Work

In Response

Year: 2010

Type: article

Abstract: We thank Drs. Kruse and Slangen for their comments and request for additional data about our recent findings that timing of diagnosis of HPV18/45-related CIN3+ is delayed in comparison with HPV16-associated CIN3+ (1). They suggest that HPV18/45-related lesions might be detected later compared with HPV16-related lesions because acetowhite lesions due to HPV18/45 may be located higher in the endocervix and thus out of the reach of visual evaluation and conventional cytologic evaluation.Unfortunately, we did not capture the location of CIN lesions within the LEEP specimen in ALTS. However, we were able to use data from a previously published analysis in ALTS of the diagnostic utility of endocervical curettage (ECC) among women who had biopsy and ECC performed at colposcopy and were diagnosed with CIN2+ throughout the study (2). When we reanalyzed those data stratified by HPV16 versus HPV18/45 to evaluate whether there was a difference in the proportion of ECC positivity, there was no significant difference in percent ECC positivity for HPV16 CIN2+ (23 of 153 or 15%) compared with percent ECC positivity for HPV18/45 CIN2+ (7 of 64 or 11%), as shown in Table 1. Stratification on whether the paired biopsy showed CIN2+ did not alter the conclusions; moreover, the same patterns were seen when we examined the more stringent disease end point of CIN3+.It is important to mention that ALTS was not designed to address this question specifically. In ALTS, ECCs were done at the discretion of the clinician and thus performed on a small, nonrandom percentage of approximately 18.5% of colposcopy procedures (2). As a consequence, the sample size was small and not sufficiently powered to evaluate the issue raised by Drs. Kruse and Slangen. Therefore, we cannot rule out the possibility that HPV18/45 lesions may be harder to detect because of an endocervical location compared with HPV16 lesions. We agree with Drs. Kruse and Slangen that this is a clinically important question that needs to be addressed in future studies.No potential conflicts of interest were disclosed.Grant Support: National Cancer Institute, NIH, Department of Health and Human Services contract nos. CN-55153, CN-55154, CN-55155, CN-55156, CN-55157, CN-55158, CN-55159, and CN-55105. Some of the equipment and supplies were donated or provided at reduced costs by Digene Corporation (Gaithersburg, MD), Cytyc Corporation (Fenton, MO), Denvu (Tucson, AZ), Roche Molecular Systems (Alameda, CA), and TriPath Imaging, Inc. (Burlington, NC).The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

Source: Cancer Research

DOI: 10.1158/0008-5472.can-09-3750

Authors: Mahboobeh Safaeian, Mark Schiffman, Julia Gage, Philip E. Castle, Diane Solomon, Cosette M. Wheeler