感染艾滋病毒的非洲女性的宫颈上皮内瘤变（CIN）：在HARP研究终点确定中，一组病理学家进行严格组织病理学审查的作用和影响

Cervical intraepithelial neoplasia (CIN) in African women living with HIV: role and effect of rigorous histopathological review by a panel of pathologists in the HARP study endpoint determination.

作者信息

Doutre Sylviane, Omar Tanvier, Goumbri-Lompo Olga, Kelly Helen, Clavero Omar, Zan Souleymane, Chikandiwa Admire, Sawadogo Bernard, Delany-Moretlwe Sinead, Costes Valérie, Mayaud Philippe, Segondy Michel

机构信息

Department of Biology and Pathology, University Hospital (CHU), Montpellier, France.

Department of Pathology, National Health Laboratory Services Johannesburg, South Africa.

出版信息

J Clin Pathol. 2018 Jan;71(1):40-45. doi: 10.1136/jclinpath-2017-204512. Epub 2017 Jun 9.

DOI:10.1136/jclinpath-2017-204512

PMID:28600294

Abstract

AIMS

To analyse the effect of the expert end-point committee (EPC) review on histological endpoint classification of cervical intraepithelial neoplasia (CIN).

METHODS

A cohort of women living with HIV were recruited in Burkina Faso (BF) and South Africa (SA) and followed over 18 months. Four-quadrant cervical biopsies were obtained in women with abnormalities detected by at least one screening test. A central review by a panel of five pathologists was organised at baseline and at endline.

RESULTS

At baseline the prevalence of high-grade CIN (CIN2+) was 5.1% (28/554) in BF and 23.3% (134/574) in SA by local diagnosis, and 5.8% (32/554) in BF and 22.5% (129/574) in SA by the EPC. At endline the prevalence of CIN2+ was 2.3% (11/483) in BF and 9.4% (47/501) in SA by local diagnosis, and 1.4% (7/483) in BF and 10.2% (51/501) in SA by EPC. The prevalence of borderline CIN1/2 cases was 2.8% (32/1128) and 0.8% (8/984) at baseline and endline. Overall agreement between local diagnosis and final diagnosis for distinguishing CIN2+ from ≤CIN1 was 91.2% (κ=0.82) and 88.9% (κ=0.71) for BF at baseline and endline, and 92.7% (κ=0.79) and 98.7% (κ=0.97) for SA at baseline and endline. Among the CIN1/2 cases, 12 (37.5%) were graded up to CIN2 and 20 (62.5%) were graded down to CIN1 at baseline, and 3 (37.5%) were graded up to CIN2 and 5 (62.5%) were graded down to CIN1 at endline.

CONCLUSIONS

This study highlights the importance of a centralised rigorous re-reading with exchange of experiences among pathologists from different settings.

摘要

目的

分析专家终点委员会（EPC）审查对宫颈上皮内瘤变（CIN）组织学终点分类的影响。

方法

在布基纳法索（BF）和南非（SA）招募了一组感染艾滋病毒的女性，并对其进行了18个月的随访。对至少一项筛查试验检测出异常的女性进行宫颈四象限活检。在基线和终线时组织了由五名病理学家组成的小组进行集中审查。

结果

在基线时，通过当地诊断，BF的高级别CIN（CIN2+）患病率为5.1%（28/554），SA为23.3%（134/574）；通过EPC审查，BF为5.8%（32/554），SA为22.5%（129/574）。在终线时，通过当地诊断，BF的CIN2+患病率为2.3%（11/483），SA为9.4%（47/501）；通过EPC审查，BF为1.4%（7/483），SA为10.2%（51/501）。临界CIN1/2病例在基线和终线时的患病率分别为2.8%（32/1128）和0.8%（8/984）。在BF，基线和终线时区分CIN2+与≤CIN1的当地诊断与最终诊断之间的总体一致性分别为91.2%（κ=0.82）和88.9%（κ=0.71）；在SA，基线和终线时分别为92.7%（κ=0.79）和98.7%（κ=0.97）。在CIN1/2病例中，基线时有12例（37.5%）升级为CIN2，20例（62.5%）降级为CIN1；终线时有3例（37.5%）升级为CIN2，5例（62.5%）降级为CIN1。