Importance of HPV Genotyping for the Screening, Therapy and Management of Cervical Neoplasias

Abstract

In the last decade, the detection of human papillomaviruses (HPV) has become increasingly important in cervical cancer screening and the treatment of cancer precursors. HPV screening is recommended for the further evaluation of abnormal Pap tests or during follow-up after treating precancerous lesions. Several randomised controlled studies have shown that screening for cervical cancer using HPV detection can be more effective than cytology alone. Genotyping of different high-risk HPV (hrHPV) types obtained from smear tests has not yet gained widespread acceptance in clinical practice. However, significant differences have been noted in the oncogenicity of hrHPV genotypes. HPV 16 is by far the most common and oncogenic genotype. Genotyping of hrHPV could be helpful for the risk stratification of HPV-positive women.

Zusammenfassung

Der Nachweis humaner Papillomviren (HPV) im Rahmen der Vorsorge und Behandlung des Zervixkarzinoms und insbesondere seiner Vorstufen hat in den vergangenen Jahren zunehmend an Bedeutung gewonnen. Die HPV-Bestimmung wird beispielsweise zur weiteren Abklärung auffälliger Pap-Abstriche oder in der Nachsorge nach Behandlung präinvasiver Veränderungen empfohlen. Mehrere randomisierte kontrollierte Studien konnten zudem eine Überlegenheit gegenüber einem reinen Zytologie-Screening zeigen. Die Typisierung der unterschiedlichen Hochrisiko-HPV-Typen aus Abstrichproben hat dagegen erst in geringerem Maße Anwendung in der Praxis gefunden. Es zeigen sich jedoch große Unterschiede in der onkogenen Potenz und Relevanz der unterschiedlichen Genotypen. HPV 16 hat zahlenmäßig und auch prospektiv mit Abstand die höchste Bedeutung für die Entstehung zervikaler Neoplasien. Die Genotypisierung kann daher für eine bessere Risikostratifizierung HPV-positiver Frauen hilfreich sein.

Key words

cervical cancer - cervical interepithelial neoplasia (CIN) - human papillomavirus

Schlüsselwörter

Zervixkarzinom - Zervixpräkanzerose - humane Papillomviren

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