Tamizaje del cáncer de cuello uterino con test de HVP

Primeros resultados en el sistema público de Uruguay

Palabras clave: NEOPLASIAS DEL CUELLO UTERINO, INFECCIONES POR PAPILLOMAVIRUS, PRUEBA DE PAPANICOLAOU, CRIBADO, PREVENCIÓN SECUNDARIA

Resumen

Introduccción: en Uruguay, el cáncer de cuello uterino ocupó el tercer lugar con una incidencia promedio de 312 nuevos casos por año; fallecieron 134 mujeres promedio por año en el período 2010 - 2014.
Objetivo: el objetivo de este trabajo fue analizar los primeros resultados de una experiencia piloto con la aplicación del test de HPV captura híbrida HC2 (QiagenR ) como test de tamizaje primario del cáncer de cuello uterino en una zona del departamento de Canelones.
Método: se estudiaron 1.010 mujeres asintomáticas entre 30 y 64 años que concurrieron a realizarse el test de PAP a dos unidades de toma de muestras del Programa de prevención del cáncer de cuello uterino. Se realizó la extracción conjunta de la muestra para PAP, que fue derivada a uno de los laboratorios de citología de la Red de Atención Primaria de Salud y la muestra de HPV que fue procesada con la técnica de captura híbrida en el laboratorio de biología molecular del Centro Hospitalario Pereira Rossell. Las usuarias con resultados HPV + y PAP anormales (ASC-US+) fueron derivadas a colposcopia, con biopsia y posterior tratamiento cuando correspondió.
Resultados: el test de HPV fue positivo en 126/1.010 mujeres (12,5%) y el PAP anormal en 167/1.010 (16,5%). El test de HPV fue positivo en todos los casos CIN2+ 13/13 (100%) mientras que el PAP fue anormal (ASCUS+) en 7/13 (54%) para CIN2+ por biopsia.
Conclusión: el test de HPV resultó más eficaz y eficiente que el PAP para la detección de lesiones precancerosas de cuello uterino.

Citas

(1) International Agency for Research on Cancer (IARC). Global Cancer Observatory 2012. Disponible en: https://gco.iarc.fr/. Consulta: 24 marzo 2019.

(2) Comisión Honoraria de Lucha Contra el Cáncer (CHLCC). Registro Nacional de Cáncer. Situación epidemiológica del Uruguay en relación al cáncer-Mayo 2019. Disponible en: http://www.comisioncancer.org.uy/uc_513_1.html. Consulta: 25 marzo 2019.

(3) Rodríguez G, Alonso R, Ortiz de Taranco M. Programa de prevención de cáncer de cuello uterino en el Uruguay “Dr. Enrique Pouey”: estrategia y manual de procedimientos. Montevideo: CHLCC, 2007:129 p.

(4) Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003; 348(6):518-27.

(5) Bosch FX, Lorincz A, Muñoz N, Meijer CL, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55(4):244-65.

(6) Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189:12-9.

(7) Ostör AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 1993; 12(2): 186-92.

(8) Organización Panamericana de la Salud. Control integral del cáncer cervicouterino: guía de prácticas esenciales. 2ª ed. Wahington, DC: OPS, 2016. Disponible en: http://iris.paho.org/xmlui/bitstream/handle/123456789/28512/9789275318799_spa.pdf?ua=1. Consulta: 27 marzo 2019.

(9) Qiagen NV. Digene HC2 HPV DNA Test (5196-1330 19300) Disponible en: https://www.qiagen.com/mq/search.aspx?q=REF%205196-1330%2019300#&&pg=1. Consulta: 26 marzo 2019.

(10) Ronco G, Giorgi-Rossi P, Carozzi F, Confortini M, Dalla Palma P, Del Mistro A, et al. Results at recruitment from a randomized controlled trial comparing human papillomavi rus testing alone with conventional cytology as the primary cervical cancer screening test. J Natl Cancer Inst 2008; 100(7):492-501.

(11) Ronco G, Giorgi-Rossi P, Carozzi F, Confortini M, Dalla Palma P, Del Mistro A, et al. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial. Lancet Oncol 2010; 11:249-57.

(12) Kjaer SK, van den Brule AJ, Paull G, Svare EI, Sherman ME, Thomsen BL, et al. Type specific persistence of high risk human papillomavirus (HPV) as indicator of high grade cervical squamous intraepithelial lesions in young women: population based prospective follow up study. BMJ 2002; 325(7364):572.

(13) Petry KU, Menton S, Menton M, van Loenen-Frosch F, de Carvalho Gomes H, Holz B, et al. Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: results for 8466 patients. Br J Cancer 2003; 88:1570-7.

(14) Clavel C, Masure M, Bory JP, Putaud I, Mangeonjean C, Lorenzato M, et al. Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women. Br J Cancer 2001; 84:1616-23.

(15) de Sanjose S, Almirall R, Lloveras B, Font R, Diaz M, Muñoz N, et al. Cervical human papillomavirus infection in the female population in Barcelona, Spain. Sex Transm Dis 2003; 30:788-93.

(16) Schiffman M, Wentzensen N, Wacholder S, Kinney W, Gage JC, Castle PE. Human papillomavirus testing in the prevention of cervical cancer. J Natl Cancer Inst 2011; 103(5):368-83.

(17) Almonte M. EStudio multicéntrico de TAMizaje y triaje usando la prueba de PApilomavirus humano (ESTAMPA). Disponible en: https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=experiencias-implementacion-programas-tamizaje-cacu-basados-prueba-vph-31jul-1ago-2018-washington-dc-9978&alias=46029-estudio-multicentrico-tamizaje-triaje-usando-prueba-papilomavirus-humano-estampa-maribel-almonte-iarc-029&Itemid=270&lang=en. Consulta: 3 setiembre 2017.

(18) Bulkmans NW, Berkhof J, Rozendaal L, van Kemenade J, Boeke A, Bulk S, et al. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial. Lancet 2007; 370(9601):1764-72.

(19) Kitchener HC, Gilham C, Sargent A, Bailey A, Albrow R, Roberts C, et al. A comparison of HPV DNA testing and liquid based cytology over three rounds of primary cervical screening: extended follow up in the ARTISTIC trial. Eur J Cancer 2011; 47(6):864-71.

(20) Kotaniemi-Talonen L Nieminen P, Anttila A, Hakama M. Routine cervical screening with primary HPV testing and cytology triage protocol in a randomised setting. Br J Cancer 2005; 93(8):862-7.

(21) Leinonen M, Nieminen P, Kotaniemi-Talonen L, Malila N, Tarkkanen J, Laurila P, et al. Age-specific evaluation of primary human papillomavirus screening vs conventional cytology in a randomized setting. J Natl Cancer Inst 2009; 101(23):1612-23.

(22) Naucler P, Ryd W, Törnberg S, Strand A, Wadell G, Elfgren K, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med 2007; 357(16):1589-97.

(23) Naucler P, Ryd W, Törnberg S, Strand A, Wadell G, Elfgren K, et al. Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening. J Natl Cancer Inst 2009; 101(2):88-99.

(24) Rijkaart DC, Berkhof J, Rozendaal L, van Kemenade FJ, Bulkmans NW, Heideman DA, et al. Human papillomavirus testing for the detection of high-grade cervical intraepithelial neoplasia and cancer: final results of the POBASCAM randomised controlled trial. Lancet Oncol 2012; 13(1):78-88.

(25) Ronco G, Arbyn M, Meijer CJLM, Snijders PJF, Cuzick J. Screening for cervical cancer with primary testing for human papillomavirus. En: Anttila A, Arbyn A, De Vuyst H, Dillner J, Dillner L, Franceschi S, et al, eds. European guidelines for quality assurance in cervical cancer screening. Supplements. 2a ed. Luxembourg: Office of the European Union, 2015:1-59. Disponible en: https://www.gisci.it/documenti/news/EW0115451ENN_002.pdf. Consulta: 26 marzo 2019.

(26) Organización Panamericana de la Salud. Incorporación de la prueba del virus del papiloma humano en programas de prevención de cáncer cervicouterino. Manual para gerentes de programas de salud. Washington, OPS, 2016. Disponible en: https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=guias-manuales-3444&alias=36609-incorporacion-prueba-virus-papiloma-humano-programas-prevencion-cancer-cervicouterino-manual-gerentes-programas-salud-609&Itemid=270&lang=en. Consulta: 26 marzo 2019.

(27) Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, et al. The lower anogenital squamous terminology standardization project for HPV-associated lesions: background and consensus recommendations from de College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. J Low Genit Tract Dis 2012; 16(3):205-42.

(28) Brown LD, Cai TT, DasGupta A. Interval estimation for a binomial proportion: rejoinder. Statist Sci 2001; 16(2):128-.

(29) Arrossi S, Thouyaret L, Herrero R, Campanera A, Magdaleno A, Cuberli M, et al. Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial. Lancet Glob Health 2015; 3(2):e85-94.

(30) Berois N, Heard I, Fort Z, Alonso R, Sica A, Moerzinger P, et al. Prevalence of type-specific HPV infection in Uruguay. J Med Virol 2014; 84(4):647-52.

(31) Papillocheck®. Manual de Instrucciones REF 465 060. (Revisión: BQ-013-07) Frickenhausen, Deu: Greiner Bio-One, 2011. Disponible en: https://www.gbo.com/fileadmin/user_upload/Downloads/IFU_Instructions_for_Use/IFU_Diagnostics/PapilloCheck/IFU_PapilloCheck_Rev._BQ-013-07_ES.pdf. Consulta: 24 marzo 2019.

(32) IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. IARC monographs on the evaluation of carcinogenic risks to humans: volume 90. Human Papillomaviruses. Lyon: IARC, 2007. Disponible en: https://monographs.iarc.fr/wp-content/uploads/2018/06/mono90.pdf. Consulta: 27 marzo 2019.

(33) Gravitt P, Kovacic M, Herrero R, Schiffman M, Bratti C, Hildesheim A, et al. High load for most high human papillomavirus genotypes is associated with prevalent cervical cancer precursors but only HPV 16 load predicts the development of incident disease. Int J Cancer 2007; 121(12): 2787-93.

(34) Lorincz A, Castle P, Sherman M, Scott D, Glass A, Wacholder S, et al. Viral load of human papillomavirus and risk of CIN3 or cervical cancer. Lancet 2002; 360(9328):228-9.

(35) Kinney W, Stoler M, Castle P. Special commentary: patient safety and the next generation of HPV DNA tests. Am J Clin Pathol 2010; 134(2):193-9.

(36) Ramas V, Mirazo S, Bonilla S, Mendoza L, Lago O, Basiletti J, et al. Human papillomavirus genotypes distribution in cervical samples from Uruguayan women. J Med Virol 2013; 85(5):845-51.

(37) de Sanjosé S, Diaz M, Castellsagué X, Clifford G, Bruni L, Muñoz N, et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis 2007; 7(7):453-9.

(38) Solomon D, Nayar R, eds. The Bethesda system for reporting cervical cytology. Definitions, criteria, and explanatory notes. New York: Springer-Verlag, 2004.

(39) Uruguay. Ministerio de Salud Pública. Guía de práctica clínica de tamizaje de cáncer de cuello de útero. Montevideo: MSP, 2005.

(40) Shiffman M, Solomon D. Findings to date from the ASCUS-LSIL Triage Study (ALTS). Arch Pathol Lab Med 2003; 127(8):946-9.

(41) Tworek J, Jones B, Raab S, Clary K, Wolsh M. The value of monitoring human papillomavirus DNA results of Papanicolaou tests diagnosed as atypical squamous cells of undetermined significance: a College of American Pathologists Q-Probes study of 68 institutions. Arch Pathol Lab Med 2007; 131(10):1525-31.

(42) Davey D, Woodhouse S, Styer P, Stastny J, Mody D. Atypical epithelial ells and pecimen dequacy: current laboratory practices of participants in the college of American pathologists interlaboratory comparison program in cervicovaginal cytology. Arch Pathol Lab Med 2000; 124:203-11.

(43) Rodríguez E, Reynolds J, Jenkins S, Winter S, Henry M, Nassar A. Atypical squamous cells of undetermined significance in patients with HPV positive DNA testing and correlation with disease progression by age group: an institutional experience. Int J Clin Exp Pathol 2012; 5(5):428-35.

(44) Massad L, Einstein M, Huh W, Katki H, Kinney W, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17:S1-S27.

(45) García López JA, Vilaplana Ortego E, López Segura MD, Meisels A, do Vilaplana Vilaplana E. ASCUS en citología cervicovaginal de rastreo y captura híbrida II: ¿Una quimera en nuestro medio? Rev Esp Patol 2003; 36(1):59-64.

(46) Tota J, Bentley J, Blake S, Coutlée F, Duggan M, Ferency A, et al. Introduction of HPV testing as in cervical cancer screening in Canada. (Evidence Review and Report, 9 december 2015). Disponible en:

http://healthydebate.ca/wp-content/uploads/2016/04/Report-on-HPV-primary-screening.pdf. Consulta: 24 marzo 2019.

(47) Herrero R, Ferreccio C, Salmerón J, Almonte M, Sánchez G, Lazcano-Ponce E, et al. New approaches to cervical cancer screening in Latin America and the Caribbean. Vaccine 2008; 26(Suppl. 11):L49-58.

(48) Koliopoulos G, Nyaga V, Santesso N, Bryant A, Martin-Hirsch P, Mustafa R, et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev 2017; 8:CD008587.

(49) Arbyn M, Ronco G, Anttila A, Meijer C, Chris J, Poljak M, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine 2012, 30(Suppl.5):F88-99.

(50) Ronco G, Dillner J, Elfstrom M, Tunesi S, Snijders P, Arbyn M, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomized controlled trials. Lancet 2014; 383(9916):524-32.

(51) Dillner J, Rebolj M, Birembaut P, Petri K, Szarewski A, Munk C, et al. Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study. BMJ 2008; 377:a1754.

(52) Anttila A, Kotaniemi-Talonen L, Leinonen M, Hakama M, Laurila P, Tarkkanen J, et al. Rate of cervical cancer, severe intraepithelial neoplasia, and adenocarcinoma in situ in primary HPV DNA screening with cytology triage: randomised study within organized screening programme. BMJ 2010; 340:c1804.

Publicado
2019-11-04
Cómo citar
1.
Rodríguez G, García L, Beracochea A, Alonso R, Caserta B, Pérez N, Larrosa D, Vero MJ, Ardao G, Santos MN, Hernández ML, Almonte M, Herrero R, Uruguay GE. Tamizaje del cáncer de cuello uterino con test de HVP. Rev. Méd. Urug. [Internet]. 4 de noviembre de 2019 [citado 21 de noviembre de 2024];35(4):267-80. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/304
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