巴氏涂片检查结果为不典型腺细胞的女性中，辅助性高危型人乳头瘤病毒 DNA 检测的临床实用性。

Clinical utility of adjunctive high-risk human papillomavirus DNA testing in women with Papanicolaou test findings of atypical glandular cells.

机构信息

Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213, USA.

出版信息

Arch Pathol Lab Med. 2010 Jan;134(1):103-8. doi: 10.5858/2008-0755-OAR1.1.

DOI:10.5858/2008-0755-OAR1.1

PMID:20073612

Abstract

CONTEXT

Atypical glandular cell (AGC) Papanicolaou (Pap) test interpretations are challenging. Most biopsy findings are benign, but AGC results may also reflect highly significant noninvasive neoplastic and malignant histologic outcomes. High-risk human papillomavirus (hrHPV) test use with AGC Pap test results is evolving.

OBJECTIVE

To further evaluate the utility and limitations of hrHPV testing with AGC Pap tests.

DESIGN

Hospital records were searched for AGC Pap tests results from June 1, 2005, to August 31, 2007. Cases of AGC with hrHPV tests and histopathologic follow-up were included.

RESULTS

Of the 662 women with AGC Pap test results and follow-up analyzed, hrHPV results were available for 309 (46.7%) and were positive in 75 cases (24.3%). Among the 75 cases with hrHPV+ AGC results, 13 (17.3%) had cervical intraepithelial neoplasia grades 2/3, 10 (13.3%) had adenocarcinoma in situ, and 3 (4.0%) had cervical invasive adenocarcinoma, whereas for 234 women with hrHPV(-) results, 1 (0.4%) had cervical intraepithelial neoplasia grades 2/3, 1 (0.4%) had adenocarcinoma in situ, 1 each (0.4%) had cervical adenocarcinoma and ovarian carcinoma, and 8 (3.4%) had endometrial carcinoma.

CONCLUSIONS

Positive hrHPV AGC results were most strongly associated with cervical intraepithelial neoplasia grades 2/3 and adenocarcinoma in situ in women younger than 50 years. Positive hrHPV AGC results were also present in all 3 cases of invasive cervical adenocarcinoma in women younger than 50 years. Of note, hrHPV(-) AGC results were present in 10 of 13 carcinomas (76.9%) detected after AGC Pap tests, all in women 40 years or older with endometrial adenocarcinomas (n = 8), ovarian carcinoma (n = 1), and cervical adenosquamous carcinoma in a woman (n = 1) in her 50s. Testing for hrHPV after AGC Pap testing was most helpful in the detection of cervical intraepithelial neoplasia grades 2/3, adenocarcinoma in situ, and invasive cervical adenocarcinomas in women younger than 50 years.

摘要

背景

非典型腺细胞（AGC）巴氏涂片检查结果具有挑战性。大多数活检结果为良性，但 AGC 结果也可能反映出高度显著的非浸润性肿瘤和恶性组织学结果。高危型人乳头瘤病毒（hrHPV）检测与 AGC 巴氏涂片检测结果的联合应用正在不断发展。

目的

进一步评估 AGC 巴氏涂片检测与 hrHPV 检测联合应用的效用和局限性。

设计

检索 2005 年 6 月 1 日至 2007 年 8 月 31 日的 AGC 巴氏涂片检测结果的医院记录。纳入 AGC 巴氏涂片检测与 hrHPV 检测及组织病理学随访的病例。

结果

在分析的 662 例 AGC 巴氏涂片检测结果和随访病例中，309 例（46.7%）有 hrHPV 检测结果，75 例（24.3%）hrHPV 检测结果为阳性。在 75 例 hrHPV+ AGC 结果中，13 例（17.3%）有宫颈上皮内瘤变 2/3 级，10 例（13.3%）有原位腺癌，3 例（4.0%）有宫颈浸润性腺癌，而在 234 例 hrHPV（-）结果中，1 例（0.4%）有宫颈上皮内瘤变 2/3 级，1 例（0.4%）有原位腺癌，各 1 例（0.4%）有宫颈腺癌和卵巢癌，8 例（3.4%）有子宫内膜癌。

结论

hrHPV 阳性的 AGC 结果与 50 岁以下女性的宫颈上皮内瘤变 2/3 级和原位腺癌关系最密切。hrHPV 阳性的 AGC 结果也存在于 50 岁以下的所有 3 例浸润性宫颈腺癌中。值得注意的是，hrHPV（-）的 AGC 结果在 13 例（76.9%）经 AGC 巴氏涂片检测后发现的癌中均存在，均为 40 岁及以上的女性，其中子宫内膜腺癌 8 例，卵巢癌 1 例，50 多岁的宫颈腺鳞癌 1 例。在 50 岁以下女性中，AGC 巴氏涂片检测后进行 hrHPV 检测对宫颈上皮内瘤变 2/3 级、原位腺癌和浸润性宫颈腺癌的检测最有帮助。