Zhao Chengquan, Austin R Marshall
Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA 15213, USA.
Cancer. 2008 Aug 25;114(4):242-8. doi: 10.1002/cncr.23598.
Current guidelines recommend that women with negative Papanicolaou (Pap) test results and no endocervical/transformation zone (EC/TZ) sample return for screening within 12 months. For some women, this represents earlier follow-up than advocated in several routine screening guidelines. Controversy remains with regard to the correlation between sampling of the EC/TZ, Pap test quality, and disease risk assessment.
A retrospective study was conducted reviewing the results from 143,438 liquid-based cervical Pap tests performed at a large academic women's hospital between July 2005 and December 2006. Vaginal Pap tests were excluded from the study. Women with any Pap result, women with low-grade squamous intraepithelial lesions (LSILs), and patients with high-grade squamous intraepithelial lesion (HSIL) Pap test results were stratified by 10-year age groups and according to the presence or absence of an EC/TZ sample (EC/TZS). Women with LSIL and HSIL Pap test results with and without an EC/TZS were also compared for rates of high-risk human papillomavirus (hrHPV) DNA detection.
Of the total of 143,438 cervical Pap tests performed, 27,359 (19.1%) were reported to be lacking an EC/TZS. The absence of an EC/TZS was found to be highest in adolescents and in mature women aged >or=50 years. The overall detection rate of LSIL was 4.29% and that of HSIL was 0.64%. Both the LSIL and HSIL rates were found to be significantly higher in Pap tests with an EC/TZS compared with Pap tests without an EC/TZS (LSIL: 4.51% vs 3.37% and HSIL: 0.72% vs 0.29%). However, when women with LSILs and HSILs were divided into a group in which EC/TZS was present and a group in which EC/TZS was absent, no significant differences were found to be present with regard to hrHPV DNA rates between the 2 groups.
Adjunctive hrHPV DNA testing is effective in stratifying risk for the presence of SIL in women with and without an EC/TZS. This finding is consistent with recently reported data from >9000 patients with negative Pap results, which found that hrHPV DNA-positive test rates are independent of the presence or absence of an EC/TZS. hrHPV DNA results provide a useful new optional adjunctive tool for the objective stratification of disease risk in women with negative Pap tests and no EC/TZS.
当前指南建议，巴氏试验（Pap）结果为阴性且未获得宫颈管内膜/转化区（EC/TZ）样本的女性应在12个月内返回进行筛查。对于一些女性而言，这意味着比一些常规筛查指南所倡导的更早进行随访。关于EC/TZ采样、Pap试验质量和疾病风险评估之间的相关性仍存在争议。
进行了一项回顾性研究，回顾了2005年7月至2006年12月期间在一家大型学术性女子医院进行的143,438例液基宫颈Pap试验结果。阴道Pap试验被排除在研究之外。将任何Pap结果的女性、低度鳞状上皮内病变（LSIL）女性和高级别鳞状上皮内病变（HSIL）Pap试验结果的患者按10岁年龄组并根据是否存在EC/TZ样本（EC/TZS）进行分层。还比较了有和没有EC/TZS的LSIL和HSIL Pap试验结果女性的高危人乳头瘤病毒（hrHPV）DNA检测率。
在总共进行的143,438例宫颈Pap试验中，有27,359例（19.1%）报告缺少EC/TZS。发现青少年和年龄≥50岁的成熟女性中EC/TZS缺失率最高。LSIL的总体检出率为4.29%，HSIL的总体检出率为0.64%。与没有EC/TZS的Pap试验相比，有EC/TZS的Pap试验中LSIL和HSIL的检出率均显著更高（LSIL：4.51%对3.37%，HSIL：0.72%对0.29%）。然而，当将有LSIL和HSIL的女性分为有EC/TZS组和无EC/TZS组时，两组之间的hrHPV DNA率未发现显著差异。
辅助hrHPV DNA检测对于有和没有EC/TZS的女性中SIL存在风险的分层是有效的。这一发现与最近报道的9000多名Pap结果为阴性的患者的数据一致，该数据发现hrHPV DNA阳性检测率与是否存在EC/TZS无关。hrHPV DNA结果为对Pap试验阴性且无EC/TZS的女性进行疾病风险客观分层提供了一种有用的新的可选辅助工具。
