Wang Jiajian, Tian Qifang, Zhang Su, Lyu Liping, Dong Jie, Lyu Weiguo
Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
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Zhonghua Fu Chan Ke Za Zhi. 2015 Apr;50(4):253-7.
To explore the clinical significance of human papillomavirus L1 capsid protein detection in cervical exfoliated cells in high-risk HPV positive women.
From November 2012 to June 2013, 386 high-risk HPV positive (detected by hybrid capture II) cases were enrolled as eligible women from Huzhou Maternity & Child Care Hospital and Women's Hospital, School of Medicine, Zhejiang University. All eligible women underwent liquid-based cytology (ThinPrep) followed by colposcopy. Biopsies were taken if indicated. Cervical exfoliated cells were collected for HPV L1 capsid protein detection by immunocytochemistry. Expression of HPV L1 capsid protein in groups with different histological diagnosis were compared, and the role of HPV L1 capsid protein detection in cervical exfoliated cells in cervical lesions screening was accessed.
Total 386 enrolled eligible women were finally diagnosed histologically as follwed: 162 normal cervix, 94 low-grade squamous intraepithelial lesion (LSIL), 128 high-grade squamous intraepithelial lesion (HSIL) and 2 squamous cervical cancer (SCC). The positive expression rate of HPV L1 in HSIL+ (HSIL or worse) group was significantly lower than that in LSIL- (LSIL or better) group (19.2% vs 66.4%, P=0.000). While identifying HSIL+ in HPV positive cases and compared with cytology, HPV L1 detection resulted in significant higher sensitivity (80.77% vs 50.77%, P=0.000) and negative predictive value (NPV; 87.18% vs 76.47%, P=0.004), significant lower specificity (66.41% vs 81.25%, P=0.000), and comparable positive predictive value (PPV; 54.97% vs 57.89%, P=0.619). To identify HSIL+ in HPV-positive/cytology-negative women, the sensitivity, specificity, PPV, and NPV of HPV L1 detection were 87.50%, 61.54%, 41.18%, and 94.12% respectively, while 80.00%, 86.36%, 80.00% and 86.36% respectively in HPV-positive/atypical squamous cell of undetermined significance (ASCUS) women.
HPV L1 capsid detection in cervical exfoliated cells have a role in cervical lesions screening in high-risk HPV positive women, and may be a promising triage for high-risk HPV-positive/cytology-negative or ASCUS women.
探讨高危型人乳头瘤病毒（HPV）阳性女性宫颈脱落细胞中人乳头瘤病毒L1衣壳蛋白检测的临床意义。
选取2012年11月至2013年6月期间，来自浙江大学医学院附属妇产科医院及湖州市妇幼保健院的386例高危型HPV阳性（采用杂交捕获二代法检测）女性作为研究对象。所有入选女性均接受液基细胞学检查（ThinPrep），随后进行阴道镜检查。必要时取活检。收集宫颈脱落细胞，采用免疫细胞化学法检测HPV L1衣壳蛋白。比较不同组织学诊断组中HPV L1衣壳蛋白的表达情况，并评估宫颈脱落细胞中HPV L1衣壳蛋白检测在宫颈病变筛查中的作用。
386例入选女性最终组织学诊断结果如下：162例宫颈正常，94例低级别鳞状上皮内病变（LSIL），128例高级别鳞状上皮内病变（HSIL），2例宫颈鳞癌（SCC）。HSIL +（HSIL及更严重病变）组中HPV L1的阳性表达率显著低于LSIL -（LSIL及更轻病变）组（19.2% 对66.4%，P = 0.000）。在HPV阳性病例中鉴别HSIL +，与细胞学检查相比，HPV L1检测的灵敏度显著更高（80.77%对50.77%，P = 0.000），阴性预测值（NPV；87.18%对76.47%，P = 0.004）显著更低，特异性（66.41%对81.25%，P = 0.000）显著更低，阳性预测值（PPV；54.97%对57.89%，P = 0.619）相当。在HPV阳性/细胞学检查阴性的女性中鉴别HSIL +，HPV L1检测的灵敏度、特异性、PPV和NPV分别为87.50%、61.54%、41.18%和94.12%，而在HPV阳性/意义不明确的非典型鳞状细胞（ASCUS）女性中分别为80.00%、86.36%、80.00%和86.36%。
宫颈脱落细胞中HPV L1衣壳蛋白检测在高危型HPV阳性女性的宫颈病变筛查中具有一定作用，对于高危型HPV阳性/细胞学检查阴性或ASCUS女性可能是一种有前景的分流检查方法。
