Fakhreldin Marwa, Elmasry Karim
Department of Obstetrics and Gynecology, Corniche Hospital, Abu Dhabi, United Arab Emirates.
Department of Obstetrics and Gynecology, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
Vaccine. 2016 Feb 3;34(6):823-30. doi: 10.1016/j.vaccine.2015.12.011. Epub 2015 Dec 30.
Cervical cancer is the second commonest cancer in women worldwide. Infection with oncogenic types of human Papillomavirus (HPV) is the most important risk factor for developing cervical cancer. Reflex High risk HPV (HR-HPV) testing is of significant value in the assessment of Papanicolaou (Pap) smear results where ASCUS are identified.
To improve the performance of reflex HR-HPV testing in triage of ASCUS and analyze the factors impacting it.
In this study, we generated a database of 9641 women who had cervical smears collected during the study period from the cytopathology record in a large tertiary hospital in UAE. These included 297 smears with ASCUS diagnosis. All cases were retrospectively followed up with a mean duration of 2.44 years. We analyzed data according to the outcome based on several follow-up Pap smear analysis as the reference assessment.
We detected HR-HPV infection in 17.9% of cases. 9.1% <25, 28.8% 25-34 and 62.1% ≥35 years old. HR-HPV prevalence was higher among premenopausal women (20.7%) compared to postmenopausal women (9.5%) (P-value=0.044). The rate of progression to high grade lesions was also higher (28.7%) in the premenopausal group compared to (12.8%) in the postmenopausal group. Reflex HPV testing had an overall sensitivity of 41.1%, specificity of 88.2%, positive predictive value (PPV) of 62.1%, and negative predictive value (NPV) of 75.9% in detection of cervical lesions. These figures were higher on combining premenopausal status and complaint of abnormal bleeding or discharge/itching (66.7%, 93.3%, 66.8% and 93.3% respectively).
The sensitivity, specificity and NPV of reflex HPV testing in the triage of ASCUS cases can be more accurate in premenopausal women upon adding age group and presenting complaint as a triage item. This improves the performance of reflex HPV testing and the subsequent selection of high risk patients for colposcopy.
宫颈癌是全球女性中第二常见的癌症。感染致癌型人乳头瘤病毒（HPV）是患宫颈癌最重要的风险因素。在对巴氏涂片检查结果为非典型鳞状细胞意义不明确（ASCUS）的情况进行评估时，反射性高危型HPV（HR-HPV）检测具有重要价值。
提高反射性HR-HPV检测在ASCUS分流中的性能，并分析影响其的因素。
在本研究中，我们从阿联酋一家大型三级医院的细胞病理学记录中生成了一个数据库，其中包含在研究期间接受宫颈涂片检查的9641名女性。这些病例包括297例诊断为ASCUS的涂片。所有病例均进行了回顾性随访，平均随访时间为2.44年。我们根据基于多次随访巴氏涂片分析的结果作为参考评估来分析数据。
我们在17.9%的病例中检测到HR-HPV感染。年龄<25岁的占9.1%，25-34岁的占28.8%，≥35岁的占62.1%。绝经前女性的HR-HPV患病率（20.7%）高于绝经后女性（9.5%）（P值=0.044）。绝经前组进展为高级别病变的比率（28.7%）也高于绝经后组（12.8%）。反射性HPV检测在检测宫颈病变方面的总体敏感性为41.1%，特异性为88.2%，阳性预测值（PPV）为62.1%，阴性预测值（NPV）为75.9%。将绝经前状态与异常出血或分泌物/瘙痒主诉相结合时，这些数字更高（分别为66.7%、93.3%、66.8%和93.3%）。
在ASCUS病例分流中，将年龄组和就诊主诉作为分流项目加入后，反射性HPV检测在绝经前女性中的敏感性、特异性和NPV可能更准确地。这提高了反射性HPV检测的性能以及随后对高危患者进行阴道镜检查的选择。
