From the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhao and Li); the Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Nayar); the Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Dr Levi); the Department of Pathology, Mount Kisco Medical Group PC, Mount Kisco, New York (Dr Winkler); the Department of Esoteric Testing, AmeriPath, Indianapolis, Indiana (Dr Moriarty); the Department of Pathology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois (Dr Barkan); the Department of Pathology & Laboratory Medicine, University of California, Los Angeles (Dr Rao); the Department of Pathology, Metropolitan Pathologists PC, Lakewood, Colorado (Ms Miller); the Department of Pathology & Laboratory Medicine, University of Kansas Medical Center, Kansas City (Dr Fan); the Department of Pathology and Laboratory Medicine, University Rochester Medical Center, Rochester, New York (Dr Zhou); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Si); the Department of Pathology, University of Massachusetts Memorial Medical Center, Inc, Worcester (Dr Fischer); Providence Regional Medical Center, Everett, Washington (Dr Sturgis); the Department of Pathology, University of Michigan, Ann Arbor (Dr Jing); the Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora (Dr Marshall); the Department of Pathology, University of Utah, Salt Lake City (Dr Witt); the Department of Pathology & Laboratory Medicine, Emory University School Medicine, Atlanta, Georgia (Dr Birdsong); and the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Crothers).
Arch Pathol Lab Med. 2015 Feb;139(2):184-8. doi: 10.5858/arpa.2014-0028-OA. Epub 2014 Apr 2.
Persistent high-risk human papillomavirus (hrHPV) infection is essential for the development of cervical cancer and its precursor lesions. High-risk HPV testing has a higher sensitivity than cytology does for detecting cervical epithelial lesions. However, a large study from a single institution showed 31% of patients with invasive cervical cancer had negative baseline hrHPV testing within 5 years preceding the diagnosis.
To investigate the limitation of hrHPV testing in detecting invasive cervical cancer.
Cases from 2012 with a histologic diagnosis of invasive cervical carcinoma were retrieved from multiple institutions. From those records, prior hrHPV testing and Papanicolaou test results in the 5 years before the cancer diagnosis were recorded.
Seventy patients with cervical carcinoma were included in the study. Negative HPV test result rates were 9% (5 of 53), 23% (6 of 26), and 25% (2 of 8) during the periods of less than 1 year, 1 to 3 years, and 3 to 5 years before the histologic diagnoses, respectively. Negative Papanicolaou testing results in the same time intervals were 3.4% (2 of 59), 33% (10 of 30), and 40% (6 of 15). Although the HPV(-) rate seemed to be different among different HPV test methods, no statistical significance was detected because of small sample size. Negative hrHPV rates in patients with adenocarcinoma were similar to those in patients with squamous cell carcinoma.
These data expose limitations for the potential use of primary HPV testing. In addition, current screening guidelines recommending cotesting at 5-year intervals should be evaluated further with additional historic data collection because there are women with negative results for both Papanicolaou tests and hrHPV testing within the period of 3 to 5 years before an invasive carcinoma diagnosis.
持续性高危型人乳头瘤病毒（hrHPV）感染是宫颈癌及其前体病变发展的必要因素。高危型 HPV 检测在检测宫颈上皮病变方面比细胞学检测具有更高的敏感性。然而，一项来自单一机构的大型研究表明，31%的浸润性宫颈癌患者在诊断前 5 年内基线 hrHPV 检测呈阴性。
探讨 hrHPV 检测在检测浸润性宫颈癌中的局限性。
从多个机构检索 2012 年有组织学诊断为浸润性宫颈癌的病例。从这些记录中，记录了癌症诊断前 5 年内之前的 hrHPV 检测和巴氏涂片检测结果。
本研究共纳入 70 例宫颈癌患者。在癌症诊断前不到 1 年、1 至 3 年和 3 至 5 年的时间段内，HPV 检测结果阴性率分别为 9%（5/53）、23%（6/26）和 25%（2/8）。在相同的时间间隔内，巴氏涂片检测结果阴性率分别为 3.4%（2/59）、33%（10/30）和 40%（6/15）。尽管不同 HPV 检测方法的 HPV（-）率似乎不同，但由于样本量小，未检测到统计学意义。腺癌患者的 hrHPV 阴性率与鳞癌患者相似。
这些数据揭示了原发性 HPV 检测的潜在应用局限性。此外，由于在浸润性癌诊断前 3 至 5 年内有女性同时出现巴氏涂片检测和 hrHPV 检测结果为阴性，目前建议每 5 年进行一次联合检测的筛查指南应进一步结合更多的历史数据进行评估。
