Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, SciLifeLab, Uppsala University Hospital, Uppsala, Sweden.
Br J Cancer. 2011 Aug 23;105(5):694-7. doi: 10.1038/bjc.2011.277. Epub 2011 Aug 2.
Testing for high-risk human papillomavirus (HPV) in primary screening for cervical cancer is considered more sensitive, but less specific, in comparison with Pap-smear cytology. Women with persistent HPV infections have a higher risk of developing cervical intraepithelial neoplasia 2+ (CIN2+) lesions. This study was performed to evaluate the gain in specificity for detection of histologically confirmed CIN2+ lesions achieved by short-time repeat testing for high-risk HPV in women aged 30-65 years, with the primary sample for HPV analysis taken by self-sampling.
A total of 8000 women in Uppsala County, aged 30-65 years, who had not attended organised screening for 6 years or longer, were offered self-sampling of vaginal fluid at home and the samples sent for HPV typing. Of these, 8% (669) were not possible to contact or had performed hysterectomy. Women positive for high-risk HPV in the self-sampling test were invited for a follow-up HPV test and a cervical biopsy on average 3 months after the initial HPV test.
In all, 39% (2850/7331) of invited women chose to perform self-sampling of vaginal fluid at home. High-risk HPV infection was found in 6.6% (188) of the women. In all, 89% of the women testing HPV positive performed a follow-up examination, on average 2.7 months, after the first test and 59% of these women were HPV positive in the follow-up test. The prevalence of CIN2+ lesions in women with an initial HPV-positive test was 23% (95% CI 18-30%) and in women with two consecutive HPV-positive tests was 41% (95% CI 31-51%). In women with two positive HPV tests, the prevalence of CIN2+ lesions varied from 49% in women at age 30-39 years to 24% in women at age 50-65 years. Short-time repeat HPV testing increased the specificity for detection of CIN2+ lesions from about 94.2% to 97.8%. The most prevalent HPV types were HPV16 (32%), followed by HPV18/45 (19%) and HPV 33/52/58 (19%).
The short-time persistence of high-risk HPV infection in this age group was about 60%. Repeat testing for high-risk HPV using self-sampling of vaginal fluid can be used to increase the specificity in the screening for cervical cancer in women aged 30-65 years.
与巴氏涂片细胞学检查相比，检测高危型人乳头瘤病毒（HPV）在宫颈癌的初筛中更敏感，但特异性更低。持续性 HPV 感染的女性发展为宫颈上皮内瘤变 2 级及以上（CIN2+）病变的风险更高。本研究旨在评估在 30-65 岁女性中，通过短时间重复检测高危型 HPV 对组织学证实的 CIN2+病变的检测特异性的提高，HPV 分析的初始样本通过自我采样获得。
乌普萨拉县共有 8000 名年龄在 30-65 岁、未参加组织筛查 6 年或更长时间的女性被邀请在家中进行阴道液的自我采样，并将样本送去进行 HPV 分型。其中，8%（669 人）无法联系或已行子宫切除术。自我采样试验中 HPV 高危型阳性的女性被邀请进行随访 HPV 检测和宫颈活检，平均在初始 HPV 检测后 3 个月进行。
共有 39%（2850/7331）受邀女性选择在家中进行阴道液的自我采样。6.6%（188 人）的女性检测出高危型 HPV 感染。所有 HPV 阳性的女性中，89%接受了随访检查，平均在第一次检查后 2.7 个月进行，其中 59%的女性在随访检查中 HPV 阳性。初次 HPV 阳性试验中 CIN2+病变的患病率为 23%（95%CI 18-30%），两次连续 HPV 阳性试验中 CIN2+病变的患病率为 41%（95%CI 31-51%）。在两次 HPV 检测均为阳性的女性中，CIN2+病变的患病率从 30-39 岁女性的 49%到 50-65 岁女性的 24%不等。短时间重复 HPV 检测可将 CIN2+病变的检测特异性从约 94.2%提高到 97.8%。最常见的 HPV 类型是 HPV16（32%），其次是 HPV18/45（19%）和 HPV33/52/58（19%）。
在该年龄组中，高危型 HPV 感染的短期持续性约为 60%。使用阴道液自我采样进行高危型 HPV 重复检测可提高 30-65 岁女性宫颈癌筛查的特异性。
