Nijhawan Raje, Mittal Neha, Suri Vanita, Rajwanshi Arvind
Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Diagn Cytopathol. 2010 Sep;38(9):645-51. doi: 10.1002/dc.21278.
Cervical neoplasia is attributed to a persistent Human Papilloma Virus infection. The Pap smear being the mainstay of cervical cancer screening in low-resource settings, we studied the nonclassical features which might indicate HPV infection. These included abortive koilocytes, mild dyskeratosis, parakeratosis, mild nuclear hyperchromasia, bi/multinucleation, measles cells, and keratohyaline-like granules. Two hundred and eight women with a satisfactory Pap smear and a Hybrid Capture II test were compared against the "HPV Gold Standard" for validation of the nonclassical signs. This was defined as one with any/all of the following: definite HPV-related lesions on Pap smear (LSIL and above), hrHPV positivity, and CIN I, or above on histology. The highest PPV and NPV were achieved by bi/multinucleation and mild nuclear hyperchromasia, respectively. The mean number of nonclassical signs for HPV Gold Standard-positive and -negative groups was 5.52 and 3.12 per smear, respectively (P < 0.0005). Abortive koilocytes, mild dyskeratosis, mild nuclear hyperchromasia, bi/multinucleation, parakeratosis, and diffuse keratohyaline granules had the best correlation with the gold standard (P < 0.05). Addition of nonclassical signs to established intraepithelial lesions on Pap smear increased the sensitivity from 52.31 to 59.10% and reduced the specificity from 100 to 98%. To maximize the benefit from grouping of these signs, various combinations were studied. The best was: abortive koilocytes, mild nuclear hyperchromasia, and bi/multinucleation. Another was abortive koilocytes, mild nuclear hyperchromasia, bi/multinucleation, and mild dyskeratosis. In conclusion, these signs proved useful for identifying HPV infection. Population-based studies are required to corroborate our findings.
宫颈肿瘤形成归因于持续性人乳头瘤病毒感染。巴氏涂片检查是资源匮乏地区宫颈癌筛查的主要手段，我们研究了可能提示人乳头瘤病毒感染的非典型特征。这些特征包括不全角化细胞、轻度角化不良、角化不全、轻度核深染、双核/多核、麻疹样细胞和透明角质样颗粒。将208例巴氏涂片检查结果满意且进行了杂交捕获二代检测的女性与“人乳头瘤病毒金标准”进行比较，以验证这些非典型征象。“人乳头瘤病毒金标准”定义为符合以下任何一项/全部的情况：巴氏涂片上有明确的与人乳头瘤病毒相关的病变（低度鳞状上皮内病变及以上）、高危型人乳头瘤病毒阳性，以及组织学检查为一级宫颈上皮内瘤变或以上。双核/多核和轻度核深染分别具有最高的阳性预测值和阴性预测值。人乳头瘤病毒金标准阳性组和阴性组每张涂片非典型征象的平均数量分别为5.52个和3.12个（P<0.0005）。不全角化细胞、轻度角化不良、轻度核深染、双核/多核、角化不全和弥漫性透明角质颗粒与金标准的相关性最佳（P<0.05）。在巴氏涂片已确定的上皮内病变基础上增加非典型征象，可使灵敏度从52.31%提高到59.10%，特异性从100%降低到98%。为了从这些征象的组合中获得最大益处，研究了各种组合。最佳组合是：不全角化细胞、轻度核深染和双核/多核。另一个组合是：不全角化细胞、轻度核深染、双核/多核和轻度角化不良。总之，这些征象被证明对识别高危型人乳头瘤病毒感染有用。需要进行基于人群的研究来证实我们的发现。
