Introduction/Background Recognition of high-grade severe cervical intraepithelial neoplasia (CIN2+) during pregnancy is a matter of concern in areas where pregnant women are covered with well-arranged screening, but generally cervical screening is rather opportunistic due to low awareness among population about its vital significance (like in Ukraine). According to guidelines during pregnancy CIN2+ are left untreated with next check-up when puerperal period comes to the end, unless invasive cancer is suspected. But if CIN2+ was misconstrued as low-grade lesion and a patient was not properly alerted, she may fail to come for check-up. Reliable tools for recognition CIN2+, especially those destined to progress are very important for cervical triage during pregnancy
Methodology Study comprised 85 HPV16,18-positive pregnant women, all of them underwent colposcopy. Every cervical sample was tested for expression of p16INK4A, Ki-67, HPV L1, DNA methylation of L1 region of HPV 16 and 18. Results were collated with colposcopy conclusion verified by biopsy.
Results Colposcopy revealed 47,1% patients with occult LSIL and 39,4% with occult HSIL (normal PAP-smear). Hypermethylation of L1 region was detected in all cases of CIN2+, being much more significant in CIN3. L1 gene methylation matches colposcopy in capacity to recognize CIN2+ (positive PV >95%) but less affected by human mistake. L1 gene methylation proved to be much more informative for distinguishing LSIL from mimics than p16INK4A. Alarming expression of p16INK4A, Ki-67 was spotted sporadically and its sensitivity for CIN2+ fell behind sensitivity of L1 gene methylation.
Conclusion DNA methylation of L1 region of HPV 16 and 18 can improve workflow for hrHPV-positive pregnant women triage because of its high sensitivity and specificity for CIN2+. It is plausible, that CIN3 lesions destined to progress were consistent with higher level of methylation comparatively to those of indolent entity, but further study is necessary in order to confirm that assumption.
Disclosure Nothing to disclose
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