Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom.
J Clin Microbiol. 2023 Aug 23;61(8):e0140322. doi: 10.1128/jcm.01403-22. Epub 2023 Jul 13.
Twelve high-risk alpha human papillomavirus (HPV) genotypes cause approximately 690,000 cancer cases annually, with cervical and oropharyngeal cancer being the two most prominent types. HPV testing is performed in laboratory settings for various applications of a clinical, epidemiological, and research nature using a range of clinical specimens collected by clinicians or by individuals (self-collected specimens). Here, we reflect on the importance and justification of using the right test for the right application and provide practical updates for laboratories either participating in or anticipating involvement in HPV testing in three specimen types, namely, urine, blood, and oral specimens, which are considered "alternative" specimens by many. In addition to clinician-collected cervical samples and self-collected cervicovaginal samples, first-void urine is emerging as a credible specimen for HPV-based cervical cancer screening, triage of HPV screen-positive women, monitoring HPV vaccine impact, and HPV testing in groups for which a less invasive sample is preferred. Detection of cell-free DNA (including HPV DNA) in blood has great promise for the early detection of HPV-attributable oropharyngeal cancer (HPV-AOC) and potentially other HPV-driven cancers and as an adjunct prognostic marker in long-term tumor surveillance, including treatment response. The moderate sensitivity of HPV testing in oral rinses or swabs at HPV-AOC diagnosis prevents its use in HPV-AOC secondary prevention but represents a promising prognostic tool in HPV-AOC tertiary prevention, where the HPV persistence in oral rinses throughout treatment may predict early HPV-AOC recurrences and/or the development of secondary HPV-AOC. The increasing sophistication of specific collection devices designed for alternative samples and the enhanced precision of novel molecular technologies are likely to support the evolution of this field and catalyze potential translation into routine practice.
十二种高危型人乳头瘤病毒（HPV）基因型每年导致约 69 万例癌症病例，其中宫颈癌和口咽癌是两种最突出的类型。HPV 检测在实验室中进行，用于临床、流行病学和研究性质的各种应用，使用临床医生或个人收集的一系列临床标本（自我采集标本）。在这里，我们反思了为正确的应用选择正确的测试的重要性和合理性，并为参与或预期参与 HPV 检测的实验室提供了实用的更新，涉及三种标本类型，即尿液、血液和口腔标本，这些标本在许多人看来是“替代”标本。除了临床医生采集的宫颈样本和自我采集的宫颈阴道样本外，首次排空尿液作为基于 HPV 的宫颈癌筛查、HPV 筛查阳性女性的分流、HPV 疫苗效果监测以及首选较不侵入性样本的人群 HPV 检测的可信标本正在出现。血液中游离细胞 DNA（包括 HPV DNA）的检测为 HPV 相关性口咽癌（HPV-AOC）和潜在其他 HPV 驱动的癌症的早期检测以及在长期肿瘤监测（包括治疗反应）中作为辅助预后标志物提供了巨大的前景。HPV 在口咽癌诊断时在漱口液或拭子中的检测敏感性适中，因此不能用于 HPV-AOC 的二级预防，但在 HPV-AOC 的三级预防中代表了一种有前途的预后工具，其中治疗期间漱口液中 HPV 的持续存在可能预测 HPV-AOC 的早期复发和/或继发性 HPV-AOC 的发展。专门设计用于替代样本的特定采集设备的日益复杂化和新型分子技术的增强精度可能会支持该领域的发展，并促进潜在的转化为常规实践。
