Lyons Yasmin A, Kamat Aparna A, Zhou Haijun, Mody Dina R, Schwartz Mary R, Hobday Christopher, Ge Yimin
Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas.
Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
Cancer Cytopathol. 2015 Jul;123(7):435-42. doi: 10.1002/cncy.21549. Epub 2015 Apr 22.
The current management strategy for women with low-grade squamous intraepithelial lesions (LSILs) is inefficient and expensive because of the inability to identify patients at high risk for disease progression. The current study was designed to determine the genotypic patterns of human papillomavirus (HPV) associated with the persistence and progression of cervical lesions in women with an initial interpretation of LSIL.
One hundred sixty-seven women with LSIL on Papanicolaou tests collected between December 1, 2009 and March 30, 2011 were studied. HPV DNA was extracted from residual SurePath specimens, genotypes were determined with a DNA microarray containing 40 HPV genotype probes, and microarray data were confirmed by sequencing. Follow-up Papanicolaou tests and/or biopsies were performed within a 20- to 46-month period after the initial diagnosis.
Ninety-seven of the 167 cases with follow-up results were included in the study. Compared with the women with a regressed cervical lesion, those with a persistent cervical lesion (PCL) were significantly more commonly infected with high-risk human papillomavirus (HR-HPV) genotypes (P < .01) and particularly with non-16/18 HR-HPV genotypes (P < .05). The PCL group also had a significantly higher average number of HR-HPV genotypes and non-16/18 HPV genotypes per specimen (P < .01). Infection with HPV-16/18 genotypes was not significantly associated with the persistence or progression of cervical lesions.
Infection with non-16/18 HR-HPV genotypes but not with HPV-16/18 genotypes was a strong predictor of the persistence and progression of cervical disease upon follow-up. Genotyping solely for HPV-16/18 would miss the majority of patients with LSIL who progress to high-grade squamous intraepithelial lesions. Pooled HR-HPV tests provide a better predictive value than HPV-16/18 genotyping alone in guiding the clinical management of patients with LSIL.
由于无法识别疾病进展高危患者，目前针对低度鳞状上皮内病变（LSIL）女性的管理策略效率低下且成本高昂。本研究旨在确定与初始诊断为LSIL的女性宫颈病变持续存在和进展相关的人乳头瘤病毒（HPV）基因型模式。
对2009年12月1日至2011年3月30日期间收集的167例巴氏试验结果为LSIL的女性进行研究。从剩余的SurePath标本中提取HPV DNA，使用包含40种HPV基因型探针的DNA微阵列确定基因型，并通过测序确认微阵列数据。在初次诊断后的20至46个月内进行随访巴氏试验和/或活检。
167例中有随访结果的97例纳入研究。与宫颈病变消退的女性相比，宫颈病变持续存在（PCL）的女性感染高危人乳头瘤病毒（HR-HPV）基因型的情况更为常见（P <.01），尤其是感染非16/18 HR-HPV基因型（P <.05）。PCL组每个标本的HR-HPV基因型和非16/18 HPV基因型的平均数量也显著更高（P <.01）。HPV-16/18基因型感染与宫颈病变的持续存在或进展无显著关联。
随访时，感染非16/18 HR-HPV基因型而非HPV-16/18基因型是宫颈疾病持续存在和进展的有力预测指标。仅对HPV-16/18进行基因分型会遗漏大多数进展为高级别鳞状上皮内病变的LSIL患者。在指导LSIL患者的临床管理方面，联合HR-HPV检测比单独的HPV-16/18基因分型具有更好的预测价值。
