Aerssens A, Claeys P, Beerens E, Garcia A, Weyers S, Van Renterghem L, Praet M, Temmerman M, Velasquez R, Cuvelier C A
International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
Cytopathology. 2009 Feb;20(1):27-35. doi: 10.1111/j.1365-2303.2008.00567.x. Epub 2008 May 28.
To assess the role of human papillomavirus (HPV) testing and cytology as predictors of residual/recurrent disease after treatment of high-grade cervical intraepithelial lesions.
One hundred and thirty-eight women with cervical intraepithelial neoplasia (CIN) grade 2/3 lesion on biopsy were included in a prospective follow-up study in Belgium and Nicaragua. All women were treated with loop electrosurgical excision procedure (LEEP) and follow-up visits took place at 6 weeks, 6 months, 1 year and 2 years. During these visits, a Papanicolaou (Pap) smear test was taken, colposcopy was performed and specimens were collected for HPV testing. Cytology, high-risk (HR) HPV presence, persistent HR HPV infection and combinations of these tests at different time points during follow-up were correlated with histologically confirmed residual/recurrent disease.
Thirteen patients (9%) developed residual/recurrent disease during follow-up. Abnormal cytology at 6 weeks after treatment was significantly correlated with residual/recurrent disease. Nine of thirty-seven patients with abnormal cytology at 6 weeks had recurrent disease versus three of seventy with a normal cytology [odds ratio (OR): 7.2; 95% confidence interval (CI): 1.8-28.5; P = 0.003). Sensitivity of this test was 75.0%, specificity 70.5%. Combining abnormal cytology and the presence of HR HPV within the first 6 months after treatment gave the best correlation with residual/recurrent disease: of the 54 women with abnormal cytology and/or HR HPV presence within the first 6 months, 11 developed residual/recurrent disease (OR 10.2; 95% CI: 2.2-48.3). Sensitivity of this combination was 84.6% and specificity 65.0%.
Cytology remains the cornerstone in the early follow-up after LEEP for CIN lesions of the cervix. HPV testing can add value as it increases the sensitivity of cytology in concomitant testing within the first 6 months.
评估人乳头瘤病毒（HPV）检测和细胞学检查作为高级别宫颈上皮内瘤变治疗后残余/复发性疾病预测指标的作用。
138例活检显示为宫颈上皮内瘤变（CIN）2/3级病变的女性纳入比利时和尼加拉瓜的一项前瞻性随访研究。所有女性均接受环形电切术（LEEP）治疗，并在6周、6个月、1年和2年进行随访。随访期间进行巴氏涂片检查、阴道镜检查并采集标本进行HPV检测。随访期间不同时间点的细胞学检查、高危（HR）HPV感染情况、持续性HR HPV感染以及这些检查结果的组合与组织学确诊的残余/复发性疾病相关。
13例患者（9%）在随访期间出现残余/复发性疾病。治疗后6周时的异常细胞学检查与残余/复发性疾病显著相关。6周时细胞学检查异常的37例患者中有9例出现复发性疾病，而细胞学检查正常的70例患者中有3例出现复发性疾病[比值比（OR）：7.2；95%置信区间（CI）：1.8 - 28.5；P = 0.003]。该检查的敏感性为75.0%，特异性为70.5%。治疗后前6个月内将异常细胞学检查与HR HPV感染情况相结合与残余/复发性疾病的相关性最佳：在前6个月内细胞学检查异常和/或存在HR HPV感染的54例女性中，11例出现残余/复发性疾病（OR 10.2；95% CI：2.2 - 48.3）。该组合的敏感性为84.6%，特异性为6毛0%。
对于宫颈CIN病变，LEEP术后早期随访中细胞学检查仍是基石。HPV检测可增加价值，因为它在前6个月的联合检测中提高了细胞学检查的敏感性。
