Tao Xiang, Griffith Christopher C, Zhou Xiangrong, Wang Zhiheng, Yan Yabin, Li Zaibo, Zhao Chengquan
Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Pathology, Magee-Womens Hospital of UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Cancer Cytopathol. 2015 Jul;123(7):421-7. doi: 10.1002/cncy.21545. Epub 2015 May 8.
Current cervical cancer screening guidelines recommend screening with a Papanicolaou (Pap) test or by cotesting (Pap and human papillomavirus [HPV]). Given the importance of high-risk HPV (hrHPV) infection in the development of cervical cancer, some studies are now suggesting the use of primary hrHPV testing as a possible screening modality. To gain further insight into the role of both Pap testing and hrHPV testing, the authors examined prior screening results in a population of Chinese patients with invasive cervical carcinoma.
Cases with a histologic diagnosis of invasive cervical carcinoma were retrieved from the Obstetrics and Gynecology Hospital of Fudan University from January 2011 to October 2014. Prior hrHPV testing and Pap test results within 3 years before the cancer diagnosis were recorded.
Of 3714 patients with invasive cervical carcinoma, over a 46-month period, 525 had prior hrHPV testing using Hybrid Capture 2 within 3 years and 238 patients had Pap cytology testing within 1 year before the histological diagnosis. Within the 1-year period before diagnosis, the overall hrHPV-negative rate was 15.5% (74 of 477 patients) and the Pap-negative rate was also 15.5% (37 of 238 patients). Only 9 of 231 patients with both hrHPV testing and Pap testing (3.9%) had a double-negative result. Compared with squamous cell carcinoma, adenocarcinoma has significantly higher rates of prior negative results with both hrHPV and Pap cytology.
The results of the current study demonstrated prior results of hrHPV testing and Pap cytology in a population of women in China who had not undergone intensive prior screening. Both hrHPV testing and Pap cytology were found to have similar negative rates in this population and, not surprisingly, there were fewer women who had negative testing results using both testing modalities.
目前的宫颈癌筛查指南推荐采用巴氏涂片检查或联合检测（巴氏涂片与人乳头瘤病毒[HPV]检测）。鉴于高危型HPV（hrHPV）感染在宫颈癌发生中的重要性，一些研究现建议将hrHPV初筛作为一种可能的筛查方式。为了进一步深入了解巴氏涂片检查和hrHPV检测的作用，作者研究了一组中国浸润性宫颈癌患者之前的筛查结果。
从复旦大学附属妇产科医院检索2011年1月至2014年10月间组织学诊断为浸润性宫颈癌的病例。记录癌症诊断前3年内的hrHPV检测和巴氏涂片检查结果。
在3714例浸润性宫颈癌患者中，在46个月期间，525例在癌症诊断前3年内曾使用第二代杂交捕获法进行hrHPV检测，238例在组织学诊断前1年内进行了巴氏细胞学检查。在诊断前1年内，hrHPV总体阴性率为15.5%（477例患者中的74例），巴氏涂片阴性率也为15.5%（238例患者中的37例）。在231例同时进行hrHPV检测和巴氏涂片检查的患者中，只有9例（3.9%）结果均为阴性。与鳞状细胞癌相比，腺癌患者hrHPV和巴氏细胞学检查的既往阴性率显著更高。
本研究结果展示了中国一组未接受过密集筛查的女性人群中hrHPV检测和巴氏细胞学检查的既往结果。在该人群中，hrHPV检测和巴氏细胞学检查的阴性率相似，而且，不出所料，两种检测方法结果均为阴性的女性较少。
