Alanbay İbrahim, Öztürk Mustafa, Fıratlıgil Fahri Burçin, Karaşahin Kazım Emre, Yenen Müfit Cemal, Bodur Serkan
Etimesgut Military Hospital, Department of Obstetrics and Gynecology, Etlik-Ankara, Turkey.
Ginekol Pol. 2017;88(5):235-238. doi: 10.5603/GP.a2017.0044.
Discrepancies between abnormal cervical cytology or high-risk human papillomavirus (HR-HPV) status (cytolo-gy negative/HPV positive) and subsequent histological findings are a common occurrence. After using co-testing, the dis-crepancies between the HR-HPV status and cervical cytology have become an issue. In this study, we aimed to determine the characteristics of women with a discrepancy between histology and cytology/HR-HPV status, in terms of diagnosis, review and identification.
A total of 52 women, patients of the University Hospital between 2013-2015, with cytohistologi-cal or HR-HPV status discrepancy were recruited for the study and retrospectively analyzed. The cytological samples were liquid-based Pap smears, classified according to the 2001 Bethesda system. The HR-HPV status was identified using the Hybrid Capture 2 HR-HPV DNA assay. The histological samples were obtained by cervical biopsy as well as large loop exci-sion of the transformation zone (LLETZ).
A cytohistological discrepancy was demonstrated in patients with (-)cytology/HR-HPV(+), ASCUS, LSIL, ASC-H, HSIL, AGC-NOS: 17.3%, 23.07%, 26.9%, 9.5%, 17.3% and 5.7%, respectively. When the degree of atypia in cytology increases, the concurrency of cervical cytology with biopsy also increases. A positive HR-HPV co-test result (19/24, 79.1%) was observed in nearly all CIN2 ≥ (+) cases. Our study emphasizes the significance of HR-HPV testing to determine CIN2 ≥ (+) cases, even in the presence of a normal cytological result.
In case of cytohistological or HR-HPV discrepancies, a careful review of the HR-HPV status and the degree of cytological atypia should be performed before further intervention.
宫颈细胞学异常或高危型人乳头瘤病毒（HR-HPV）状态（细胞学阴性/HPV阳性）与后续组织学检查结果之间的差异很常见。采用联合检测后，HR-HPV状态与宫颈细胞学之间的差异成为一个问题。在本研究中，我们旨在确定在组织学与细胞学/HR-HPV状态存在差异的女性患者在诊断、复查及识别方面的特征。
本研究招募了2013年至2015年间大学医院的5例组织学与细胞学或HR-HPV状态存在差异的女性患者，并进行回顾性分析。细胞学样本为液基巴氏涂片，根据2001年贝塞斯达系统进行分类。采用杂交捕获2代HR-HPV DNA检测法确定HR-HPV状态。组织学样本通过宫颈活检以及转化区大环形切除术（LLETZ）获取。
在细胞学（-）/HR-HPV（+）、不典型鳞状细胞（ASCUS）、低度鳞状上皮内病变（LSIL）、不典型鳞状细胞不能明确意义但高度怀疑为HSIL（ASC-H）、高度鳞状上皮内病变（HSIL）、非特异性非典型腺细胞（AGC-NOS）患者中，组织学与细胞学差异分别为17.3%、23.07%、26.9%、9.5%、17.3%和5.7%。随着细胞学不典型程度增加，宫颈细胞学与活检结果的一致性也增加。几乎所有CIN2及以上（+）病例中均观察到HR-HPV联合检测结果为阳性（19/24，79.1%）。我们的研究强调了HR-HPV检测对于确定CIN2及以上（+）病例的重要性，即使细胞学结果正常。
在组织学与细胞学或HR-HPV存在差异的情况下，进一步干预前应仔细复查HR-HPV状态及细胞学不典型程度。
