Tsiodras et al. BMC Cancer 2010, 10:53 http://www.biomedcentral.com/1471-2407/10/53 R E S E A R C H A R T I C L E Open Access Hybrid capture vs. PCR screening of cervical human papilloma virus infections. Cytological and histological associations in 1270 women Sotirios Tsiodras1, John Georgoulakis2, Aikaterini Chranioti2,3, Zanis Voulgaris4, Amanda Psyrri5, Angeliki Tsivilika6, John Panayiotides7, Petros Karakitsos2,3* Abstract Background: We evaluated two molecular methods of HPV detection and their correlation with cytological and histological diagnosis in a large sample of Greek women. Methods: All women with liquid-based cytology performed at a University Hospital between 2000 and 2003 were included. The Hybrid Capture 2 (HC2) kit and in house Polymerase Chain Reaction (PCR) were used for HPV DNA detection. Cervical biopsy was performed for women with ASCUS+ cytology, HPV detection, or abnormal colposcopy. Positive (PLR) and negative (NLR) likelihood ratios were calculated for cytology and HPV molecular testing for the prediction of CIN2 and greater histology. Results: Of the 1270 women evaluated 241 (18.5%) had abnormal cytology. Cytology diagnosed high-grade squamous intraepithelial lesion (HSIL) or invasive carcinoma in 21(1.7%) cases whereas 26 (2%) women had CIN2+ or greater histology. PCR detected HPV in 397/1270 (31.3%) and HC2 in 260/1270 (20.4%) samples. Both molecular tests exhibited high reproducibility (Cohen’s kappa value 0.691, 95% CI: 0.664 - 0.718). Positive likelihood ratios (PLR) of 9.4, 3.8 and 3.4 and negative likelihood ratios of 0.13, 0.21, and 0 were noted for ≥ LSIL, any positive HC2 or any positive PCR-HPV testing, for predicting CIN2+ histology, respectively. All CIN 3+ lesions harbored high risk oncogenic HPV type infections. Conclusions: HPV infection was found in a large proportion of this population and was associated with CIN 2/3 lesions and infiltrating carcinomas. Thin prep testing and HPV detection by HC2 or PCR performed very well with regards to identifying high grade lesions in an environment with experienced examiners. Background Large epidemiological studies performed over the last two decades have identified infection with human papilloma virus (HPV) as a necessary cause for cervical cancer[1,2]. Furthermore, newer molecular techniques have greatly helped in identifying the association of high-risk HPV types with the development of precan- cerous lesions, as well as their role in cervical carcino- genesis[3,4]. Since the vast majority of invasive cervical carcinoma cases are associated with HPV type 16 or 18 infections[5,6], efforts have been made to develop pre- ventive measures for infections with these high risk * Correspondence: pkarakitsos@aol.com 2Department of Cytopathology, Attikon University Hospital, University of Athens Med. Sch. Athens, Greece HPV types: two specific vaccines targeting infection with HPV types 16 and 18 have recently been intro- duced[7]. Specific HPV testing may not be appropriate as a pri- mary screening due to claims that it lacks specificity[8] but it may assist in the management of women with cytological changes[9]. The association of findings from conventional cytological testing with those of newer molecular techniques is of great importance and helps to better understand the evolution of HPV infection in different epidemiological settings. The purpose of the current study is to evaluate cyto- logical findings from a large observational population sample in association with identification of HPV infec- tion using newer molecular techniques, such as Hybrid © 2010 Tsiodras et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.