij et al., 2010). No data have yet been published on the use of HPV testing in screening programs. However, because it is most sensitive in cases with low-grade lesions and currently recommended not to use this type of testing for screening programs, the same restrictions apply to its use as PAP tests (Laheij et al., 2010). autofluid 2010 Caution: Considering the high sensitivity and specificity of HPV testing and its ability to detect neoplasias in the cervix ( ACG Appropriate Use File Guideline 2006 ), it is possible that HPV tests could be used in screening also for other epithelial cancers.
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