Srodon Monica, Parry Dilworth H, Ronnett Brigitte M
Department of Pathology, The Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland 21231, USA.
Cancer. 2006 Feb 25;108(1):32-8. doi: 10.1002/cncr.21388.
Current guidelines recommend colposcopy rather than high-risk human papillomavirus (HPV) testing for the evaluation of abnormal cervical cytology interpreted as "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" (ASC-H) based on data from the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion (ASCUS/LSIL) Triage Study (ALTS), which indicated that ASC-H had a significantly greater frequency of high-risk HPV positivity and underlying high-grade squamous intraepithelial lesions (HSIL) compared with ASCUS. The cytologic interpretations in the ALTS were expert consensus diagnoses rather than routine, single-pathologist readings.
The authors conducted a comparative analysis of Hybrid Capture 2 high-risk HPV positivity and frequency of histologically diagnosed HSIL for ASC-H and ASCUS to evaluate the performance of ASC-H as a cytologic interpretation subcategory and the potential utility of HPV testing for colposcopy triage of ASC-H in routine practice.
Sixty-four of 96 patients with ASC-H (66.7%) were HPV-positive compared with 484 of 1079 patients with ASCUS (44.9%). Among the patients who had histologic follow-up, HSIL was identified in 18 of 45 patients (40.0%) with HPV-positive ASC-H compared with 27 of 266 patients (10.2%) with HPV-positive ASCUS (P < 0.0001) and 1 of 22 patients (4.5%) with HPV-negative ASC-H (P = 0.003); the latter result was similar to the finding of HSIL in 5 of 85 patients (5.9%) with HPV-negative ASCUS. The frequency of HPV-positive ASC-H in the current study (67%) was lower than that obtained in the ALTS for ASC-H (86%) but higher than that for ASCUS in both this study (45%) and in the ALTS (51% for all ASC; 63% for ASCUS, equivocal for LSIL). Underlying HSIL was detected in a similar percentage of patients with HPV-positive ASC-H in this study and in the ALTS (41%).
The greater frequency of HPV positivity and the significantly increased risk of underlying HSIL for ASC-H compared with ASCUS indicated that ASC-H category utilization and performance are appropriate in this routine clinical practice setting. The lower frequency of HPV positivity for ASC-H compared with the ALTS data and the similar low risk of HSIL in HPV-negative ASC-H and HPV-negative ASCUS indicate that HPV testing for triage of ASC-H in routine practice has the potential to reduce the number of women who are referred for colposcopy without an increased risk of failure to detect HSIL among HPV-negative women, similar to its triage role for ASCUS.
目前的指南推荐采用阴道镜检查而非高危型人乳头瘤病毒（HPV）检测来评估被解读为“非典型鳞状细胞，不能排除高级别鳞状上皮内病变”（ASC-H）的异常宫颈细胞学检查结果。这一推荐基于非典型意义的鳞状细胞/低级别鳞状上皮内病变（ASCUS/LSIL）分流研究（ALTS）的数据，该研究表明，与ASCUS相比，ASC-H的高危型HPV阳性率及潜在高级别鳞状上皮内病变（HSIL）的发生率显著更高。ALTS中的细胞学解读是专家共识诊断，而非常规的单病理医生判读。
作者对ASC-H和ASCUS的杂交捕获2高危型HPV阳性率及组织学诊断的HSIL发生率进行了对比分析，以评估ASC-H作为一种细胞学解读亚类的性能，以及HPV检测在ASC-H阴道镜分流的常规实践中的潜在效用。
96例ASC-H患者中有64例（66.7%）HPV阳性，而1079例ASCUS患者中有484例（44.9%）HPV阳性。在接受组织学随访的患者中，45例HPV阳性的ASC-H患者中有18例（40.0%）被确诊为HSIL，相比之下，266例HPV阳性的ASCUS患者中有27例（10.2%）被确诊为HSIL（P<0.0001），22例HPV阴性的ASC-H患者中有1例（4.5%）被确诊为HSIL（P=0.003）；后一结果与85例HPV阴性的ASCUS患者中有5例（5.9%）被确诊为HSIL的结果相似。本研究中ASC-H的HPV阳性率（67%）低于ALTS中ASC-H的阳性率（86%），但高于本研究中ASCUS的阳性率（45%）以及ALTS中ASCUS的阳性率（所有ASC为51%；ASCUS为63%，LSIL为不明确）。本研究和ALTS中HPV阳性的ASC-H患者中检测到潜在HSIL的比例相似（41%）。
与ASCUS相比，ASC-H的HPV阳性率更高，潜在HSIL风险显著增加，这表明在这种常规临床实践环境中，ASC-H分类的应用和性能是合适的。与ALTS数据相比，ASC-H的HPV阳性率较低，且HPV阴性的ASC-H和HPV阴性的ASCUS中HSIL风险相似，这表明在常规实践中，HPV检测用于ASC-H分流有可能减少接受阴道镜检查的女性数量，同时不会增加HPV阴性女性中未能检测到HSIL的风险，这与其在ASCUS分流中的作用相似。
