Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Int J Cancer. 2013 Feb 15;132(4):959-66. doi: 10.1002/ijc.27723. Epub 2012 Aug 3.
Low-grade squamous intraepithelial lesion (LSIL) is a common cytologic finding in cervical screening, yet only about 10-20% have significant histologic abnormalities and these are almost always positive for high-risk human papillomavirus (hrHPV). This analysis aims to clarify the role of hrHPV DNA testing in the triage of women with LSIL cytology. In the ATHENA screening trial, we examined 1,084 cases of LSIL, of which 925 had an evaluable biopsy, to determine the extent to which hrHPV testing can identify those patients who have precursor lesions in need of immediate clinical referral and those who have changes more likely to regress spontaneously. Overall, 71.2% of LSIL cases were hrHPV positive, but the prevalence was age dependent, with only 56.1% in women ≥ 40 years. Among women with LSIL, 11.6% (107/925) had a cervical intraepithelial neoplasia grade 2 or worse (CIN2+) histologic diagnosis and, of these, only nine were hrHPV negative. For CIN3+, 91.7% (44/48) of women with LSIL were hrHPV positive. The negative predictive value of hrHPV testing for CIN3+ in LSIL was 100% for women aged ≥ 40 years. Women who were HPV16 positive had a higher positive predictive value for CIN2+ (25.4%) than those who were positive for 12 other pooled hrHPV types (11.5%). Testing for hrHPV in women with LSIL is effective in identifying high-grade cervical lesions, thereby avoiding unnecessary referrals to colposcopy and potential over-treatment of non-progressive lesions, especially for women aged ≥ 40 years.
低度鳞状上皮内病变（LSIL）是宫颈筛查中常见的细胞学发现，但只有约 10-20%有明显的组织学异常，这些异常几乎都是高危型人乳头瘤病毒（hrHPV）阳性。本分析旨在阐明 hrHPV DNA 检测在 LSIL 细胞学患者分流中的作用。在 ATHENA 筛查试验中，我们检查了 1084 例 LSIL 病例，其中 925 例有可评估的活检，以确定 hrHPV 检测在多大程度上可以识别那些有需要立即临床转诊的前驱病变的患者，以及那些更有可能自发消退的病变患者。总体而言，71.2%的 LSIL 病例为 hrHPV 阳性，但阳性率随年龄而异，≥40 岁的女性中阳性率仅为 56.1%。在 LSIL 患者中，11.6%（107/925）有宫颈上皮内瘤变 2 级或更高级别（CIN2+）的组织学诊断，其中只有 9 例 hrHPV 阴性。对于 CIN3+，LSIL 中 91.7%（44/48）的女性为 hrHPV 阳性。对于≥40 岁的女性，hrHPV 检测对 LSIL 中 CIN3+的阴性预测值为 100%。HPV16 阳性的女性 CIN2+的阳性预测值（25.4%）高于其他 12 种混合 hrHPV 类型阳性的女性（11.5%）。对 LSIL 患者进行 hrHPV 检测可有效识别高级别宫颈病变，从而避免不必要的阴道镜转诊和潜在的过度治疗非进展性病变，尤其是对于≥40 岁的女性。
