Gosvig Camilla F, Huusom Lene D, Deltour Isabelle, Andersen Klaus K, Duun-Henriksen Anne Katrine, Madsen Ellen Merete, Petersen Lone K, Elving Lisbeth, Schouenbourg Lars, Iftner Angelika, Svare Edith, Iftner Thomas, Kjaer Susanne K
Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 2015 Apr;94(4):405-11. doi: 10.1111/aogs.12601. Epub 2015 Feb 27.
Adequate follow-up of women who have undergone conization for high-grade cervical lesions is crucial in cervical cancer screening programs. We evaluated the performance of testing for high-risk human papillomavirus (HPV) types, cytology alone, and combined testing in predicting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after conization.
Prospective cohort study.
Denmark.
667 women attending for conization.
Cervical specimens were collected during 2002-2006 at first visit after conization for cytological examination and Hybrid Capture 2 detection of high-risk HPV. The women were passively followed until 2 years after first follow-up visit by linkage to the nationwide Pathology Data Bank.
At first visit after conization (median time, 3.4 months), 20.4% were HPV-positive and 17.2% had atypical squamous intraepithelial lesions or more severe cytology (ASCUS+). The 2-year incidence of CIN2+ after conization was 3.6%. Sensitivity for detection of CIN2+ after conization was 81.0% [95% confidence interval (CI) 58.1-94.6] for positive cytology (ASCUS+ threshold) and 95.2% (95% CI 76.2-99.9) for HPV testing and for combined testing. Specificity of ASCUS+ cytology (85.2%; 95% CI 82.0-88.0) was higher than that of HPV testing (82.4%; 95% CI 79.0-85.4) and markedly higher than that of combined testing (73.2%; 95% CI 69.3-76.8). The margin status had no significant added value.
Testing for high-risk HPV three to four months after conization is more sensitive than ASCUS+ cytology for identifying women at risk for relapse of CIN2+ within 2 years. Further studies are needed to evaluate whether HPV testing could be a stand-alone test in follow up after conization.
在宫颈癌筛查项目中，对因高级别宫颈病变接受锥切术的女性进行充分随访至关重要。我们评估了高危型人乳头瘤病毒（HPV）检测、单纯细胞学检查以及联合检测在预测锥切术后宫颈上皮内瘤变2级或更严重病变（CIN2+）方面的性能。
前瞻性队列研究。
丹麦。
667名接受锥切术的女性。
2002年至2006年期间，在锥切术后首次就诊时采集宫颈标本，进行细胞学检查和高危型HPV的杂交捕获2检测。通过与全国病理数据库建立联系，对这些女性进行被动随访，直至首次随访后2年。
锥切术后首次就诊时（中位时间为3.4个月），20.4%的女性HPV呈阳性，17.2%的女性有非典型鳞状上皮内病变或更严重的细胞学异常（ASCUS+）。锥切术后2年CIN2+的发生率为3.6%。锥切术后检测CIN2+的敏感性，阳性细胞学检查（以ASCUS+为阈值）为81.0%[95%置信区间（CI）58.1 - 94.6]，HPV检测和联合检测为95.2%（95%CI 76.2 - 99.9）。ASCUS+细胞学检查的特异性（85.2%；95%CI 82.0 - 88.0）高于HPV检测（82.4%；95%CI 79.0 - 85.4），且显著高于联合检测（73.2%；95%CI 69.3 - 76.8）。切缘状态无显著附加价值。
锥切术后三到四个月进行高危型HPV检测，在识别2年内有CIN2+复发风险的女性方面比ASCUS+细胞学检查更敏感。需要进一步研究评估HPV检测在锥切术后随访中是否可作为独立检测方法。
