Ikenberg Hans
Cytomol, Frankfurt, Germany.
Curr Probl Dermatol. 2014;45:166-74. doi: 10.1159/000356515. Epub 2014 Mar 13.
Human papillomaviruses (HPVs) are associated with numerous cutaneous or mucosal benign and malignant neoplasms. The majority of available data on routine HPV diagnostics has been centered on evaluating the cervix. Consequently, there is limited data on the utility and efficacy of HPV diagnostics in cutaneous lesions. Therefore the vast majority of data presented in this short review are derived from cervical cancer prevention measures. The balance between analytical (low) and clinical (high) sensitivity is crucial for the specificity of a routine HPV test as limited specificity would result in unnecessary treatment of healthy women. Furthermore, HPV-16 and -18 confer a much higher risk for the development of a cervical intraepithelial lesion 2+ compared to the other HPV high-risk types. It is therefore deemed appropriate to test for these HPV types independently. With the exception of testing for these HPV high-risk types, testing for individual HPV types is of very limited clinical value. Until now HPV diagnostics have mainly been based on DNA detection for which signal and target amplification methods are available. PCR techniques can be divided into type-specific and consensus PCRs. Due to its high clinical sensitivity and its relatively high specificity the Hybrid Capture 2 (HC2) test became the gold standard in routine HPV testing. The HC2 method hybridizes 13 (near) full-length stabilized RNA probes of high-risk HPV types to denatured target DNA followed by detection with antibodies and chemiluminescence. To avoid costly validation studies for new HPV tests, internationally accepted standards for evaluation have been defined. Meanwhile several new HPV detection assays have been commercialized. Three tests have received Food and Drug Administration approval (Cervista™, signal amplification; Cobas™ HPV test, real-time PCR; APTIMA™ HPV RNA test). Among them the Cobas HPV test has been most broadly validated for use in triage and as an adjunct to cytology. HPV RNA testing is another promising option with potentially higher specificity.
人乳头瘤病毒（HPV）与众多皮肤或黏膜的良性及恶性肿瘤相关。关于HPV常规诊断的大多数现有数据都集中在宫颈评估方面。因此，关于HPV诊断在皮肤病变中的效用和功效的数据有限。所以，本简短综述中呈现的绝大多数数据都源自宫颈癌预防措施。分析（低）敏感性和临床（高）敏感性之间的平衡对于常规HPV检测的特异性至关重要，因为有限的特异性会导致对健康女性进行不必要的治疗。此外，与其他高危型HPV相比，HPV - 16和 - 18导致宫颈上皮内病变2级及以上的风险要高得多。因此，单独检测这些HPV类型被认为是合适的。除了检测这些高危型HPV外，检测单个HPV类型的临床价值非常有限。到目前为止，HPV诊断主要基于DNA检测，有信号和靶标扩增方法可用。PCR技术可分为型特异性PCR和共识PCR。由于其高临床敏感性和相对较高的特异性，杂交捕获2（HC2）检测成为常规HPV检测的金标准。HC2方法将13种高危型HPV的（近）全长稳定RNA探针与变性的靶标DNA杂交，然后用抗体和化学发光进行检测。为避免对新的HPV检测进行昂贵的验证研究，已定义了国际认可的评估标准。与此同时，几种新的HPV检测方法已商业化。有三种检测方法已获得美国食品药品监督管理局批准（Cervista™，信号扩增；Cobas™ HPV检测，实时PCR；APTIMA™ HPV RNA检测）。其中，Cobas HPV检测在分流和作为细胞学辅助检测方面得到了最广泛的验证。HPV RNA检测是另一个有前景的选择，可能具有更高的特异性。
