Correlation of Human Papillomavirus Genotypes with Cytological Findings for Development of Cervical Cancer Screening Guidelines

Abstract

Objective : To investigate the association between high-risk Human Papillomavirus (HPV) genotypes and cytological and colposcopic findings, and to utilize the study findings to develop guidelines for cervical cancer screening, result reporting, referral system, and patient follow-up in Maha Sarakham Province.

Method : This Research and Development (R&D) study consisted of two phases. Phase I was a retrospective analytical study involving women aged 30–60 years who underwent cervical cancer screening using HPV DNA testing at Maha Sarakham Hospital during January 1 to December 31, 2023. Data on HPV genotypes, Liquid-Based Cytology (LBC), and colposcopic findings were retrieved and analyzed using SPSS statistical software. Phase II involved the development of guidelines for specimen submission, HPV result reporting, and follow-up of HPV-positive women based on the findings from Phase I.

Result : In phase I, among 17,276 women screened, the overall HPV positivity rate was 11.1%. Of the 480 women with complete LBC data, abnormal cytological findings (≥ASC-US) were identified in 5.0% of cases. HPV 58 was significantly associated with abnormal cytology
(p = 0.038). Among 155 women who underwent colposcopy, significant differences in colposcopic findings were observed between HPV 16 and HPV 18 infections (p = 0.013). HPV 16 was more strongly associated with HSIL/CIN2-3 lesions, whereas HPV 18 was associated with a higher proportion of cervical cancer cases. Furthermore, HPV 16 demonstrated high sensitivity for predicting HSIL/CIN2-3 (81.08%), while HPV 18 showed superior sensitivity, specificity, and overall accuracy for predicting cervical cancer. In Phase II, three components were developed: (1) a risk-based referral guideline, (2) a genotype-specific HPV DNA reporting system, and (3) a digital follow-up system, HPV Care Track, for women with HPV-positive results. The developed guideline was evaluated by an expert panel and received the highest level of appropriateness across all domains, with a median score of 5.00 and an interquartile range (IQR) of 0.00–1.00. The developed system improved the efficiency of result reporting and patient follow-up, resulting in  77% of HPV-positive women who returned for follow-up Liquid-Based Cytology (LBC) examination. The experts agreed that the guideline was academically sound, clearly presented, feasible for implementation in routine clinical practice, and appropriate for the management of HPV-positive women in Maha Sarakham Province.

Conclusion : HPV 58 was associated with abnormal cytological findings. HPV 16 and HPV 18 were strongly associated with high-grade lesions and cervical cancer. These findings support the use of HPV genotyping for risk stratification and provide evidence for improving cervical cancer screening, reporting, referral system, and follow-up systems at the provincial level.