Cervical Cancers Diagnosed Across Ghana, a Study of Histopathological Characteristics and Hpv Type Distribution Using an Automated Ampfire Pcr Detection System

Abstract

Abstract Introduction: Due to the absence of a national screening and vaccination program, the burden of cervical cancer in Ghana is staggering. Geographical variations in high-risk Human Papilloma Virus (hrHPV) incidence and type have been documented and should be considered during vaccine improvement and screening, especially in Low Middle-Income Countries (LMICs). We determined the types of hrHPV associated with cervical cancer and compared this to histopathological characteristics of cervical cancer. Methods: Cervical cancers were assessed for histopathological features by two independent pathologists following WHO 2014 and 2022 guidelines for the reporting of cervical Squamous Cell Carcinoma (SCC) and Endocervical Adenocarcinoma (EAC). In addition, the novel Tumour Budding and Nest Size Grade (TBNS) for SCC, SILVA pattern of invasion for EAC and Tumour Infiltrating Lymphocytes (TILs) were assessed. High Risk HPV testing was done using an isothermal, multiplex nucleic acid amplification method from ATILA biosystem (Mountain View California, USA). Results: A total of 297 cases were identified for the study with ages ranging from 20 to 95 years. The peak age group for cervical cancer was 46 to 55 years. For those tested, hrHPV positivity rate was 85.4% [ EAC (84.6%) and SCC (85.6%)]. The top five hrHPV serotypes for both histological cancers were 59(40%), 35(32%), 18(30%), 16(15%), and 33(10%) respectively. Approximately, 58.2% of infections were multiple. Single hrHPV infections were mostly caused by 59 (28.9%), and hrHPV 16 (26.3%). TBNS grade for SCC, SILVA pattern of invasion for EAC and TILs did not show any statistically significant relationship with hrHPV, though TBNS grade for SCC and SILVA invasion pattern for EAC mirrored the reported late stage and poor prognosis of cervical cancer in Ghana. Conclusion: We affirm reported variations in hrHPV types in cervical cancer in Ghana with hrHPV types such as 59, 35, and 33 playing a more significant role. Variations should guide vaccine improvement and triaging of hrHPV positives. Though multiple infections are more common, some hrHPV types such as hrHPV 16 and 59 are responsible for most single infections that result in cervical cancer. Simple haematoxylin and eosin-based morphological assessments can improve the prognostication of patients with cervical cancer.