Department of Pathology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
Yonsei Med J. 2014 Mar;55(2):331-8. doi: 10.3349/ymj.2014.55.2.331.
Landmark indicators have not yet to be developed to detect the regression of cervical intraepithelial neoplasia (CIN). We propose that quantitative viral load and indicative histological criteria can be used to differentiate between atypical squamous cells of undetermined significance (ASCUS) and a CIN of grade 1.
We collected 115 tissue biopsies from women who tested positive for the human papilloma virus (HPV). Nine morphological parameters including nuclear size, perinuclear halo, hyperchromasia, typical koilocyte (TK), abortive koilocyte (AK), bi-/multi-nucleation, keratohyaline granules, inflammation, and dyskeratosis were examined for each case. Correlation analyses, cumulative logistic regression, and binary logistic regression were used to determine optimal cut-off values of HPV copy numbers. The parameters TK, perinuclear halo, multi-nucleation, and nuclear size were significantly correlated quantitatively to HPV copy number.
An HPV loading number of 58.9 and AK number of 20 were optimal to discriminate between negative and subtle findings in biopsies. An HPV loading number of 271.49 and AK of 20 were optimal for discriminating between equivocal changes and obvious koilocytosis.
We propose that a squamous epithelial lesion with AK of >20 and quantitative HPV copy number between 58.9-271.49 represents a new spectrum of subtle pathological findings, characterized by AK in ASCUS. This can be described as a distinct entity and called "regressing koilocytosis".
目前尚未开发出用于检测宫颈上皮内瘤变（CIN）消退的标志性指标。我们提出，定量病毒载量和指示性组织学标准可用于区分非典型鳞状细胞意义不明确（ASCUS）和 1 级 CIN。
我们收集了 115 份 HPV 阳性女性的组织活检样本。对每个病例检查了 9 个形态学参数，包括核大小、核周晕、异染色质、典型空泡细胞（TK）、流产空泡细胞（AK）、双核/多核、角质透明颗粒、炎症和非典型角化。采用相关分析、累积逻辑回归和二元逻辑回归确定 HPV 拷贝数的最佳截断值。TK、核周晕、多核和核大小这 4 个参数与 HPV 拷贝数呈显著的定量相关性。
HPV 载量为 58.9 和 AK 数量为 20 时，可最佳区分活检中的阴性和细微发现。HPV 载量为 271.49 和 AK 数量为 20 时，可最佳区分可疑变化和明显空泡化。
我们提出，AK 数量＞20 和定量 HPV 拷贝数在 58.9-271.49 之间的鳞状上皮病变代表了一种新的细微病理发现谱，以 ASCUS 中的 AK 为特征。这可以被描述为一种明确的实体，并称为“消退性空泡化”。
