HPV detection and/or cytological diagnostics

Abstract

The aim of this review article is to demonstrate the role and importance of the pathologist/cytologist in screening and to emphasise the importance of introducing the state-of-the-art molecular biology methods into the screening programme, in addition to providing an overview of the screening methods. Dr Tedros Adhanom Ghebreyesus, World Health Organization Director-General, announced a global call for action to eliminate cervical cancer and made it a public health priority in 2018. Cervical screening tests can detect precancerous lesions of the cervix in apparently healthy, asymptomatic women. Many institutions still use the conventional or Pap test, while many others have started using the modern test i.e. liquid-based cytology, which significantly reduces the pre-analytical phase errors. To date, studies comparing the two techniques have not provided consistent evidence that liquid-based cytology offers significant improvements in sensitivity or specificity, so both are considered acceptable. With the discovery of the etiological link between the HPV virus and cervical cancer in 1983, new methods were developed for cervical cancer screening by designing tests aimed at identifying the virus/infection rather than at the onset of the disease and detecting altered cells. The application of the HPV test as the first line of the screening programme is becoming routine. The advantages of applying the molecular technique are that it has a high predictive value, high reproducibility and high throughput. In the Republic of Serbia, the screening programme has been implemented by the National Decree since 2013, as an organised, decentralised programme and has its own difficulties in terms of personnel, financial and organisational deficiencies. The HPV primary screening would enable those difficulties to be overcome to a considerable degree, especially if liquid-based cytology were to be implemented and digital pathology introduced along with HPV screening. All of this, however, has one prerequisite, which is centralisation. Looking at the situation also from the aspect of introducing vaccines against the HPV virus, I believe that we are on the right track to control cervical cancers, and to eradicate them in the not so distant future.