Comparison of mRNA Testing, HPV DNA Testing, and Repeat Cytology - Book Report/Review Example

A Comparison of mRNA Testing, HPV DNA Testing, and Repeat Cytology Synopsis of the Article The article authored by Persson Maria and her colleagues is titled “Triage of HR-HPV Positive Women with Minor Cytological Abnormalities: A Comparison of mRNA Testing, HPV DNA Testing, and Repeat Cytology Using a 4-Year Follow-Up of a Population-Based Study” and offers insight into the use of different techniques of testing the risk of women with high-risk human papillomaviruses (HR-HPV). The purpose of testing the level of risk associated with the specific type of the HPV virus is being able to determine women who are susceptible to developing cervical cancer. As highlighted in the article, the human Papillomavirus (HPV) is responsible for about 99% of cervical cancer cases. With the increasing prevalence of cervical cancer, there is a salient need for the development of effective testing techniques of the type of HPV that women have and determine whether they need to obtain early medication in the prevention of the cancer development. According to the modern technology, there are three different testing techniques with varying efficiency and specificity. This article presents the findings of a four-year follow up study based on an identified population. The three techniques under comparison include, HPV-DNA testing, mRNA testing using the APTIMA HPV assay and repeat cytology (Persson et al, 2014). According to the authors, cytology based testing has been in use for the longest time and has registered a level of efficiency in reducing the development of cervical cancer. However, the authors have highlighted that, cytology based methodologies are only able to detect minimal abnormalities and present a level of non-specificity. Without doubt, there was a salient need for the development of more specific techniques that could identify the presence of the high risk types of the HPV virus. For example, it has been noted that HPV 16 and 18 are responsible for over 70% immunocytochemistry (ICC) occurring in the globe. Other methodologies developed have been the HPV-DNA testing, which involves the isolation of the DNA from samples and further analysis to determine the presence of oncogenes cording for the different types of HPV. HPV-DNA testing presents a high level of sensitivity and may present an unwanted negative predictive value. HPV-DNA testing relies on the genotyping of the different HPV types using the Roche diagnostics. The third technique which has been developed recently is the mRNA testing using the APTIMA technique. APTIMA functions by an application process of nucleic acids in the messenger RNA and is then used to detect different HPV types. Notably, APTIMA does not have the functionalities of differentiating different HPV types (Persson et al, 2014). The study carried out aimed at comparing the three techniques described above. The authors identified 219 women, who tested positive for the HR-HPV. These women were diagnosed with atypical squamous cells of undetermined significance (ASCUS) and others exhibited the presence of low-grade squamous intraepithelial lesions (LSIN). Samples were collected from these women who were required to either undergo repeat cytology or colposcopy. The samples obtained from these women were analyzed using the three techniques, namely repeat cytology, HPV-DNA testing and HPV E6/ E7 mRNA testing using APTIMA. Cytology tests were repeated after 12 months in order to be categorized under repeat cytology. According to the results of the three triage options, it emerged that, HPV 16 presented the highest prevalence in the group with ASCUS and also that with LSIL. According to the results, HPV 53 was ranked the second most prevalent in the ASCUS group while types 51 and 52 of the Papillomavirus in human were more likely to be second most prevalent in the group with LSIL. From the mRNA testing using APTIMA, 162 women registered positive results. Notably, the comparison sought to determine whether MRNA testing had the potential of registering a higher specificity than the previously used techniques (Persson et al, 2014). From the three tests conducted, APTIMA proved to have the highest level of sensitivity in the ASCUS group. However, the authors highlighted that, the level of sensitivity became significant when compared to repeat cytology but relying on a cut-off of HSIL in the prediction of cervical intraepithelial neoplasia (CIN) of grade 2. When APTIMA was compared to DNA testing of the HPV type 16, it proved less significant. More specific results indicated that, 36% of women in the ASCUS group and a similar percentage of participants in the LSIL group exhibited the presence of CIN grade 2 within the four years of the study. 74% of the total participants proved to be APTIMA positive. With this technique presenting the highest level of sensitivity in the prediction of CIN grade 2 and 3 in the ASCUS group as well as the LSIL group. Notably, the sensitivity of APTIMA in the LSIL group proved to be insufficient (Persson et al, 2014). When APTIMA was compared to repeat cytology and HPV 16 DNA attesting, it was ranked less the least specific. In the discussion section, the authors present a detailed comparison for the performance of each of the techniques used in detecting the different HPV types. It becomes evident that the mRNA testing methodology exhibits a measure of desirable performance in detecting the HPV types. Notably, its efficiency and specificity in women with ASCUS is remarkably high. Therefore, this technique can be adopted in the modern day as an effective technique of detecting HPV infection of high risk (Persson et al, 2014). Why I Chose the Article My motivation to choose the analyzed article is the fact that it presents details of a comparison between different triage options which have been developed in the recent past. The article moves from the repeat cytology technique which has been in use for the longest time to modern molecular techniques that can present efficiency and specificity in the detection of different HPV types. The new molecular techniques described include the HPV DNA testing and the mRNA testing using the APTIMA technique. The fact that the authors present a comparison using statistical significance comparisons makes it more valid. Notably, the molecular techniques described form part of modern diagnostic options and their implementation in different diagnostic laboratories can be effected. The article was published in February of this year a factor that places emphasis on its relevance as a more recent source highlighting the newest techniques in the detection of HPV in women (Debaque & Eide, n.d). With the increasing prevalence of HPV, this article is of significant contribution to successful diagnostic procedures. What I Learned from the Article and its Appropriateness in Class Presentation From the article, I learned that molecular techniques have emerged as preferable diagnostic techniques in the detection of the HPV types that affect women. Without doubt, cervical cancer has become a challenge to the health system just like many other cancers. Research into the development of cervical cancer has highlighted that early detection can contribute to successful intervention. This is the reason why the HPV DNA testing method and the APTIMA based MRNA testing have been recently developed to serve as additional techniques to a higher level of sensitivity and specificity in detecting high risk HPV types. Through my close analysis of the article, I noted that mRNA testing is highly specific in the group of women with ASCUS. Therefore, it can be adopted in modern laboratories in the detection of HPV types (Eide & Debaque, 2012). Notably, the APTIMA test presents a level of remarkable performance and can be adopted in HPV diagnosis. This article is appropriate for the class presentation as it will serve to enlighten the class on the efficiency of the APTIMA test as a new molecular technique used in the detection of HPV. Therefore, the class will gain familiarity with these new molecular techniques that can be implemented. References Debaque, H., & Eide, M. (n.d). HPV detection methods and genotyping techniques in screening for cervical cancer. Annales De Pathologie, 32(6), 401-409. Eide, M., & Debaque, H. (2012). Review: HPV detection methods and genotyping techniques in screening for cervical cancer. Annales De Pathologie, 32(Numero special : Cytopathologie), e15-e23. doi:10.1016/j.annpat.2012.09.231. Persson, M., Elfström, K., Brismar Wendel, S., Weiderpass, E., & Andersson, S. (2014). Triage of HR-HPV Positive Women with Minor Cytological Abnormalities: A Comparison of mRNA Testing, HPV DNA Testing, and Repeat Cytology Using a 4-Year Follow-Up of a Population-Based Study. Plos ONE, 9(2), 1-8. doi:10.1371/journal.pone.0090023. Read More