Lertvutivivat Supapen, Chanthasenanont Athita, Chanthasenanont Athita, Muangto Teerapat, Nanthakomon Tongta, Pongrojpaw Densak, Bhamarapravatana Kornkarn, Suwannarurk Komsun
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital, Bangkok, Thailand E-mail :
Asian Pac J Cancer Prev. 2016;17(9):4353-4356.
To study the prevalence of CIN2+ diagnosis in women with atypical Papaniculoau (Pap) smears to suggest appropriate management option for Thai health care.
Data from all patients with liquid based cytology with human papillomavirus (HPV) testing between May 2013 - May 2016 were collected from medical records. Women with atypical cervical Pap smears were recruited. Results for age, HPV testing, HPV 16, 18, 45 and other genotypes tested, colposcopic examination and histopathological assessment were all collected. Atypical smears were defined as atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot be exclude high grade squamous intraepithelial lesion (ASC-H).
A total of 2,144 cases were recruited. Twenty six women with ASC-US on cytology had high risk (HR) HPV detection while eight cases with ASC-H had HR-HPV (40.0% VS 72.7%, p=0.005). Among the 26 women with ASC-US cytology and positive HR-HPV, HPV type 16 (n=8, 30.8%), type 18 (n=1, 3.8%), type 45 (n=1, 3.8%) and other HPV types (n=17, 65.4%) were found. Eight women with ASC-H and positive HR-HPV demonstrated type 16 (n=6, 75%) and other HPV types (n=2, 25%). Fifty seven women with ASC-US had normal colposcopy, CIN1 and CIN2+ at percentages of 80.7 (46/57), 14.0 (8/57) and 5.3 (3/57), respectively. In the ASC-H group, 7 out of 10 women had normal colposcopy and three (30%) had CIN2+ results.
In women with ASC-US cytology, immediate colposcopy is highly recommended. HPV testing can be performed if colposcopy is not an available option because there was high prevalence (5.3%) of CIN2+ in our findings. ASCCP recommendations for ASC-H that colposcopy should be performed on all ASC-H cases regardless of HPV result are thereby supported by the findings of this investigation.
研究非典型巴氏涂片女性中CIN2+诊断的患病率，以为泰国医疗保健提出合适的管理方案。
收集2013年5月至2016年5月间所有进行了人乳头瘤病毒（HPV）检测的液基细胞学检查患者的病历数据。招募非典型宫颈巴氏涂片的女性。收集年龄、HPV检测结果、检测的HPV 16、18、45及其他基因型、阴道镜检查和组织病理学评估结果。非典型涂片定义为意义不明确的非典型鳞状细胞（ASC-US）和不能排除高级别鳞状上皮内病变的非典型鳞状细胞（ASC-H）。
共招募了2144例病例。26例细胞学检查为ASC-US的女性检测到高危（HR）HPV，而8例ASC-H的病例检测到HR-HPV（40.0%对72.7%，p=0.005）。在26例细胞学检查为ASC-US且HR-HPV阳性的女性中，发现HPV 16型（n=8，30.8%）、18型（n=1，3.8%）、45型（n=1，3.8%）和其他HPV类型（n=17，65.4%）。8例ASC-H且HR-HPV阳性的女性显示为16型（n=6，75%）和其他HPV类型（n=2，25%）。57例ASC-US的女性阴道镜检查正常、CIN1和CIN2+的比例分别为80.7%（46/57）、14.0%（8/57）和5.3%（3/57）。在ASC-H组中，10名女性中有7名阴道镜检查正常，3名（30%）有CIN2+结果。
对于细胞学检查为ASC-US的女性，强烈建议立即进行阴道镜检查。如果无法进行阴道镜检查，可以进行HPV检测，因为我们的研究结果显示CIN2+的患病率较高（5.3%）。本研究结果支持了美国阴道镜及宫颈病理学会（ASCCP）对ASC-H的建议，即无论HPV结果如何，所有ASC-H病例均应进行阴道镜检查。
