Alonso Immaculada, Torné Aureli, Puig-Tintoré Luis M, Esteve Roser, Quinto Llorenç, Campo Elias, Pahisa Jaume, Ordi Jaume
Department of Obstetrics and Gynecology, IDIBAPS-Hospital Clínic, University of Barcelona School of Medicine, Barcelona, Spain.
Gynecol Oncol. 2006 Nov;103(2):631-6. doi: 10.1016/j.ygyno.2006.04.016. Epub 2006 Jun 14.
To evaluate whether high-risk human papillomavirus (HR-HPV) detection and viral load prior to treatment and status of cone margins can predict residual/recurrent disease as well as the ability of current diagnostic tools to identify residual/recurrent disease during follow-up of high-grade cervical intraepithelial neoplasia (CIN) treated by conization using loop electrosurgical procedure (LEEP).
Two hundred and three women (mean age 38.6 +/- 9.7; range 22-83) with CIN2-3 treated by LEEP conization and confirmed in the surgical specimen, attending follow-up visits were included. Age, HR-HPV detection and viral load determined by HybridCapture 2, and cone margins were evaluated as possible predictors of residual/recurrent disease. Value of single and repeated cytology as well as HR-HPV detection and viral load during follow-up were analyzed as screening tools of recurrence.
Residual/recurrent disease was demonstrated by colposcopy guided biopsy in 36 patients (17.7%). High HR-HPV load (>1000 RLU) prior to LEEP and positive cone margins were significantly associated with higher risk of recurrence (31.8% vs. 9.4%, P = 0.005; and 36.4% vs. 11.9%, P < 0.001 respectively). HR-HPV detection at 6-12 m after LEEP showed higher sensitivity than a single or repeated cytology (97.2% vs. 83.3% and 94.4% respectively) although it showed less specificity (81.4% vs. 92.2% and 82.6%). The combination of HR-HPV detection and the first cytology during follow-up detected all patients with residual/recurrent disease (sensitivity 100%, negative predictive value 100%) with an acceptable specificity (76.6%).
The inclusion of HR-HPV testing with cytology in follow-up of patients treated for CIN2-3 would allow for fewer post-treatment visits and avoid unnecessary cytologies. High HR-HPV load prior to LEEP or positive margins should be considered as risk factors for developing residual/recurrent disease.
评估在使用环形电切术（LEEP）治疗高级别宫颈上皮内瘤变（CIN）的随访过程中，治疗前高危型人乳头瘤病毒（HR-HPV）检测、病毒载量以及锥切切缘状态能否预测残留/复发性疾病，以及当前诊断工具识别残留/复发性疾病的能力。
纳入203例接受LEEP锥切术治疗且手术标本确诊为CIN2-3并接受随访的女性（平均年龄38.6±9.7岁；范围22-83岁）。评估年龄、通过杂交捕获2法测定的HR-HPV检测及病毒载量以及锥切切缘，将其作为残留/复发性疾病的可能预测指标。分析单次及重复细胞学检查结果以及随访期间HR-HPV检测和病毒载量，将其作为复发的筛查工具。
36例患者（17.7%）经阴道镜引导下活检证实存在残留/复发性疾病。LEEP术前HR-HPV高病毒载量（>1000 RLU）和切缘阳性与复发风险显著相关（分别为31.8%对9.4%，P = 0.005；以及36.4%对11.9%，P < 0.001）。LEEP术后6-12个月时HR-HPV检测的敏感性高于单次或重复细胞学检查（分别为97.2%对83.3%和94.4%），尽管其特异性较低（81.4%对92.2%和82.6%）。随访期间HR-HPV检测与首次细胞学检查相结合可检测出所有残留/复发性疾病患者（敏感性100%，阴性预测值100%），特异性尚可（76.6%）。
在CIN2-3治疗患者的随访中纳入HR-HPV检测与细胞学检查，可减少治疗后就诊次数并避免不必要的细胞学检查。LEEP术前HR-HPV高病毒载量或切缘阳性应被视为发生残留/复发性疾病的危险因素。
