Franquemont D W, Ward B E, Andersen W A, Crum C P
Department of Pathology, University of Virginia Health Sciences Center, Charlottesville 22908.
Am J Clin Pathol. 1989 Nov;92(5):577-82. doi: 10.1093/ajcp/92.5.577.
Certain human papillomavirus (HPV) types (such as type 16) have been linked to high-grade precancers and invasive carcinomas of the cervix. However, the accuracy with which morphologic characteristics will predict the presence and type of HPV infection is controversial. Three pathologists independently classified 102 consecutive cervical biopsies with the use of specific criteria and correlated their findings with the presence of HPV 11, 16, and 18 RNA sequences by in situ hybridization. Based on the presence and distribution of nuclear atypia, abnormal mitotic figures, and koilocytosis, biopsies were classified into borderline condyloma, condyloma, borderline cervical intraepithelial neoplasia (CIN) with koilocytotic atypia (CINK), and CIN. Two or more observers agreed on the diagnosis in 96% of cases. HPV 16-related sequences alone were detected in 0% of borderline condylomata, 17% of flat condylomata, 43% of borderline CINK, 67% of CINK, and 77% of CIN lesions. Other HPVs, including those producing signals with more than one probe, were present in 0, 50, 14, 9, and 0% of these lesions, respectively. The authors data suggest that consistent identification of HPV-related cervical disease requires the presence of specific cytologic changes. In the authors' series, when HPV-related disease is present, CIN is the most common lesion and most (71%) contain HPV 16-related nucleic acids. Thus, a high proportion (88%) of histologic abnormalities associated with HPV-16 could be distinguished as CIN by morphologic characteristics alone, and this distinction could be made by most observers.
某些人乳头瘤病毒（HPV）类型（如16型）已被证实与高级别癌前病变和宫颈癌浸润癌相关。然而，形态学特征预测HPV感染的存在及类型的准确性存在争议。三位病理学家采用特定标准对102例连续的宫颈活检标本进行独立分类，并通过原位杂交将他们的发现与HPV 11、16和18 RNA序列的存在情况进行关联。根据核异型性、异常有丝分裂象和挖空细胞的存在及分布情况，活检标本被分为边缘性湿疣、湿疣、伴有挖空细胞异型性的边缘性宫颈上皮内瘤变（CIN）（CINK）和CIN。96%的病例中两位或更多观察者对诊断达成一致。在边缘性湿疣中未检测到仅与HPV 16相关的序列，扁平湿疣中为17%，边缘性CINK中为43%，CINK中为67%，CIN病变中为77%。其他HPV，包括那些用不止一种探针产生信号的HPV，分别在这些病变的0%、50%、14%、9%和0%中存在。作者的数据表明，HPV相关宫颈疾病的一致识别需要特定细胞学改变的存在。在作者的系列研究中，当存在HPV相关疾病时，CIN是最常见的病变，且大多数（71%）含有HPV 16相关核酸。因此，高达88%的与HPV - 16相关的组织学异常仅凭形态学特征即可被区分为CIN，并且大多数观察者都能做出这种区分。
