Griesser Henrik, Sander Heinz, Walczak Cindy, Hilfrich Ralf A
Center of Pathology and Cytodiagnostics, Cologne, Germany.
Am J Clin Pathol. 2009 Dec;132(6):840-5. doi: 10.1309/AJCPCU0HBFFFGDTV.
Prediction of the clinical outcome of nonadvanced, early dysplastic lesions is one of the unresolved problems of cervical cancer screening programs. We examined the influence of human papillomavirus (HPV) L1 capsid protein detection in a randomized, prospective study of 187 high-risk HPV+ early dysplastic lesions during 36 to 46 months. The difference in the clinical outcome of the HPV L1- cases and the HPV L1+ cases was highly statistically significant (P < .0001) and independent of the classification of low-grade squamous intraepithelial lesion (mild dysplasia) and high-grade squamous intraepithelial lesion of the moderate dysplastic type. L1+ mild and moderate dysplasias, reflecting productive HPV infection, showed low malignant potential, justifying a wait-and-watch strategy to prevent overtreatment, especially in young women. L1- early dysplastic lesions, as nonproductive infections or precancerous lesions, have a high malignancy potential and close follow-up with colposcopy and histologic evaluation should be advised.
非进展性早期发育异常病变临床结局的预测是宫颈癌筛查项目中尚未解决的问题之一。在一项针对187例高危HPV阳性早期发育异常病变的随机前瞻性研究中，我们在36至46个月期间检测了人乳头瘤病毒（HPV）L1衣壳蛋白。HPV L1阴性病例和HPV L1阳性病例临床结局的差异具有高度统计学意义（P <.0001），且与低级别鳞状上皮内病变（轻度发育异常）和中度发育异常型高级别鳞状上皮内病变的分类无关。L1阳性的轻度和中度发育异常反映了HPV的有效感染，显示出低恶性潜能，证明采取观察等待策略以防止过度治疗是合理的，尤其是对于年轻女性。L1阴性早期发育异常病变作为非有效感染或癌前病变，具有高恶性潜能，建议通过阴道镜检查和组织学评估进行密切随访。
