Department of Clinical Pathology, University Hospital of North Norway, 9038 Tromsø, Norway.
Curr Pharm Des. 2013;19(8):1401-5. doi: 10.2174/1381612811319080006.
In delayed HPV triage women with atypical squamous cells of uncertain significance (ASC-US) cytology are retested after 6-12 months in order to decide whether they should be referred for colposcopy, further follow-up cytology or routine screening in three years. Triage using a specific HPV E6/E7 mRNA test may reduce referrals for colposcopy of women with ASC-US cytology compared to HPV DNA testing. We explored whether HPV mRNA triaging could reduce the time from ASC-US index cytology to biopsy compared with repeat cytology, and whether the positive predictive value (PPV) of the HPV mRNA test for high grade cervical intraepithelial neoplasia (CIN2+) was comparable with the PPV of repeat cytology.
We used repeat cytology and the HPV mRNA test PreTect HPV-Proofer, which detects E6/E7 mRNA from HPV subtypes 16, 18, 31, 33 and 45, in the triage of women with ASC-US. We included all women from the two northernmost counties of Norway with a first ASC-US cytology during the period 2004-2008. Two triage methods were evaluated 1) only repeat cytology (n=964) and 2) both HPV mRNA testing and cytology (n=542). Histologically confirmed CIN2+ was the study endpoint.
Among 1506 women with an ASC-US index cytology, 59 women (3.9%) had biopsy taken, of whom 49 women had CIN2+ (PPV 83.1%). The mean time from index ASC-US cytology until the case was resolved (biopsy or return to screening) was 10.6 months in the repeat cytology group and 7.3 months in the HPV group (P < 0.001). Of the 964 women in the group with repeat cytology only, 35 women (3.6%) had biopsy and 30 had CIN2+ (PPV 85.7%). Of the 542 women in the group with both HPV test and cytology, 24 women (4.4%) had biopsy and 19 had CIN2+ (PPV 79.2%).
In triage of women with ASC-US, the HPV mRNA test significantly reduced the time from the first abnormal cytology until biopsy and had predictive values comparable with those of repeat cytology.
在 HPV 延迟分流中，对于非典型鳞状细胞意义不明确（ASC-US）细胞学的女性，在 6-12 个月后进行复查，以决定是否应行阴道镜检查、进一步随访细胞学检查或在 3 年内进行常规筛查。与 HPV DNA 检测相比，使用特定的 HPV E6/E7 mRNA 检测进行分流可减少 ASC-US 细胞学女性的阴道镜检查转诊率。我们探讨了 HPV mRNA 分流是否可以减少 ASC-US 索引细胞学与活检之间的时间，以及 HPV mRNA 检测对高级别宫颈上皮内瘤变（CIN2+）的阳性预测值（PPV）是否与重复细胞学检查的 PPV 相当。
我们在 ASC-US 女性的分流中使用了重复细胞学检查和 HPV mRNA 检测 PreTect HPV-Proofer，该检测可检测 HPV 亚型 16、18、31、33 和 45 的 E6/E7 mRNA。我们纳入了 2004-2008 年期间挪威最北部两个县首次出现 ASC-US 细胞学的所有女性。我们评估了两种分流方法：1）仅重复细胞学检查（n=964）和 2）HPV mRNA 检测和细胞学检查均进行（n=542）。组织学证实的 CIN2+为研究终点。
在 1506 例 ASC-US 索引细胞学女性中，59 例（3.9%）进行了活检，其中 49 例（83.1%）为 CIN2+。在重复细胞学检查组中，从 ASC-US 索引细胞学到病例解决（活检或返回筛查）的平均时间为 10.6 个月，在 HPV 组中为 7.3 个月（P<0.001）。在仅重复细胞学检查的 964 例女性中，35 例（3.6%）进行了活检，30 例为 CIN2+（PPV 85.7%）。在进行 HPV 检测和细胞学检查的 542 例女性中，24 例（4.4%）进行了活检，19 例为 CIN2+（PPV 79.2%）。
在 ASC-US 女性的分流中，HPV mRNA 检测显著缩短了从首次异常细胞学检查到活检的时间，其预测值与重复细胞学检查相当。
