Department of Pathology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Arch Pathol Lab Med. 2010 Aug;134(8):1130-5. doi: 10.5858/2009-0624-OA.1.
Data on cytologic screening and follow-up disproportionately reflect findings from frequently screened younger women, and data from screened women 50 years and older using newer screening technologies remain limited.
To better understand the utility of adjunctive high-risk human papillomavirus (hrHPV) testing for disease risk stratification in women 50 years and older with a range of liquid-based cytology, abnormal, squamous cell Papanicolaou test results.
Liquid-based cytology cases interpreted as high-grade squamous intraepithelial lesion (HSIL); low-grade squamous intraepithelial lesion (LSIL); atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H); and atypical squamous cells of undetermined significance (ASC-US) at Magee-Womens Hospital (Pittsburgh, Pennsylvania) were retrospectively identified for a 36-month period between July 1, 2005, and June 30, 2008, from women 50 years and older who also had hrHPV DNA test results. Histopathologic follow-up diagnoses were analyzed.
During the study period, 4855 women 50 years and older had HSIL, LSIL, ASC-H, or ASC-US Papanicolaou test results and hrHPV testing. In 89.3% of HSIL cases, 71.0% of LSIL cases, 38.9% of ASC-H cases, and 14.2% of ASC-US cases, hrHPV test results were positive. The positive predictive value of a positive hrHPV test for histopathologic cervical intraepithelial neoplasia 2/3(+) detection was 90.5% with HSIL, 15% with ASC-H, 9.8% with LSIL, and 3.2% with ASC-US. A negative hrHPV test result had a 100% negative predictive value for histopathologic cervical intraepithelial neoplasia 2/3(+) in both LSIL and ASC-H cases.
In women 50 years and older, a positive hrHPV test result significantly increased the likelihood of follow-up histopathologic diagnoses of cervical intraepithelial neoplasia 2 /3(+) in patients with HSIL, LSIL, and ASC-H Papanicolaou test results compared with women with negative hrHPV test results. No cervical intraepithelial neoplasia 2/3(+) diagnoses were documented in women 50 years and older with LSIL or ASC-H Papanicolaou test results and negative hrHPV test results.
细胞学筛查和随访的数据主要反映了经常接受筛查的年轻女性的发现，而使用新的筛查技术对 50 岁及以上接受筛查的女性的数据仍然有限。
更好地了解在接受各种液基细胞学检查、异常鳞状细胞巴氏涂片检查结果的 50 岁及以上女性中，辅助高危型人乳头瘤病毒（hrHPV）检测在疾病风险分层中的作用，这些女性的年龄在 50 岁及以上。
2005 年 7 月 1 日至 2008 年 6 月 30 日期间，匹兹堡 Magee-Womens 医院对液基细胞学检查结果为高级别鳞状上皮内病变（HSIL）；低级别鳞状上皮内病变（LSIL）；非典型鳞状细胞，不能排除高级别鳞状上皮内病变（ASC-H）；以及非典型鳞状细胞意义不明确（ASC-US）的病例进行了回顾性分析，这些病例为 50 岁及以上的女性，且均进行了 hrHPV DNA 检测。对组织病理学随访诊断进行了分析。
在研究期间，4855 名 50 岁及以上的女性进行了液基细胞学检查，巴氏涂片检查结果为 HSIL、LSIL、ASC-H 或 ASC-US，并进行了 hrHPV 检测。在 89.3%的 HSIL 病例中，71.0%的 LSIL 病例，38.9%的 ASC-H 病例和 14.2%的 ASC-US 病例中，hrHPV 检测结果为阳性。HSIL 阳性 hrHPV 检测对组织病理学宫颈上皮内瘤变 2/3（+）检测的阳性预测值为 90.5%，ASC-H 为 15%，LSIL 为 9.8%，ASC-US 为 3.2%。LSIL 和 ASC-H 病例中，hrHPV 检测阴性的阴性预测值为 100%，对组织病理学宫颈上皮内瘤变 2/3（+）为阴性。
在 50 岁及以上的女性中，与 hrHPV 检测阴性的女性相比，HSIL、LSIL 和 ASC-H 巴氏涂片检查结果阳性的女性，hrHPV 检测结果阳性显著增加了随访组织病理学诊断为宫颈上皮内瘤变 2/3（+）的可能性。在接受液基细胞学检查结果为 LSIL 或 ASC-H 且 hrHPV 检测结果为阴性的 50 岁及以上女性中，未发现宫颈上皮内瘤变 2/3（+）的诊断。
