High-Risk HPV Positivity With NILM Cytology: The Added Value of HPV Genotyping in a Case Report
DOI:
https://doi.org/10.54361/LJMR.20.3.96Keywords:
Pap test, HR HPV Test, Cervical Cytology, HPV Serotype, NILMAbstract
Background: High-risk human papillomavirus (HR-HPV) positivity with negative for intraepithelial lesion or malignancy (NILM) cytology represents a discordant cervical cancer screening result in which HPV DNA is detected despite the absence of cytological evidence of an intraepithelial lesion or malignancy. HPV genotyping and molecular triage approaches have been evaluated to further characterise risk among HPV-positive women. Case Presentation: A cervical cytology specimen obtained during cervical cancer screening was processed using liquid-based cytology with the ThinPrep® system and Papanicolaou staining. Microscopic examination demonstrated a satisfactory specimen with adequate representation of squamous epithelial cells and no cytological evidence of intraepithelial lesion or malignancy. High-risk HPV testing was performed using polymerase chain reaction with the Xpert® HPV HR assay on the GeneXpert® Dx System. HPV16 and HPV18/45 were negative, as were the HPV31/35/33/52/58 and HPV51/59 genotype groups. HPV DNA was detected within the HPV39/68/56/66 genotype group. Sample adequacy and probe check controls passed, and the test was completed successfully without an error. Integrated Interpretation: The case demonstrates an HR-HPV-positive/NILM cytological pattern. The positive molecular result indicates detection of high-risk HPV DNA but does not establish the presence of cervical intraepithelial neoplasia or a precancerous lesion. Because the Xpert® HPV HR assay reports the positive result as a genotype group, the specific genotype responsible for the positive result cannot be determined from this test alone. Conclusion: This case illustrates the added information provided by HPV genotype-group analysis in an HR-HPV-positive/NILM screening result. The findings support risk-based clinical follow-up according to applicable cervical cancer screening guidelines rather than a diagnosis of precancerous disease.
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