Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Elevhemmet H2:00, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden.
Oncol Rep. 2012 Jul;28(1):346-52. doi: 10.3892/or.2012.1755. Epub 2012 Apr 3.
The aim of this study was to assess the use of human papillomavirus (HPV) E6/E7 mRNA testing in the follow-up of women treated for cervical intraepithelial neoplasia (CIN) by conization and to compare the prognostic value of HPV E6/E7 mRNA to HPV L1 DNA and cytology. One hundred and forty-three women underwent cytological/histological testing, HPV DNA genotyping by Linear Array, and HPV E6/E7 mRNA testing by APTIMA HPV assay during follow-up after surgical treatment for histologically verified CIN. High-grade residual/recurrent disease (CIN2+/HSIL+) was identified in 7 (4.9%) women, and low-grade disease (CIN1/LSIL) in 25 (17.5%). At the inclusion visit 33 (23%) women were HPV DNA-positive; 13 (9.0%) were HPV E6/E7 mRNA-positive. HPV E6/E7 mRNA did not identify three women with high-grade disease. Presence of high-risk HPV DNA at the inclusion visit predicted 100% (95% CI 64.6-100) of high-grade residual/recurrent disease, with a specificity of 80.9% (95% CI 73.5-86.6); cytology had a sensitivity of 85.7%, and a specificity of 87.5%. HPV E6/E7 mRNA testing was a poor predictor of treatment failure, with a sensitivity of 57.1% (95% CI 25.0-84.2), but high specificity (93.4%; 95% CI 87.9-96.5). Detection of high-risk HPV DNA after treatment by conization identified 100% of women with residual/recurrent high-grade disease, whereas HPV E6/E7 mRNA testing was a poor predictor of treatment failure. This study suggests that a negative HPV mRNA result cannot exclude the risk of malignant progression, and that HPV E6/E7 mRNA testing by APTIMA HPV assay is not useful in the follow-up of women treated for CIN.
本研究旨在评估人乳头瘤病毒（HPV）E6/E7 mRNA 检测在接受宫颈上皮内瘤变（CIN）锥切治疗后的女性随访中的应用，并比较 HPV E6/E7 mRNA 与 HPV L1 DNA 和细胞学检测的预后价值。143 名女性在接受锥切治疗后接受了细胞学/组织学检测、线性阵列 HPV DNA 基因分型和 APTIMA HPV 检测 HPV E6/E7 mRNA 检测。在组织学证实的 CIN 治疗后随访期间，7 名（4.9%）女性发现高级别残留/复发疾病（CIN2+/HSIL+），25 名（17.5%）女性发现低级别疾病（CIN1/LSIL）。在纳入时，33 名（23%）女性 HPV DNA 阳性；13 名（9.0%）HPV E6/E7 mRNA 阳性。HPV E6/E7 mRNA 未能发现 3 名患有高级别疾病的女性。在纳入时存在高危型 HPV DNA 可预测 100%（95%CI 64.6-100）的高级别残留/复发疾病，特异性为 80.9%（95%CI 73.5-86.6）；细胞学检测的敏感性为 85.7%，特异性为 87.5%。HPV E6/E7 mRNA 检测对治疗失败的预测效果不佳，敏感性为 57.1%（95%CI 25.0-84.2），但特异性高（93.4%；95%CI 87.9-96.5）。锥切治疗后检测到高危型 HPV DNA 可发现 100%的残留/复发高级别疾病女性，而 HPV E6/E7 mRNA 检测对治疗失败的预测效果不佳。本研究表明，HPV mRNA 检测阴性不能排除恶性进展的风险，且 APTIMA HPV 检测 HPV E6/E7 mRNA 检测在 CIN 治疗后的随访中没有用处。
