Lie A K, Risberg B, Borge B, Sandstad B, Delabie J, Rimala R, Onsrud M, Thoresen S
Department of Pathology, The Norwegian Radium Hospital, Oslo, Norway.
Gynecol Oncol. 2005 Jun;97(3):908-15. doi: 10.1016/j.ygyno.2005.02.026. Epub 2005 Apr 15.
To compare DNA-based and mRNA-based methods for detection of high-grade cervical neoplasia in Norway.
HPV prevalence was analyzed in 383 women with positive index cytology, selected from gynecology clinics. All patients were investigated by a new PAP smear, histology, and two commercially available HPV tests: Hybrid Capture II (Digene, Gaithersburg, MD) and the Pre Tect HPV-Proofer (NorChip AS). Cases with positive DNA test and negative mRNA test and cases with high-grade histology and negative HPV tests were retested with PCR and sequencing. We regarded the infection as latent or transient if sequencing revealed an HPV type included in both assays.
High-risk HPV was detected in 99.7% of the histological confirmed high-grade lesions (CIN2+) (290/291). The DNA test was positive in 95% (275/291), and the mRNA test was positive in 77% (225/291) of the histological confirmed high-grade lesions. All invasive carcinomas were mRNA positive. The DNA test was significantly more often positive in benign and low-grade lesions, some of which were found to be false positive due to cross-contamination with unrelated types. High-grade histology was detected in 83% of women with normal cytology and positive mRNA test. Latent or transient infections were detected in 11 low-grade and 12 high-grade preinvasive lesions. Sequencing revealed high-risk HPV types included only in the DNA test in 35 high-grade preinvasive lesions, HPV 52 and 58 were the most prevalent HPV types.
These HPV tests have the potential to improve the detection rate of high-grade cervical neoplasia, with some limitations. The mRNA test seems to be more appropriate for risk-evaluation. Larger scale, population based studies are necessary to evaluate the predictive values of HPV testing in Norway.
比较基于DNA和基于mRNA的方法在挪威检测高级别宫颈肿瘤的效果。
对从妇科诊所选取的383名索引细胞学检查呈阳性的女性进行HPV感染率分析。所有患者均接受了新的巴氏涂片检查、组织学检查以及两种市售HPV检测：杂交捕获二代检测法（Digene公司，美国马里兰州盖瑟斯堡）和Pre Tect HPV检测试剂（挪威芯片公司）。DNA检测呈阳性而mRNA检测呈阴性的病例以及组织学检查为高级别且HPV检测呈阴性的病例，采用PCR和测序法进行重新检测。如果测序显示两种检测方法均检测到的HPV类型，则认为该感染为潜伏性或短暂性感染。
在组织学确诊的高级别病变（CIN2+）中，99.7%（290/291）检测到高危型HPV。在组织学确诊的高级别病变中，DNA检测呈阳性的占95%（275/291），mRNA检测呈阳性的占77%（225/291）。所有浸润性癌的mRNA检测均为阳性。在良性和低级别病变中，DNA检测呈阳性的情况明显更为常见，其中一些被发现是由于与无关类型的交叉污染导致的假阳性。在细胞学检查正常但mRNA检测呈阳性的女性中，83%检测到高级别组织学病变。在11例低级别和12例高级别浸润前病变中检测到潜伏性或短暂性感染。测序显示，在35例高级别浸润前病变中，只有DNA检测到高危型HPV，HPV 52和58是最常见的HPV类型。
这些HPV检测方法有提高高级别宫颈肿瘤检测率的潜力，但存在一些局限性。mRNA检测似乎更适合风险评估。有必要开展更大规模的基于人群的研究，以评估挪威HPV检测的预测价值。
