Institut Alfred Fournier, Paris, France.
J Low Genit Tract Dis. 2000 Apr;4(2):108-13.
To evaluate the performance of HPV testing in identifying cervical neoplasia.
Minor cytologic atypia of the uterine cervix, particularly atypical squamous cells of undetermined significance (ASCUS) represent a vast group, at least three times more frequent than cytologic high-grade squamous intraepithelial lesions (HGSIL). Even though, individually, ASCUS smears correspond to a normal cervix in nearly 80% of cases, their marked prevalence in the screened population suggests that this category of smear is one of the main sources of histologically confirmed high-grade SIL.The recent recommendations by the National Agency of Accreditation and Evaluation (ANAES) for managing ASCUS smears indicate that it is possible to advise a follow-up smear at regular intervals or immediate colposcopy. The follow-up smear option has limitations related to its incomplete sensitivity (25-40% of existing high-grade SIL can go unrecognized). Colposcopy has optimal sensitivity in recognizing high-grade lesions, but falls short due to lack of specificity.The Hybrid Capture (HC II) (Digene, Silver Spring, MD) test is an objective and reproducible test that makes it possible to detect nononcogenic and oncogenic types of human papillomavirus (HPV) and the DNA viral load, thereby increasing the probability that significant cervical lesions will not go unrecognized.
The Hybrid Capture test is simple to perform and positive results for high-risk HPV strongly correlate with the presence of high-grade CIN (sensitivity of approximately 98%). The test's nearly 100% negative predictive value makes it possibly to fully reassure patients who have had an ASCUS smear, freeing them from regular cytologic follow-up, colposcopy, and biopsy. A Hybrid Capture II test that is positive for oncogenic HPV significantly increases the probability of recognizing significant, precancerous cervical lesions. When the reference smear has been done in a liquid suspension, the Hybrid Capture test can be done on the residual cells in the suspension, thereby avoiding an additional visit.
Recent French and international evaluations and publications should encourage the ANAES task force to propose the HPV test as a possible option for managing smears with minor atypia.▪.
评估 HPV 检测在识别宫颈癌前病变中的性能。
子宫颈的轻度细胞学不典型性，特别是非典型鳞状细胞意义不明确（ASCUS），代表了一个广泛的群体，至少比细胞学高级别鳞状上皮内病变（HGSIL）常见三倍。尽管如此，ASCUS 涂片在近 80%的情况下对应于正常宫颈，但在筛查人群中的明显高发率表明，这种涂片类别是组织学证实的高级别 SIL 的主要来源之一。最近，法国国家认可和评估机构（ANAES）对管理 ASCUS 涂片的建议表明，可以建议定期进行随访涂片或立即行阴道镜检查。随访涂片的选择存在局限性，因为其不完全敏感（存在的高级别 SIL 中 25-40%可能无法识别）。阴道镜检查在识别高级别病变方面具有最佳的敏感性，但由于特异性不足而存在局限性。杂交捕获（HC II）（Digene，Silver Spring，MD）检测是一种客观和可重复的检测方法，可检测非致癌和致癌型人乳头瘤病毒（HPV）以及病毒 DNA 载量，从而增加识别重要宫颈病变的可能性。
杂交捕获检测易于操作，高危型 HPV 阳性结果与高级别 CIN （约 98%的敏感性）的存在密切相关。该检测的近 100%阴性预测值使得可以充分安慰患有 ASCUS 涂片的患者，使他们免于定期细胞学随访、阴道镜检查和活检。杂交捕获 II 检测阳性的致癌 HPV 显著增加了识别重要的癌前宫颈病变的可能性。当参考涂片以液体悬浮液形式进行时，可以在悬浮液中的残留细胞上进行杂交捕获检测，从而避免额外的就诊。
最近的法国和国际评估和出版物应鼓励 ANAES 工作组提出 HPV 检测作为管理轻度不典型涂片的可能选择。
