Role of HPV Genotyping and p16 Expression in the Detection of Precancerous Cervical Lesions

Open Access

Abstract

Background: Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer. Although HPV DNA testing is widely used for screening, its specificity for high-grade cervical lesions is limited. p16 immunohistochemistry has emerged as a surrogate marker of transforming HPV infection. This study aimed to evaluate the role of HPV genotyping and p16 expression in detecting precancerous cervical lesions, particularly high-grade squamous intraepithelial lesions (HSIL). Methods & Materials: This cross-sectional study included 72 screen-positive women aged 30–60 years attending the colposcopy clinic of Bangladesh Medical University (BMU), Shahbagh, Dhaka in 2022-2023. Colposcopy-directed cervical biopsy and/or LEEP specimens were examined histopathologically as the gold standard. p16 immunohistochemistry was performed and interpreted as diffuse (positive) or focal/negative. HPV genotyping was conducted to detect high-risk HPV types. Diagnostic performance indicators including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: Histopathology confirmed HSIL (CIN II/III) in 61.1% of cases. Diffuse p16 expression was significantly associated with HSIL (p < 0.001; OR 142.7, 95% CI 16.6–1229.1). p16 demonstrated high sensitivity (84.1%) and specificity (96.4%), with PPV of 97.4%, NPV of 79.4%, and overall accuracy of 88.9%. In contrast, HPV genotyping was not significantly associated with HSIL (p = 0.675) and showed lower diagnostic performance. Conclusion: Diffuse p16 expression shows superior diagnostic performance compared with HPV genotyping alone for detecting high-grade precancerous cervical lesions. Incorporating p16 immunohistochemistry into routine diagnostic evaluation may enhance risk stratification and reduce overtreatment.