Schmidt D
Institut für Pathologie, A2,2, 68159, Mannheim, Deutschland.
Pathologe. 2011 Nov;32(6):484-90. doi: 10.1007/s00292-011-1478-3.
Despite the success of the German screening program for cervical cancer a new discussion has started with the aim to improve its quality. The main reason for this new discussion has been the finding of many international studies that the quality of screening programs could be improved by introducing human papillomavirus (HPV) testing. It is well known that the sensitivity of the HPV test is much better than that of a single Papanicolaou (PAP) smear. On the other hand, it is generally accepted that the specificity of the established HPV tests is significantly lower than that of cytology, i.e. the HPV test produces more false positive diagnoses. The introduction of new biomarkers could solve this problem and one of these biomarkers is p16(INK4a) which is a surrogate marker for the oncogenic transformation of cervical cells. Using this biomarker it is now possible to identify cases which should be sent for colposcopy and possibly biopsy directly, among those cases which have been classified cytologically as unclear (ASC-US) or mild and moderately dysplastic cervical intraepithelial neoplasia (CIN 1/2). Moreover, it is now feasible to identify the vast majority of underlying high-grade CIN disease in women tested Pap negative/HPV positive, while reducing the number of colposcopies to a level of approximately 25%. In addition, the combination of p16 and L1 probably allows a better estimate of the prognosis of cases with mild or moderate dysplasia.
尽管德国宫颈癌筛查项目取得了成功，但旨在提高其质量的新一轮讨论已经展开。引发这新一轮讨论的主要原因是许多国际研究发现，引入人乳头瘤病毒（HPV）检测可提高筛查项目的质量。众所周知，HPV检测的灵敏度远高于单一巴氏涂片检测。另一方面，人们普遍认为，现有HPV检测的特异性显著低于细胞学检测，即HPV检测会产生更多假阳性诊断。引入新的生物标志物可以解决这一问题，其中一种生物标志物是p16（INK4a），它是宫颈细胞致癌转化的替代标志物。利用这种生物标志物，现在有可能在细胞学上分类为不明确（非典型鳞状细胞不能明确意义，ASC-US）或轻度及中度发育异常的宫颈上皮内瘤变（CIN 1/2）的病例中，直接识别出应送去做阴道镜检查甚至活检的病例。此外，现在还可以在巴氏涂片阴性/HPV阳性的女性中识别出绝大多数潜在的高级别CIN疾病，同时将阴道镜检查的数量减少到大约25%的水平。此外，p16和L1的联合使用可能有助于更好地评估轻度或中度发育异常病例的预后。
