Carozzi F, Ronco G, Confortini M, Noferini D, Maddau C, Ciatto S, Segnan N
Cytology Unit, Centre for Cancer Study and Prevention (CSPO), Firenze, Italy.
Br J Cancer. 2000 Dec;83(11):1462-7. doi: 10.1054/bjoc.2000.1491.
Human papillomavirus (HPV) testing has been suggested for primary screening of cervical cancer. Prediction of future high-grade cervical lesions is crucial for effectiveness and cost. We performed a case control study in a retrospective cohort of women with at least two cervical smears, all but the last one being negative, from the organized cervical screening programme in Florence, Italy. We searched for high-risk HPV in all previous, archival, smears from cases (new histologically confirmed cervical intraepithelial neoplasia (CIN) grade II or worse) and in one previous smear from each control (last smear cytologically normal, matched by age and interval (latency) from last smear). We applied polymerase chain reaction (PCR), and the b-globin gene was used as a DNA preservation marker. High-risk HPV was identified in 71/92 (77.17%) previous smears from 79 cases and 17/332 controls (5.12%). The odds ratio (OR) was 63.76 (95% CI 30.57-132.96). Among cases the proportion of HPV-positive smears declined slightly with increasing latency. Among cases, HPV was found in 81.24% (95% CI 69.93-88.96%) of smears with latency < 4 years and in 67.80% (95% CI 47.72-82.93%) of those taken at longer intervals, up to 6 years. These findings suggest that testing for high-risk HPV allows predicting 80% of CINII/III 3 years before the cytological diagnosis and two thirds 6 years before. They also suggest that testing women negative for high-risk HPV at longer interval and strictly following-up women who are HPV positive could be an effective strategy for cervical cancer screening.
有人建议将人乳头瘤病毒(HPV)检测用于宫颈癌的初次筛查。预测未来的高级别宫颈病变对于有效性和成本至关重要。我们在意大利佛罗伦萨有组织的宫颈筛查项目中,对至少有两次宫颈涂片检查的女性回顾性队列进行了病例对照研究,除最后一次涂片外,其余涂片均为阴性。我们在所有既往存档的病例涂片(新组织学确诊的宫颈上皮内瘤变(CIN)二级或更严重)中检测高危HPV,并在每个对照的一次既往涂片中检测(最后一次涂片细胞学正常,按年龄和距最后一次涂片的间隔时间(潜伏期)匹配)。我们应用聚合酶链反应(PCR),并将β-珠蛋白基因用作DNA保存标记。在79例病例的92份既往涂片中,71份(77.17%)检测到高危HPV,在332例对照中,17份(5.12%)检测到高危HPV。比值比(OR)为63.76(95%可信区间30.57 - 132.96)。在病例中,HPV阳性涂片的比例随潜伏期延长略有下降。在病例中,潜伏期<4年的涂片中,81.24%(95%可信区间69.93 - 88.96%)检测到HPV,间隔时间长达6年的涂片中,67.80%(95%可信区间47.72 - 82.93%)检测到HPV。这些发现表明,检测高危HPV可在细胞学诊断前3年预测80%的CINII/III病例,在6年前预测三分之二的病例。它们还表明,对间隔时间较长的高危HPV检测呈阴性的女性进行检测,并对HPV阳性女性进行严格随访,可能是宫颈癌筛查的有效策略。