Salmerón Jorge, Lazcano-Ponce Eduardo, Lorincz Attila, Hernández Mauricio, Hernández Pilar, Leyva Ahideé, Uribe Mario, Manzanares Horacio, Antunez Alfredo, Carmona Enrique, Ronnett Brigitte M, Sherman Mark E, Bishai David, Ferris Daron, Flores Yvonne, Yunes Elsa, Shah Keerti V
Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Morelos, México.
Cancer Causes Control. 2003 Aug;14(6):505-12. doi: 10.1023/a:1024806707399.
To compare the performance of human papillomavirus (HPV) assays with conventional Pap cytology for cervical cancer (CC) screening in Mexico.
Pap smears, self-collected vaginal specimens (SS) for HPV testing, and clinician-collected cervical specimens (CS) for HPV testing were obtained from 7868 women, aged 15-85 years old, attending CC screening at the Mexican Institute of Social Security (IMSS) between May and October, 1999. SS and CS specimens were screened for oncogenic HPV DNA by Hybrid Capture 2. Women who received cytological interpretations of atypical squamous cells of undetermined significance (ASCUS), and/or a positive HPV test were referred for colposcopy and histologic studies. The relative estimates for sensitivity, specificity and predictive values of each test were calculated using histological diagnoses of cervical intraepithelial neoplasia (CIN) grades 2 or 3, or CC histological diagnosis.
Oncogenic HPV detection rate was 11.6% for SS, and 9.3% for CS. Pap smear abnormalities were observed in 2.4% of the women. Of 1147 women who had at least one abnormal test result, 88.5% underwent colposcopy, and 101 biopsy-confirmed CIN2/3 or cancer cases were identified. The relative sensitivity estimates for the Pap test, SS and CS were 59.4% (95% CI: 49.2-68.9), 71.3% (95% CI: 61.3-79.6), and 93.1% (95% CI: 85.8-96.9), respectively, while the specificities were 98.3% (95% CI: 98.0-98.6), 89.2% (95% CI: 88.5-89.9), and 91.8% (95% CI: 91.2-92.4), respectively. The positive predictive values of Pap, SS and CS were 36.1, 9.1 and 14.9, the colposcopy referrals needed to detect a case of CIN2/3 or cancer were 2.8, 11.0 and 6.7, respectively.
Both HPV assays detected more cases of CIN2/3 or CC than Pap cytology alone. However, the HPV assays increased the number of colposcopy referrals. Our study suggests that HPV testing could be an effective way to improve the performance of CC screening.
比较人乳头瘤病毒（HPV）检测与传统巴氏细胞学检查在墨西哥宫颈癌（CC）筛查中的表现。
收集了1999年5月至10月期间在墨西哥社会保障局（IMSS）进行CC筛查的7868名年龄在15 - 85岁女性的巴氏涂片、用于HPV检测的自行采集阴道标本（SS）以及用于HPV检测的临床医生采集宫颈标本（CS）。采用杂交捕获2法对SS和CS标本进行致癌性HPV DNA筛查。对接受非典型鳞状细胞意义不明确（ASCUS）细胞学诊断和/或HPV检测呈阳性的女性进行阴道镜检查和组织学研究。使用宫颈上皮内瘤变（CIN）2或3级的组织学诊断或CC组织学诊断计算每项检测的敏感性、特异性和预测值的相对估计值。
SS的致癌性HPV检测率为11.6%，CS为9.3%。2.4%的女性巴氏涂片出现异常。在1147名至少有一项检测结果异常的女性中，88.5%接受了阴道镜检查，共确诊101例CIN2/3或癌症病例。巴氏试验、SS和CS的相对敏感性估计值分别为59.4%（95%置信区间：49.2 - 68.9）、71.3%（95%置信区间：61.3 - 79.6）和93.1%（95%置信区间：85.8 - 96.9），特异性分别为98.3%（95%置信区间：98.0 - 98.6）、89.2%（95%置信区间：88.5 - 89.9）和91.8%（95%置信区间：91.2 - 92.4）。巴氏试验、SS和CS的阳性预测值分别为36.1、9.1和14.9，检测一例CIN2/3或癌症所需的阴道镜检查转诊数分别为2.8、11.0和6.7。
两种HPV检测方法检测出的CIN2/3或CC病例均多于单独的巴氏细胞学检查。然而，HPV检测增加了阴道镜检查转诊的数量。我们的研究表明，HPV检测可能是提高CC筛查效果的有效方法。
