**Acknowledgements**

cases will self-resolve and never develop into cancer. The high sensitivity of PCR is thus a detriment in HPV screening, because PCR can detect even miniscule amounts of virus that

46 Human Papillomavirus and Related Diseases – From Bench to Bedside A Diagnostic and Preventive Perspective

There are many advantages to the PCR technology for such screening applications, including automation capabilities, turnaround time, multiplexing, sensitivity/specificity, multiple specimen types, and small-specimen volume. The major concern with the in vitro amplification technologies is the potential for contamination [107]. PCR require that laboratories determine a threshold of detection representing a clinically significant result. Likewise, the detection of non cancer-causing, low-risk strains of HPV has virtually no clinical utility. Knowing that a low-risk HPV strain is present does not have an impact on the clinical management of a patient with cutaneous or mucosal warts. In order to prevent superfluous laboratory testing, clinicians should also heed the ASCCP guidelines for the management of women with or without

The clinical laboratory must evaluate many factors in the adoption of an appropriate HPV test, including consideration of the population being served. In underprivileged areas, for example, HPV screening tests with less than optimal clinical sensitivities and specificities may still far surpass current cervical cancer screening methods. As new data emerge from recently established HPV screening methods, researchers and clinicians will continue to strive toward

Molecular biology techniques with different sensitivity and specificity have facilitated the characterization of the entire HPV genome, where different functional regions are identified, as a profile of their gene expression. Additionally, molecular tools have been recognized as the most appropriate method to identify and type HPV genomes because of its higher sensitivity and specificity. Although the cervical cytology for CIN has been used to reduce the incidence of mortality worldwide, molecular technologies continue to evolve for many molecular diagnostic applications. Novel strategies for detection and genotyping are impor‐ tant to complement the screening programmes for HPV detection in women at risk of cervical

It is also important to mention the WHO Global HPV LabNet as a WHO initiative established to support the world-wide implementation of HPV vaccines through improved laboratory standardization and quality assurance of HPV testing and typing methods to promote international comparability of results. The major methods for achieving progress towards this goal are developing international biological standards as well as preparing and validating proficiency panels to qualify methods. And finally, the incorporation of HPV testing into cervical cancer screening strategies has the potential to allow both increased disease detection and increased length of screening intervals. The recommendations are described above (Table 3) and follows the so-called "Meyer-criteria" that present scientific evidence for minimal

the goal of early and accurate detection of cervical cancer [59].

may have no clinical significance [59].

cytological abnormalities [59].

**5. Conclusion**

cancer.

criteria for an HPV test.

This chapter was written by the researchers of the HPV Study Group in Goiânia-GO, Brazil. The authors thank S. Quail for English support.
