Chen Longwen, Yang Bin
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Cancer. 2008 Aug 25;114(4):236-41. doi: 10.1002/cncr.23639.
Reflex human papillomavirus (HPV) testing for atypical squamous cells of undetermined significance (ASC-US) has improved the sensitivity and specificity in detecting high-grade squamous dysplasia (cervical intraepithelial neoplasia [CIN]2+). However, to the authors' knowledge there are no guidelines for performing reflex HPV testing in women with atypical endocervical cells (AEC) before colposcopy. This report is of a 5-year experience with reflex HPV testing in women with AEC and assessment of the potential role of reflex HPV testing in guiding subsequent colposcopy-directed cervical biopsy/curettage in a large tertiary care hospital setting.
All AEC cases cytologically diagnosed from July 2001 to June 2006 were retrieved from the Cleveland Clinic database. The histopathologic diagnoses and the results of HPV testing using the Hybrid Capture 2 (HC-II) method were reviewed. The most severe histopathologic diagnosis was recorded.
Of a total 332,470 Papanicolaou (Pap) tests performed, 317 cases of AEC had histopathologic follow-up and reflex testing for high-risk HPV. Histopathologic examination of the 64 HPV-positive AEC cases revealed 18 cases of endocervical adenocarcinoma in situ/adenocarcinoma (AIS+) and 22 cases of CIN2+. Among 253 of the HPV-negative AEC women, AIS+ was found in only 3 cases and CIN2+ in 1 case. Cervical AIS+ was found in 28% of the HPV-positive AEC patients and in only 0.9% of the HPV-negative patients (P<.0001). When the significant glandular (AIS+) and squamous (CIN2+) lesions were combined, 62.5% of the lesions were detected in HPV-positive AEC cases compared with 1.6% in the HPV-negative AEC cases (P<.0001).
Because of a high sensitivity (91.0%) and high specificity (91.2%) in detecting significant cervical lesions, reflex HPV testing for cytologic diagnosis of AEC appears to be a useful ancillary tool in the selection of high-risk patients for colposcopy.
对意义不明确的非典型鳞状细胞（ASC-US）进行人乳头瘤病毒（HPV）反射检测，提高了检测高级别鳞状上皮发育异常（宫颈上皮内瘤变[CIN]2+）的敏感性和特异性。然而，据作者所知，对于阴道镜检查前宫颈非典型细胞（AEC）的女性进行HPV反射检测，尚无相关指南。本报告介绍了在一家大型三级医疗中心对AEC女性进行HPV反射检测的5年经验，并评估了HPV反射检测在指导后续阴道镜引导下宫颈活检/刮宫术中的潜在作用。
从克利夫兰诊所数据库中检索2001年7月至2006年6月间细胞学诊断的所有AEC病例。回顾组织病理学诊断以及使用杂交捕获2（HC-II）方法进行HPV检测的结果。记录最严重的组织病理学诊断。
在总共进行的332470次巴氏试验中，317例AEC病例进行了组织病理学随访和高危HPV反射检测。对64例HPV阳性的AEC病例进行组织病理学检查，发现18例宫颈原位腺癌/腺癌（AIS+）和22例CIN2+。在253例HPV阴性的AEC女性中，仅3例发现AIS+，1例发现CIN2+。宫颈AIS+在28%的HPV阳性AEC患者中发现，而在仅0.9%的HPV阴性患者中发现（P<0.0001）。当将显著的腺性（AIS+）和鳞状（CIN2+）病变合并时，62.5%的病变在HPV阳性的AEC病例中检测到，而在HPV阴性的AEC病例中为1.6%（P<0.0001）。
由于在检测显著宫颈病变方面具有高敏感性（91.0%）和高特异性（91.2%），对AEC进行细胞学诊断的HPV反射检测似乎是选择高危患者进行阴道镜检查的有用辅助工具。
