ORIGINAL ARTICLE

Detection of telomerase, its components, and human papillomavirus in cervical scrapings as a tool for triage in women with cervical dysplasia

N Reesink-Peters¹, M N Helder¹, G B A Wisman¹, A J Knol¹, S Koopmans³, H M Boezen², E Schuuring³, H Hollema³, E G E de Vries⁴, S de Jong⁴, A G J van der Zee¹

¹ Department of Gynaecological Oncology, University Hospital Groningen, 9700 RB, Groningen, The Netherlands
² Department of Epidemiology and Biostatistics, University Hospital Groningen
³ Department of Pathology, University Hospital Groningen
⁴ Department of Medical Oncology, University Hospital Groningen

Correspondence to:
Correspondence to:
Dr A G J van der Zee, University Hospital Groningen, The Netherlands;
a.g.j.van.der.zee{at}og.azg.nl

Aim: To examine whether the detection of either telomerase and its components or high risk human papillomavirus (HPV) are of value in predicting the presence of cervical intraepithelial neoplasia (CIN) grade II/III in women referred because of cervical cytology reports showing at most moderate dyskaryosis.

Methods: Cervical scrapings of 50 women referred with cytological borderline, mild, or moderate dyskaryosis were analysed. Telomerase activity was assessed by a commercially available telomere repeat amplification protocol assay and its components human telomerase RNA (hTR) and human telomerase reverse transcriptase (hTERT) were assessed by reverse transcriptase polymerase chain reaction (PCR). HPV was detected by GP5+/6+ PCR enzyme immunosassay. Histological findings on colposcopy guided biopsies or excised cervical tissue were regarded as the final pathological diagnosis. The sensitivity and specificity for detecting CIN II/III were calculated.

Results: Twenty eight women were diagnosed with CIN II/III. Telomerase activity was detected in none, hTR in 88%, hTERT in 23%, and high risk HPV was detected in 79% of these women. As a diagnostic test none of the described analyses combined a sensitivity of at least 90% with a specificity 90%. Despite the small numbers, calculation of the 95% confidence intervals excluded a combined sensitivity and specificity of at least 90% for all of the evaluated parameters.

Conclusions: Neither detection of telomerase or its components, nor detection of high risk HPV seem suitable for the triage of women with borderline, mild, and moderate cytological dyskaryosis.

Keywords: human papillomavirus; cervical neoplasia; telomerase activity; human telomerase RNA; human telomerase reverse transcriptase

Abbreviations: CIN, cervical intraepithelial neoplasia; GAPDH, glyceraldehyde-3-phosphatase dehydrogenase; GT, guanidine isothiocyanate; HPV, human papillomavirus; hTERT, human telomerase reverse transcriptase mRNA; hTR, human telomerase RNA; IQR, interquartile range; PCR, polymerase chain reaction; RT, reverse transcription; TRAP, telomere repeat amplification protocol

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