Profil HPV Genotyping dan Pap Smear LBC di MRCCC Siloam Hospitals Semanggi
DOI:
https://doi.org/10.36452/jkdoktmeditek.v31i5.3811Keywords:
cervical cancer, genotype, human papillomavirus, pap smearAbstract
Introduction: Cervical cancer is the second most common malignancy among Indonesian women after breast cancer, with 36,964 cases and 20,708 deaths in 2022. Cervical cancer screening studies using HPV genotyping and pap smear LBC have already been conducted in Indonesia using different methods. Purpose: The objectives of this study were to determine the HPV prevalence and genotype distribution, also the cytological results at MRCCC Siloam Hospitals Semanggi. Methods: A descriptive study with a cross-sectional design was conducted using 599 samples selected by consecutive non-random sampling from 2023–2024. HPV genotyping was performed using the DiagCor GenoFlow™ HPV array test, and pap smear analysis was conducted using PathTezt™ liquid-based cytology. Results: This study found 18.2% patients positive for HPV, comprising 58.7% with high-risk HPV only, 23% with low-risk HPV only, and 18.3% with mixed HPV infection Among all HPV-positive women, 53.2% had multiple HPV infections. The prevalence of high-risk HPV infection was 62.4%, with the most frequently detected genotypes were HPV-68, HPV-66, and HPV-52. The most frequent low-risk HPV infections were HPV-42, HPV-43, and HPV-44. Abnormal cytology results were found in 2.8% of patients, specifically ASC-US, LSIL, ASC-H, and AGC. Conclusion: The most prevalent HPV genotypes identified were HPV-68 (10.1%) and HPV-66 (9.6%). The study concludes that a positive HPV test is not always accompanied by abnormal cytology results. Therefore, HPV genotyping should be performed in conjunction with cytological examination for comprehensive screening.
References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin [Internet]. 2024 Feb 12 [cited 2024 Jul 29];74(3):229–63. Available from: https://doi.org/10.3322/caac.21834
International Agency for Research on Cancer. Globocan 2022 Indonesia. [cited 2024 Jul 29]; Available from: https://gco.iarc.who.int/media/globocan/factsheets/populations/360-indonesia-fact-sheet.pdf
Li J, Gao JJ, Li N, Wang YW. Distribution of human papillomavirus genotypes in western China and their association with cervical cancer and precancerous lesions. Arch Virol [Internet]. 2021 Mar 1 [cited 2024 Jul 29];166(3):853–62. Available from: https://doi.org/10.1007/s00705-021-04960-z
Gandekon C, Sidi Imorou R, Zohoncon T, Gomina M, Ouedraogo A, Traore I, et al. Prevalence of oncogenic human papillomavirus genotypes among sexually active women in Parakou (Benin, West Africa). Journal of Gynecology and Obstetrics [Internet]. 2020 Jul 28 [cited 2024 Aug 1];8(4):102. Available from: https://doi.org/10.11648/j.jgo.20200804.16
Demarco M, Hyun N, Carter-Pokras O, Raine-Bennett TR, Cheung L, Chen X, et al. A study of type-specific HPV natural history and implications for contemporary cervical cancer screening programs. EClinicalMedicine [Internet]. 2020 May 1 [cited 2024 Aug 8];22. Available from: https://doi.org/10.1016/j.eclinm.2020.100293
Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. The Lancet [Internet]. 2020 Jan 30 [cited 2024 Aug 2];395:575–90. Available from: https://doi.org/10.1016/S0140-6736(20)30068-4
WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition [Internet]. Geneva: World Health Organization; 2021 [cited 2024 Aug 14]. Available from: http://apps.who.int/bookorders.
Liang LA, Einzmann T, Franzen A, Schwarzer K, Schauberger G, Schriefer D, et al. Cervical cancer screening: comparison of conventional pap smear test, liquid-based cytology, and human papillomavirus testing as stand-alone or cotesting strategies. Cancer Epidemiology, Biomarkers & Prevention [Internet]. 2021 Mar 1 [cited 2024 Jul 29];30(3):474–84. Available from: https://doi.org/10.1158/1055-9965.EPI-20-1003
Raj S, Srivastava M. Comparative analysis of HPV DNA and LBC for screening of cervical cancer in women with unhealthy cervix. The New Indian Journal of OBGYN [Internet]. 2022 Feb [cited 2024 Oct 7];8(2):166–73. Available from: https://doi.org/10.21276/obgyn.2022.8.2.4
Shastri SS, Temin S, Almonte M, Basu P, Campos NG, Gravitt PE, et al. Secondary prevention of cervical cancer: ASCO resource-stratified guideline update. JCO Glob Oncol [Internet]. 2022 [cited 2024 Sep 23];1–24. Available from: https://doi.org/10.1200/GO.22.00217
Ekawati FM, Listiani P, Idaiani S, Thobari JA, Hafidz F. Cervical cancer screening program in Indonesia: is it time for HPV-DNA tests? Results of a qualitative study exploring the stakeholders’ perspectives. BMC Womens Health [Internet]. 2024 Feb 16 [cited 2024 Sep 24];24(1). Available from: https://doi.org/10.1186/s12905-024-02946-y
Wulandari D, Meidyandra RW, Andrijono. Genotype profiles of high-risk human papillomavirus in women of reproductive age: a community-based study. PLoS One [Internet]. 2023 Jul 1 [cited 2025 Apr 12];18(7). Available from: https://doi.org/10.1371/journal.pone.0287399
Utami TW, Nuranna L, Rahman SA, Irzami R, Utama A, Purwoto G, et al. A decade data of HPV genotypes in metropolitan regions of Indonesia: paving the way for a national cervical cancer elimination strategy. J Gynecol Oncol [Internet]. 2025 Mar 2 [cited 2025 Sep 5];36. Available from: https://doi.org/10.3802/jgo.2025.36.e85
Wong FKY, Ching JCY, Chow JKF. Comparison of the DiagCor GenoFlow human papillomavirus array test and roche linear array HPV genotyping test. Open Virol J [Internet]. 2010 Sep 22 [cited 2025 Jun 6];4:169–74. Available from: https://doi.org/10.2174/1874357901004010169
Nayar R, Wilbur DC. The bethesda system for reporting cervical cytology. 3rd ed. Switzerland: Springer International Publishing; 2015.
Mishra R, Bisht D, Gupta M. Primary screening of cervical cancer by pap smear in women of reproductive age group. J Family Med Prim Care [Internet]. 2022 Sep [cited 2025 May 12];11(9):5327–31. Available from: https://doi.org/10.4103/jfmpc.jfmpc_68_22
Hernández-Rosas F, Orozco-Hernández E, Maza-Sánchez L, Salgado-García PC, Navarro-Vidal E, León-Bautista MP de. Prevalence and correlation of human papillomavirus genotypes with clinical factors in cervical samples from Mexican women. Exp Biol Med [Internet]. 2021 Aug 28 [cited 2025 Apr 3];246(1):48–56. Available from: https://doi.org/10.1177/1535370220959747
Nabhan AF, Mburu G, Elshafeey F, Magdi R, Kamel M, Elshebiny M, et al. Women’s reproductive span: a systematic scoping review. Hum Reprod Open [Internet]. 2022 Feb 11 [cited 2025 Apr 12];2022(2). Available from: https://doi.org/10.1093/hropen/hoac005
WHO. Women of reproductive age (15-49 years) population (thousands) [Internet]. 2025 [cited 2025 Apr 12]. Available from: https://platform.who.int/data/maternal-newborn-child-adolescent-ageing/indicator-explorer-new/MCA/women-of-reproductive-age-(15-49-years)-population-(thousands)
Noori RA, Salih A, Noor A, Alhar HANK, Fatlawi SNM Al, Al-Janabi AA, et al. Prevalence and genotype distribution of HPV in gynecological patients: a cross-sectional study. Indonesian Journal of Clinical Pathology and Medical Laboratory [Internet]. 2024 Nov [cited 2025 Mar 29];(1):7–11. Available from: https://doi.org/10.24293/ijcpml.v31i1.2341
Wang L, Chen G, Jiang J. Genotype distribution and prevalence of human papillomavirus infection in women in northern Jiangsu Province of China. Cancer Manag Res [Internet]. 2021 Sep 22 [cited 2025 May 15];13:7365–72. Available from: https://doi.org/10.2147/CMAR.S332769
Babi A, Issa T, Gusmanov A, Akilzhanova A, Issanov A, Makhmetova N, et al. Prevalence of high-risk human papillomavirus infection and genotype distribution among Kazakhstani women with abnormal cervical cytology. Ann Med [Internet]. 2024 Jan 18 [cited 2025 Mar 30];56(1). Available from: https://doi.org/10.1080/07853890.2024.2304649
Yamaguchi M, Sekine M, Hanley SJB, Kudo R, Hara M, Adachi S, et al. Risk factors for HPV infection and high-grade cervical disease in sexually active Japanese women. Sci Rep [Internet]. 2021 Feb 3 [cited 2025 Sep 2];11(1). Available from: https://doi.org/10.1038/s41598-021-82354-6
Luo Q, Zeng X, Luo H, Pan L, Huang Y, Zhang H, et al. Epidemiologic characteristics of high-risk HPV and the correlation between multiple infections and cervical lesions. BMC Infect Dis [Internet]. 2023 Oct 7 [cited 2025 May 14];23(1). Available from: https://doi.org/10.1186/s12879-023-08634-w
Yan X, Shen L, Xiao Y, Wang Q, Li F, Qian Y. Prevalence, characteristics, and distribution of HPV genotypes in women from Zhejiang Province, 2016–2020. Virol J [Internet]. 2021 Oct 20 [cited 2025 Sep 2];18(1). Available from: https://doi.org/10.1186/s12985-021-01676-z
Chang ST, Chuang YF, Li AH, Fan YT, Liao MR, Chen IY, et al. Age-dependent immune profile in healthy individuals: an original study, systematic review and meta-analysis. Immunity and Ageing [Internet]. 2024 Oct 29 [cited 2025 Sep 2];21(1). Available from: https://doi.org/10.1186/s12979-024-00480-x
Welby S, Rosillon D, Feng Y, Borys D. Progression from human papillomavirus (HPV) infection to cervical lesion or clearance in women (18–25 years): Natural history study in the control arm subjects of AS04-HPV-16/18 vaccine efficacy study in China between 2008 and 2016. Expert Rev Vaccines [Internet]. 2022 Jan 24 [cited 2024 Aug 15];21(3):407–13. Available from: https://doi.org/10.1080/14760584.2022.2021077
Nikolic N, Basica B, Strbac M, Terzic L, Patic A, Kovacevic G, et al. Prevalence of carcinogenic genotypes of HPV-infected women in a ten-year period (2014–2023) in Vojvodina, Serbia. Medicina (Lithuania) [Internet]. 2024 Jun 1 [cited 2025 Mar 30];60(6). Available from: https://doi.org/10.3390/medicina60060922
Jee B, Yadav R, Pankaj S, Shahi SK. Immunology of HPV-mediated cervical cancer: current understanding. Int Rev Immunol [Internet]. 2020 Aug 27 [cited 2024 Aug 16];40(5):359–78. Available from: https://doi.org/10.1080/08830185.2020.1811859
Sravani AB, Ghate V, Lewis S. Human papillomavirus infection, cervical cancer and the less explored role of trace elements. Biol Trace Elem Res [Internet]. 2023 Mar 1 [cited 2024 Aug 16];201(3):1026–50. Available from: https://doi.org/10.1007/s12011-022-03226-2
Heck D V, Yee CL, Howley PM, Munger K. Efficiency of binding the retinoblastoma protein correlates with the transforming capacity of the E7 oncoproteins of the human papillomaviruses. Proc Natl Acad Sci U S A [Internet]. 1992 May 15 [cited 2025 Sep 5];89:4442–6. Available from: http://www.jstor.org/stable/2359344
Wang J, Tang D, Wang J, Zhang Z, Chen Y, Wang K, et al. Genotype distribution and prevalence of human papillomavirus among women with cervical cytological abnormalities in Xinjiang, China. Hum Vaccin Immunother [Internet]. 2019 Aug 3 [cited 2025 Mar 30];15(7–8):1889–96. Available from: https://doi.org/10.1080/21645515.2019.1578598
Human papillomavirus vaccines: WHO position paper (2022 update) [Internet]. Vol. 97, Weekly epidemiological record. 2022 Dec [cited 2024 Nov 10]. Available from: https://www.who.int/publications/i/item/who-wer9750-645-672
Odeh HI, Al-Badi SR, Karima B, Saeed TA, Rahamathullah N, Ibrahim EH, et al. Exploring the prevalence of human papillomavirus (HPV) genotypes in pap smear samples of women in northern region of United Arab Emirates (UAE): HPV direct flow chip system-based pilot study. PLoS One [Internet]. 2023 Sep 1 [cited 2025 May 19];18(9 September). Available from: https://doi.org/ 10.1371/journal.pone.0286889
Tao X, Zhang H, Wang S, Chen T, Cong Q, Wang L, et al. Prevalence and carcinogenic risk of high-risk human papillomavirus subtypes in different cervical cytology: a study of 124,251 cases from the largest academic center in China. J Am Soc Cytopathol [Internet]. 2021 Jul 1 [cited 2025 May 19];10(4):391–8. Available from: https://doi.org/10.1016/j.jasc.2021.03.006
Seong J, Ryou S, Lee JG, Yoo M, Hur S, Choi BS. Enhanced disease progression due to persistent HPV-16/58 infections in Korean women: a systematic review and the Korea HPV cohort study. Virol J [Internet]. 2021 Sep 17 [cited 2025 Sep 5];18(1). Available from: https://doi.org/10.1186/s12985-021-01657-2
Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, De Sanjosé S. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. Journal of Infectious Diseases [Internet]. 2010 Dec 15 [cited 2025 Mar 30];202(12):1789–99. Available from: https://doi.org/10.1086/657321
Duong LM, Tran DN, Pham TT, Vo TH, Tran H Do, Lam TTT, et al. Transition of DNA-HPV over time in HPV-infected women: a 7-year cohort study. Medical Journal of Indonesia [Internet]. 2024 Jul 2 [cited 2024 Aug 15]; Available from: https://doi.org/10.13181/mji.oa.247340
Luo Q, Zhang H, Zeng X, Han N, Ma Z, Luo H. HPV specificity and multiple infections and association with cervical cytology in Chongqing, China: a cross-sectional study. BMC Infect Dis [Internet]. 2024 Aug 9 [cited 2025 Sep 5];24(1). Available from: https://doi.org/10.1186/s12879-024-09693-3
Chaturvedi AK, Katki HA, Hildesheim A, Rodríguez AC, Quint W, Schiffman M, et al. Human papillomavirus infection with multiple types: Pattern of coinfection and risk of cervical disease. Journal of Infectious Diseases [Internet]. 2011 Apr 1 [cited 2025 Sep 5];203(7):910–20. Available from: https://doi.org/https://doi.org/10.1093/infdis/jiq139
Li J, Lai H, Qin H, Zhou D, Zhao Y, Sheng X. Current status of high-risk HPV infection and correlation with multiple infections in cervical lesions in Western Guangzhou. Front Med (Lausanne) [Internet]. 2024 Apr 17 [cited 2025 Sep 5];11. Available from: https://doi.org/10.3389/fmed.2024.1252073
Iacobone AD, Bottari F, Radice D, Preti EP, Franchi D, Vidal Urbinati AM, et al. Distribution of high-risk human papillomavirus genotypes and multiple infections in preneoplastic and neoplastic cervical lesions of unvaccinated women: a cross-sectional study. J Low Genit Tract Dis [Internet]. 2019 Oct 1 [cited 2025 Sep 5];23(4):259–64. Available from: https://doi.org/10.1097/LGT.0000000000000487
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