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2016 ; 29
(2
): 291-319
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Human Papillomavirus Laboratory Testing: the Changing Paradigm
#MMPMID26912568
Burd EM
Clin Microbiol Rev
2016[Apr]; 29
(2
): 291-319
PMID26912568
show ga
High-risk human papillomaviruses (HPVs) cause essentially all cervical cancers,
most anal and oropharyngeal cancers, and some vaginal, vulvar, and penile
cancers. Improved understanding of the pathogenesis of infection and the
availability of newer tests are changing the approach to screening and diagnosis.
Molecular tests to detect DNA from the most common high-risk HPVs are FDA
approved for use in conjunction with cytology in cervical cancer screening
programs. More-specific tests that detect RNA from high-risk HPV types are now
also available. The use of molecular tests as the primary screening tests is
being adopted in some areas. Genotyping to identify HPV16 and -18 has a
recommended role in triaging patients for colposcopy who are high-risk HPV
positive but have normal cytology. There are currently no recommended screening
methods for anal, vulvar, vaginal, penile, or oropharyngeal HPV infections. HPV
testing has limited utility in patients at high risk for anal cancer, but p16
immunohistochemistry is recommended to clarify lesions in tissue biopsy specimens
that show moderate dysplasia or precancer mimics. HPV testing is recommended for
oropharyngeal squamous cell tumors as a prognostic indicator. Ongoing research
will help to improve the content of future guidelines for screening and
diagnostic testing.