HPV-associated diseases and their cytodiagnosis
DOI:
https://doi.org/10.2478/AMB-2025-0041Keywords:
screening, HPV, `PAPAbstract
Introduction: Conventional cytodiagnosis (PAP) has been used since the 1950s as a method for cervical cancer (CRC) prevention. Through the PAP smear test, the presence of persistent HPV infection could be proven, which cytopathologists described as the presence of koilocyte changes, a consequence of the nuclear membrane destruction. The objective of the present study has been to present the relevance of the conventional PAP smear as a method for the diagnosis of HPV-associated precancerous and cancerous diseases of the cervix. Materials and Methods: During the period 2019-2021, a retrospective study was carried out covering 128 female patients from Hinkomed MC LTD and Sv. Marina University Multi-Profi le Hospital for Active Treatment (UMPHAT) LTD, Pleven. The obtained data were processed with MS Office Excel 2019 software. Results: The covered group of patients was divided into two, according to the obtained results from the PAP smear test. The first group consisted of 74 patients (57.8%) with PAP I-II results (not signaled – cytologically). HPV-associated disease was diagnosed in 74.5% (38 patients) of them, and cervical inflammation in 13 (25.5%). The second group included 54 female (42.2%) with a PAP IIIa result and a higher group, called cytologically signaled. The study proved that 2 of the cases (3.7%) were false positive, 21 of the cases were true negative. There were 46 true positive cases and 39 false negative cases. Conclusion: The PAP smear test has been insufficient for the diagnosis of HPV-associated precancerous and/or cancerous diseases of the cervix. As an independent diagnostic method, it has been used only for HPV infection detection.
References
Atanasova D, Zlatkov V. Clinical presentation of different methods for cervical screening; Obstetrics and Gynecology, 2015, 6: 3-9.
Malinova M. HPV associated diseases and opportunities for their prevention, Obstetrics and Gynecology, 2015, Appendix 1(1): 25-31.
National Framework Agreement. [Internet]. National Health Insurance fund. Available at: https://www.nhif.bg/bg/nrd/2020-2022/medical
Stoyanova E, Kamburova M. Need for preventive programs for HPV-associated diseases. In: Proceedings from the jubilee scientific conference with international participation “New approaches in public health and health policy”, November 26-28, 2020, Pleven, proceedings 128-132.
Alfareh M, Obeid D, Alhoshan H, et al. Low uptake of Pap test as a cervical cancer screen among Saudi women: Findings from a national survey. Int J Gynaecol Obstet. 2024 Apr 19. doi: 10.1002/ijgo.15532. Epub ahead of print.
Alrefai EA, Alhejaili RT, Haddad SA. Human Papillomavirus and Its Association With Cervical Cancer: A Review. Cureus. 2024 Apr 1; 16(4):e57432. doi: 10.7759/cureus.57432.
Beckmann, MW, Schneider A. Primary, secondary and tertiary prevention of cervical cancer. Arch Gynecol Obstet 289, 933–934 (2014). https://doi.org/10.1007/s00404-014-3188-6.
Cirkel C, Barop C, Beyer DA. Method comparison between Munich II and III nomenclature for Pap smear samples. J Turk Ger Gynecol Assoc. 2015 Nov 2;16(4):203-7. doi: 10.5152/jtgga.2015.0147.
Dura MC, Aktürk H, Aslan Ö, et al. Human Papillomavirus Infection (HPV) Prevalence in the Black Sea Region of Turkey: Primary HPV Screening for Cervical Cancer. Cureus. 2024 Jan 20;16(1):e52615. doi: 10.7759/cureus.52615.
Fusco E, Padula F, Mancini E, et al. History of colposcopy: a brief biography of Hinselmann. J Prenat Med. 2008;2(2):19-23.
Ghisu GP. Gynäologische Vorsorge [Importance of the Pap-smear in the age of HPV testing]. Ther Umsch. 2021;78(2):93-98. doi: 10.1024/0040-5930/a001243.
HPV and Cancer. [Internet]. National Cancer Institute. (cited Oct, 2023). 2020. Available from: https://www.can-cer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpvand-cancer
Kabaca C, Keles E, Akis S, et al. #950 The role of cytology in patients aged 25–30 who underwent colposcopy Int J Gynecol Cancer 2023;33:A350-A351.
Kaya Terzi N, Yulek O. Assessment of Cervicovaginal Smear and HPV DNA Co-Test for Cervical Cancer Screening: Implications for Diagnosis and Follow-Up Strategies. Diagnostics (Basel). 2024;14(6):611. doi: 10.3390/diagnostics14060611.
Khakwani M, Parveen R, Azhar M. Comparison of PAP smear and liquid based cytology as a screening method for cervical carcinoma. Pak J Med Sci. 2022 Sep-Oct;38(7):1827-1831. doi: 10.12669/pjms.38.7.5742.
Kim JH, Kim IW, Kim YW, et al. Comparison of single-, doubleand triple-combined testing, including Pap test, HPV DNA test and cervicography, as screening methods for the detection of uterine cervical cancer. Oncol Rep. 2013 Apr;29(4):1645-51. doi: 10.3892/or.2013.2257.
Kitchen FL, Cox CM. Papanicolaou Smear. [Updated 2022 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): Stat-Pearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470165/
Lellé RJ, Küppers, V. The Signifi cance of Cytology, Biopsy, and HPV Testing. In: Colposcopy. Springer, 2023, Cham. https://doi.org/10.1007/978-3-030-85388-4_6
Lindquist S, Frederiksen K, Petersen LK, Kjær SK. The risk of vaginal, vulvar and anal precancer and cancer according to high-risk HPV status in cervical cytology samples. Int J Cancer. 2024 Jul 1;155(1):61-70. doi: 10.1002/ijc.34896.
Macharia HC, Cheserem EJ, Bukusi E, et al. A comparative analysis of conventional Pap smear cytology, liquid based cytology and colposcopy clinical impression with colposcopy biopsy histology as gold standard in women undergoing colposcopy in Kenyatta National Hospital. Int J Reprod Contracept Obstet Gynecol [Internet]. 2016 Dec. 24 [cited 2023 November]; 3(1):58-63. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/747
Mahajan P, Kaur P. Improving cervical cancer classification in PAP smear images with enhanced segmentation and deep progressive learning-based techniques. Diagn Cytopathol. 2024 Jun;52(6):313-324. doi: 10.1002/dc.25295.
Miller AB, Nazeer S, Fonn S, et al. Report on consensus conference on cervical cancer screening and management. Int J Cancer. 2000 May 1;86(3):440-7. doi: 10.1002/(sici)1097-0215(20000501)86:3<440::aid-ijc22>3.0.co;2-a.
Musurmonova AI, Norkhidirova ZB. Diagnostics of diseases of the cervic in modern gynecology. American Journal of Pediatric
Medicine and Health Sciences, 2023, (2993-2149), 1(2), 51-55. Retrieved from https://grnjournal.us/index.php/AJPMHS/article/view/112
National Cancer Institute. National Cancer Institute; 2019. Cervical Cancer Screening (PDQ(R)): Health Professional Version. Available from: https://www.cancer.gov/types/cervical/hp/cervical-screening-pdq
Nayar R, Wilbur DC. The Pap test and Bethesda 2014. Cancer Cytopathology, 2015, 123: 271-281. https://doi.org/10.1002/cncy.21521
Pulkkinen J, Huhtala H, Kholová I. False-positive atypical endocervical cells in conventional Pap smears: Cyto-histological correlation and analysis. Acta Cytologica. 2023 Aug 10.
Rauf L, Eid A, Hamed, E. A global perspective on cervical cancer screening: a literature review. Int J Commun Med Publ Health, 2023, 10(5), 1942-1946. https://doi.org/10.18203/2394-6040.ijcmph20231044
Rodriguez NM. Participatory innovation for human papillomavirus screening to accelerate the elimination of cervical cancer. Lancet Glob Health. 2021 May;9(5):e582-e583. doi:10.1016/S2214-109X(20)30522-2.
Sharma J, Toi PCh, Siddaraju N, et al. A comparative analysis of conventional and SurePath liquid-based cervicovaginal cytology: A study of 140 cases. J Cytol. 2016 Apr-Jun;33(2):80-4. doi: 10.4103/0970-9371.182525.
Sherwani RK, Khan T, Akhtar K, et al. A comparative study of conventional pap smears and liquid based cytology. J Cytol. 2007; 24:167-72.
Smith ER, George SH, Kobetz E, Xu XX. New biological research and understanding of Papanicolaou’s test. Diagn Cytopathol. 2018 Jun;46(6):507-515. doi: 10.1002/dc.23941 .
Sreedevi A, Javed R, Dinesh A. Epidemiology of cervical cancer with special focus on India. Int J Womens Health. 2015 Apr 16;7:405-14. doi: 10.2147/IJWH.S50001.
The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer. Accessible at: https://www.cancer.org/cancer/cervical-cancer/preventionand-early-detection/cervical-cancer-screening-guidelines.html
Zhou N, Lu H. A review and comparison of midwifery management and education in five representative countries. Int J Nurs Sci. 2018 Jan 9;5(1):10-14. doi: 10.1016/j.ijnss.2017.12.007. Erratum in: Int J Nurs Sci. 2020 Dec 06;8(1):V.
Zur Hausen H. Papillomaviruses in the causation of human cancers – a brief historical account. Virology. 2009 Feb 20;384(2):260-5. doi: 10.1016/j.virol.2008.11.046.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 N. Hinkova, T. Semova, D. Dimitrov, M. Vasileva, V. Racheva, Z. Gorcheva (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
You are free to share, copy and redistribute the material in any medium or format under these terms.
Journal Acta Medica Bulgarica 
