Scholefield J H, Hickson W G, Smith J H, Rogers K, Sharp F
Department of Surgery, Northern General Hospital, Sheffield, UK.
Lancet. 1992 Nov 21;340(8830):1271-3. doi: 10.1016/0140-6736(92)92961-e.
Invasive carcinomas of the anogenital epithelium share a common aetiological factor--human papillomavirus (HPV) type 16. Although genital intraepithelial neoplasia may be multifocal, there have been no studies of the prevalence of anal intraepithelial neoplasia in women with intraepithelial neoplasia of the genital tract. We tested the hypothesis that women with high-grade cervical intraepithelial neoplasia are at higher risk of disease in the anus than are control women of similar age with no history of anogenital neoplasia. 29 (19%) of 152 women with cervical intraepithelial neoplasia grade III had histological evidence of anal intraepithelial neoplasia. Of the 29 patients, 11 had grade III anal lesions; 2 of those women had concomitant invasive anal squamous-cell carcinomas. Only 7% (8/115) women with high-grade lesions of the cervix alone had evidence of anal intraepithelial neoplasia; by contrast, 57% (21/37) of those with more than one focus of intraepithelial neoplasia (cervix plus vulva, vagina, or both) had anal lesions. HPV 16 DNA was identified in 18 (51%) of 35 anal biopsy samples in the study group. No evidence of anal intraepithelial neoplasia was found in the control group (50 women), although 2 patients had grade I cervical lesions. HPV 16 DNA was identified in 12 (24%) of biopsy samples from the cervix and 7 (14%) from the anus in the control group; all 7 women with anal HPV 16 had concomitant cervical infection. The role of anal examination in the assessment of women with any focus of genital intraepithelial neoplasia requires further investigation.
肛门生殖器上皮的浸润性癌有一个共同的病因学因素——16型人乳头瘤病毒（HPV）。尽管生殖器上皮内瘤变可能是多灶性的，但对于患有生殖道上皮内瘤变的女性，尚未有关于肛门上皮内瘤变患病率的研究。我们检验了这样一个假设：与无肛门生殖器瘤变病史的同龄对照女性相比，患有高级别宫颈上皮内瘤变的女性肛门患病风险更高。152例宫颈上皮内瘤变III级的女性中，29例（19%）有肛门上皮内瘤变的组织学证据。在这29例患者中，11例有III级肛门病变；其中2例女性同时患有浸润性肛门鳞状细胞癌。仅宫颈高级别病变的女性中，只有7%（8/115）有肛门上皮内瘤变的证据；相比之下，有一个以上上皮内瘤变病灶（宫颈加外阴、阴道或两者皆有）的女性中，57%（21/37）有肛门病变。研究组35份肛门活检样本中，18份（51%）检测到HPV 16 DNA。对照组（50名女性）未发现肛门上皮内瘤变的证据，尽管有2例患者有I级宫颈病变。对照组宫颈活检样本中12份（24%）和肛门活检样本中7份（14%）检测到HPV 16 DNA；所有7例肛门HPV 16阳性的女性同时伴有宫颈感染。对于患有任何生殖器上皮内瘤变病灶的女性，肛门检查在评估中的作用需要进一步研究。
