Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands.
Br J Cancer. 2012 Feb 28;106(5):975-81. doi: 10.1038/bjc.2011.581. Epub 2012 Jan 17.
Human papillomavirus (HPV) testing is more sensitive than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN). We evaluated the performance of high-risk HPV (hrHPV) testing in routine screening.
In all, 25,871 women (29-61) enrolled in our population-based cohort study were offered both cytology and hrHPV testing. High-risk HPV-positive women with normal cytology and an age-matched subcohort of hrHPV-negative women with normal cytology were invited for repeat testing after 1 and/or 2 years and were referred for colposcopy if they presented with abnormal cytology and/or a positive hrHPV test. The hrHPV-positive women with borderline or mild dyskaryosis (BMD) and all women with moderate dyskaryosis or worse (>BMD) were directly referred for colposcopy. Women with BMD and an hrHPV-negative test were advised to repeat cytology at 6 and 18 months and were referred for colposcopy if the repeat cytology test was abnormal. The main outcome measure was CIN grade 3 or worse (CIN3+). Results were adjusted for non-attendance at repeat testing.
The hrHPV-positive women with abnormal cytology had a CIN3+ risk of 42.2% (95% confidence interval (CI): 36.4-48.2), whereas the hrHPV-positive women with normal cytology had a much lower risk of 5.22% (95% CI: 3.72-7.91). In hrHPV-positive women with normal cytology, an additional cytology step after 1 year reduced the CIN3+ risk to only 1.6% (95% CI: 0.6-4.9) if the repeat test was normal. The CIN3+ risk in women with hrHPV-positive normal cytology was higher among women invited for the first time (29-33 years of age) (9.1%; 95% CI: 5.6-14.3) than among older women (3.0%; 95% CI: 1.5-5.5).
Primary hrHPV screening with cytology triage in women aged 30 years is an effective way to stratify women on CIN3+ risk and seems a feasible alternative to cytological screening. Repeat cytology after 1 year for hrHPV-positive women with normal cytology is however necessary before returning women to routine screening.
人乳头瘤病毒（HPV）检测比细胞学检查更能敏感地检测到高级别宫颈上皮内瘤变（CIN）。我们评估了高危型 HPV（hrHPV）检测在常规筛查中的表现。
共有 25871 名（29-61 岁）女性参加了我们的基于人群的队列研究，她们都接受了细胞学和 hrHPV 检测。高危型 HPV 阳性、细胞学正常的女性和年龄匹配的 hrHPV 阴性、细胞学正常的亚组女性，如果细胞学异常和/或 hrHPV 检测阳性，将在 1 年和/或 2 年后接受重复检测，并如果细胞学异常和/或 hrHPV 检测阳性，则进行阴道镜检查。hrHPV 阳性、边界性或轻度不典型增生（BMD）和所有中度不典型增生或更严重（>BMD）的女性直接进行阴道镜检查。BMD 和 hrHPV 阴性的女性如果细胞学检测异常，建议在 6 个月和 18 个月时重复细胞学检测，如果重复细胞学检测异常，建议进行阴道镜检查。主要观察指标为 CIN3+（包括 CIN3+）。结果根据未参加重复检测进行了调整。
细胞学异常的 hrHPV 阳性女性 CIN3+的风险为 42.2%（95%置信区间[CI]：36.4-48.2），而细胞学正常的 hrHPV 阳性女性的风险则低得多，为 5.22%（95% CI：3.72-7.91）。在细胞学正常的 hrHPV 阳性女性中，如果重复检测正常，1 年后的额外细胞学检查可将 CIN3+的风险降低至仅 1.6%（95% CI：0.6-4.9）。首次受邀（29-33 岁）的女性中，细胞学正常的 hrHPV 阳性女性的 CIN3+风险较高（9.1%；95% CI：5.6-14.3），而年龄较大的女性（3.0%；95% CI：1.5-5.5）。
对年龄≥30 岁的女性进行 hrHPV 初筛联合细胞学分流是一种有效的分层方法，可评估 CIN3+的风险，似乎是细胞学筛查的可行替代方法。对于细胞学正常的 hrHPV 阳性女性，在返回常规筛查之前，需要在 1 年后重复细胞学检查。
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