Jin Ying, Pan Ling-Ya, Wang You-Fang, Cheng Xue-Mei, Lang Jing-He
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2008 Apr 29;88(17):1173-6.
To evaluate the triage value of high risk human papilloma virus (hrHPV) detection in the women with abnormal cervical cytology.
28,650 women underwent thinprep cell test (TCT) to screen cervical cancer. 694 of the 2433 patients with abnormal cervical cytology were randomly selected to undergo hrHPV HC II test to detect high risk HPV. 275 of these 694 patients received colposcopy and biopsy, 71, 149, and 55 of which were diagnosed as with atypical squamous cell (ASC), low squamous intraepithelial lesion (LSIL), and high squamous intraepithelial lesion (HSIL) respectively. The triage value of hrHPV detection was analyzed.
Among the 694 patients, the incidence rates of hrHPV infection of those with ASC, LSIL, and HSIL were 68.4% (252/368), 87.6% (219/250), and 93.4% (71/76) respectively. Among the 275 cases who received colposcopy and biopsy the percentages of histopathologic lesion CIN2 in those with ASC, LSIL, and HSIL were 22.5%, 30.2%, and 70.9% respectively. When with CIN2 + as terminal, the sensitivity and specificity of hrHPV test were 93.8% and 23.6% in the ASC group; 93.1% and 10.6% in the LSIL group, and 97.4% and 25.0% in the HSIL group. Histopathologic lesions CIN3 or worse were seen in 7.0% of the patients with ASC, 12.2% of the patients with LSIL, and 36.4% of the patients with HSIL. When with CIN3 + as the terminal the sensitivity and specificity of hrHPV test were 100% and 21.2% in the ASC group; 100% and 10.7% in the LSIL group; and 95.0% and 11.4% in the HSIL group.
hrHPV infection is associated with preinvasive cervical cancer and invasive cervical cancer. hrHPV test is a good triage approach for the patients with ASC, able to decrease about 50% of colposcopic referral. For the patients with LSIL and HSIL, hrHPV test is not an appreciate triage test and immediate colposcopy is recommended.
评估高危型人乳头瘤病毒（hrHPV）检测在宫颈细胞学异常女性中的分流价值。
28650名女性接受薄层液基细胞学检测（TCT）以筛查宫颈癌。在2433例宫颈细胞学异常患者中随机选取694例进行hrHPV HC II检测以检测高危型HPV。这694例患者中的275例接受了阴道镜检查及活检，其中71例、149例和55例分别被诊断为非典型鳞状细胞（ASC）、低度鳞状上皮内病变（LSIL）和高度鳞状上皮内病变（HSIL）。分析hrHPV检测的分流价值。
在694例患者中，ASC、LSIL和HSIL患者的hrHPV感染发生率分别为68.4%（252/368）、87.6%（219/250）和93.4%（71/76）。在接受阴道镜检查及活检的275例病例中，ASC、LSIL和HSIL患者中组织病理学病变CIN2的比例分别为22.5%、30.2%和70.9%。以CIN2+为终点时，hrHPV检测在ASC组中的敏感性和特异性分别为93.8%和23.6%；在LSIL组中分别为93.1%和10.6%；在HSIL组中分别为97.4%和25.0%。ASC患者中有7.0%、LSIL患者中有12.2%、HSIL患者中有36.4%出现组织病理学病变CIN3或更严重病变。以CIN3+为终点时，hrHPV检测在ASC组中的敏感性和特异性分别为100%和21.2%；在LSIL组中分别为100%和10.7%；在HSIL组中分别为95.0%和11.4%。
hrHPV感染与宫颈原位癌和浸润性宫颈癌相关。hrHPV检测是ASC患者的一种良好分流方法，能够减少约50%的阴道镜转诊。对于LSIL和HSIL患者，hrHPV检测不是合适的分流检测，建议直接进行阴道镜检查。
