290 例巴氏涂片检查结果为高级别鳞状上皮内病变患者的组织病理学随访和人乳头瘤病毒 DNA 检测结果。
Histopathologic follow-up and human papillomavirus DNA test results in 290 patients with high-grade squamous intraepithelial lesion Papanicolaou test results.
机构信息
Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
出版信息
Cancer Cytopathol. 2011 Dec 25;119(6):377-86. doi: 10.1002/cncy.20176. Epub 2011 Jul 19.
BACKGROUND
The study documents histopathologic outcomes and high-risk (hr) human papillomavirus (HPV) test results in a large cohort of patients with high-grade squamous intraepithelial lesion (HSIL) liquid-based cytology (LBC) Pap test results.
METHODS
A total of 352 patients with HSIL results (338 cervical and 14 vaginal) who had hrHPV testing and 290 patients with biopsy follow-up were studied. hrHPV detection rates were compared at different ages, with or without an endocervical/transformation zone sample (EC/TZS), and for cervical and vaginal HSIL Pap smears. Histopathologic follow-up findings were also compared. hrHPV-negative HSIL slides were re-evaluated in a blinded manner.
RESULTS
A total of 325 of 338 (96.2%) cervical HSIL and 12 of 14 (87.5%) vaginal HSIL tested hrHPV-positive. A total of 271 of 281 (96.4%) EC/TZS-positive cervical HSIL and 54 of 57 (94.7%) EC/TZS-negative cervical HSIL tested hrHPV-positive. The percentage of hrHPV-positive HSIL declined slightly with increasing age. 197 of 273 (72.3%) hrHPV-positive cervical HSIL had histopathologic cervical intraepithelial neoplasia (CIN) 2/3+ follow-up, including 8 squamous carcinomas, compared with 4 of 12 (33.3%) hrHPV-negative HSIL with CIN2/3 (no carcinomas). 167 of 241 (69.2%) EC/TZS-positive HSIL had CIN2/3+ follow-up, compared with 34 of 44 (77.3%) EC/TZS-negative HSIL. Equivocal HSIL morphology characterized some HPV-negative HSIL without CIN2/3+ follow-up.
CONCLUSIONS
hrHPV was detected in LBC vials from 96.2% of 338 cervical HSIL and 85.7% of 14 vaginal HSIL. CIN2/3+ was significantly more likely with hrHPV-positive cervical HSIL than with hrHPV-negative cervical HSIL. Presence or absence of an EC/TZS did not significantly impact HSIL hrHPV or CIN2/3+ rates. Some hrHPV-negative HSIL cases may represent HSIL cytologic mimics.
背景
本研究记录了大量高级别鳞状上皮内病变（HSIL）液基细胞学（LBC）巴氏涂片结果为高危（HR）人乳头瘤病毒（HPV）阳性患者的组织病理学结果和 HR-HPV 检测结果。
方法
对 352 例 HR-HPV 检测结果为 HSIL（338 例宫颈和 14 例阴道）且有 290 例活检随访的患者进行研究。比较了不同年龄、有无宫颈/转化区样本（EC/TZS）以及宫颈和阴道 HSIL 巴氏涂片 HR-HPV 检测率。还比较了组织病理学随访结果。以盲法方式重新评估 HR-HPV 阴性 HSIL 涂片。
结果
338 例宫颈 HSIL 中 325 例（96.2%）和 14 例阴道 HSIL 中 12 例（87.5%）检测到 HR-HPV 阳性。281 例 EC/TZS 阳性宫颈 HSIL 中 271 例（96.4%）和 57 例 EC/TZS 阴性宫颈 HSIL 中 54 例（94.7%）检测到 HR-HPV 阳性。随着年龄的增长，HR-HPV 阳性 HSIL 的比例略有下降。273 例 HR-HPV 阳性宫颈 HSIL 中 197 例（72.3%）有组织病理学宫颈上皮内瘤变（CIN）2/3+随访，包括 8 例鳞癌，而 12 例 HR-HPV 阴性 HSIL 中仅 4 例（33.3%）有 CIN2/3（无癌）。241 例 EC/TZS 阳性 HSIL 中 167 例（69.2%）有 CIN2/3+随访，而 44 例 EC/TZS 阴性 HSIL 中 34 例（77.3%）有 CIN2/3+随访。一些 HPV 阴性 HSIL 表现为不典型 HSIL 形态，无 CIN2/3+随访。
结论
LBC 小瓶中检测到 338 例宫颈 HSIL 中 96.2%和 14 例阴道 HSIL 中 85.7%为 HR-HPV。HR-HPV 阳性的宫颈 HSIL 比 HR-HPV 阴性的宫颈 HSIL 更有可能发生 CIN2/3+。是否存在 EC/TZS 并不显著影响 HSIL HR-HPV 或 CIN2/3+的检出率。一些 HR-HPV 阴性的 HSIL 病例可能代表 HSIL 细胞学的类似物。
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