HPV genotyping enhances risk stratification of cervical samples

A comprehensive human papillomavirus (HPV) genotyping in combination with cytology improves risk stratification of cervical samples and patient management, suggests a Singapore study.

“Risk-based frameworks such as the Society for Colposcopy & Cervical Pathology of Singapore (SCCPS) and the American Society for Colposcopy and Cervical Pathology (ASCCP) help avoid overtreatment, enhance clinical outcomes, and conserve resources by identifying [patients] suitable for conservative follow-up instead of immediate colposcopy,” the researchers said.

Full HPV genotyping was performed in a total of 2,497 cervical specimens using real-time polymerase chain reaction. Of the samples, 327 (13.1 percent) tested positive for HPV, with 275 (84.1 percent) having available cytology results.

The researchers examined genotype prevalence and cytology correlations. They then compared follow-up management between the SCCPS and the ASCCP 2019 guidelines.

The most prevalent genotypes were HPV52 and 58, representing 32.2 percent of all HPV genotypes identified. About one in five samples (20.2 percent) had co-infections. Most of the 31 (9.5 percent) HPV16/18 cases had normal cytology, but some had atypical or low-grade changes. [Ann Acad Med Singap 2025;54:758-765]

These findings support those of previous epidemiological studies in East and Southeast Asia, where HPV52 and 58 are found to be the most common non-vaccine types. [Cancers (Basel) 2021;13:2691; J Low Genit Tract Dis 2021;25:27-37]

“Their oncogenic potential and frequent presence among HPV-positive cases further reinforce the need to incorporate them into screening and vaccine considerations,” the researchers said.

Follow-up strategies

Under the ASCCP guidelines for primary screening, 16.8 percent of cases could comply with repeat HPV testing in 1 year instead of going through immediate cytology triage under SCCPS. In co-testing, ASCCP-guided management led to a 7.4-percent decrease in colposcopy referrals since these individuals only required repeat HPV testing in a year.

There was a significant difference in downstream procedures when comparing follow-up management strategies for primary HPV screening between the SCCPS and ASCCP guidelines, the researchers said.

Under SCCPS, all 296 non-HPV16/18 positive cases would have to undergo immediate cytology triage following a positive HPV test. On the other hand, the ASCCP guidelines implement a more risk-stratified approach. Of the cases, only 241 (73.7 percent) would undergo cytology triage, while the remaining 55 cases (16.8 percent) could defer management and undergo repeat HPV testing after 1 year.

“This highlights the potential of ASCCP’s framework to reduce unnecessary cytological evaluations, thereby conserving clinical resources and reducing patient anxiety, without compromising the safety of screening outcomes,” the researchers said.

The current study had nationality data available for >68 percent of patients, with the majority being Singaporean residents.

“Nevertheless, this study demonstrates the value of comprehensive high-risk HPV genotyping in cervical screening, especially in the Singapore population where non-HPV16/18 genotypes such as HPV52 and 58 are highly prevalent,” the researchers said.

According to the researchers, HPV is the cause of more than 95 percent of cervical cancers.