Comparison of cytological and/or histopathological results of patients with single and multiple HPV positivity

Objective: The aim of this study is to examine the effects of the presence of HPV type 16, HPV type 18, and other high-risk HPV types alone or in combination on cytological and histopathological outcomes. In this study, the effects of different HPV types on clinical outcomes will be evaluated by comparing the cytological abnormalities and histopathological lesions of patients with HPV positivity. Materials and Methods: This retrospective study was conducted using data obtained from the hospital automation system of patients who applied to the Department of Obstetrics and Gynecology at Karadeniz Technical University Faculty of Medicine between 2018-2023 and were found to be HPV positive. Recorded demographic data, cytological, and histopathological data were statistically evaluated. SPSS Version 27 was used for the statistical analysis of the data. It was observed that the number of patients who underwent Pap smear + HPV testing during the specified period was 9074. Upon reviewing the hospital automation data, one or more HPV positivity was found in 825 of these patients. Seventeen of these patients were excluded from the study because they were under the age of 21, and 19 were excluded due to insufficient material obtained. Of the remaining 789 patients, 177 were not included in the study because their colposcopies were performed at an external center, and a total of 612 patient files were included in the study. The data obtained from the patient files were divided into a total of 7 groups, but a comparative analysis of 5 groups could be performed. Results: The mean age of the patients included in the study was 39.3 ± 10.6. Endocrine disease was present in 14.9% of the patients, while 4.7% had a diagnosis of immunological disease. 20.8% of the patients were smokers. HPV positivity was detected in 8.7% of the patients. When the distribution of these patients was examined in percentages, HPV type 16 was detected at a rate of 17.4%, while other high-risk HPV types were detected at 63.8%. HPV type 18 was found at a rate of 4.9%. While HPV type 16 and other high-risk HPV positivities were detected at a rate of 10.9%, the coexistence of HPV type 16 and HPV type 18 was not observed in the study population. When the cytological and histopathological data of the cases were examined, smear abnormalities were present in 15.5% (95 of the 612 cases). It was found that 71.6% of these abnormal smear results were reported as ASC-US. A significant difference was found in terms of low-grade cervical intraepithelial cytology between the HPV 16 + other high-risk positive multiple group and the HPV16 group, with this rate being 1.8% in HPV16 and 16.1% in the HPV 16 + Other group. In colposcopic biopsy data, CIN2 was observed at a rate of 2.6% and CIN3 at a rate of 0.6% in the HPV other group, while CIN2 and CIN3 were each observed at a rate of 12.7% separately in the HPV 16 group. In the HPV 16 + other v high-risk group, CIN2 and CIN3 were observed at rates of 12.9% and 3.2%, respectively. Conclusion: HPV infections are of critical importance in terms of women's health as they can lead to premalignant and malignant lesions. In our six-year retrospective analysis (2018-2023), other high-risk HPV types stand out as the most common HPV type group according to the results in 612 appropriate patients; HPV 16, on the other hand, stands out as the most oncogenic type when all cytological and histopathological results are taken into account. One of the most controversial issues in the literature is the clinical reflection of multiple HPV positivities. In our study, it is seen that the combination of HPV 16 and other high-risk HPV is superior in terms of low-grade lesions compared to the HPV 16 group but is inferior in terms of high-grade lesion incidence.