Zhang J X, Zheng T P, Liu J, Wang Q X, Zhan Y X, Zhang Z Y
Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Jul 25;52(7):467-472. doi: 10.3760/cma.j.issn.0529-567X.2017.07.007.
To explore the value of histopathologic diagnosis after colposcopy for high-risk HPV16/18 positive patients with negative cytology or atypical squamous cells of undetermined significance (ASCUS) for early screening of cervical lesions. A retrospective study of cervical histopathologic diagnosis in the HPV16/18 positive patients received colposcopy evaluation before got the histology was carried out between January 2014 and January 2016. The cytology of the patients should be negative or ASCUS. A total of 337 patients with age from 21 to 65 years old were enrolled, including 214 patients with negative cytology, and 123 patients with ASCUS. (1) The results of pathology were as follows: 63 (18.7%) cases inflammation, 89 (26.4%) cases cervical intraepithelial neoplasia (CIN)Ⅰ, 182 (54.0%) cases CINⅡ-Ⅲ and adenocarcinoma in situ (AIS), and 3 (0.9%) cases minimal invasive cancer (stageⅠa1). The incidence of CINⅡ and above cervical lesions was higher in the patients with ASCUS (71.5%, 88/123) than that in the patients with negative cytology (45.3%, 97/214; χ(2)=24.876, 0.01), and it was higher in the patients with HPV16 positive (64.4%, 150/233) than that in the patients with HPV18 positive (30.3%, 27/89; χ(2)=31.388, 0.01). There was statistically significant difference among the different age group in which the patients of 20-29 years old was 69.3% (52/75), 30-39 years old was 55.1% (75/136), 40-49 years old was 44.8% (30/67) and 50 years old and above was 47.5% (28/59; χ(2)=16.512, 0.032). (2) Among the patients with negative cytology, the incidence of CINⅡ and above cervical lesions in the patients with HPV16 positive was higher than that in the patients with HPV18 positive [54.8% (80/146) vs 26.0% (20/77) ; χ(2)=16.930, 0.01]. The incidence was also higher in the patients with HPV16 positive than that in the patients with HPV18 positive [76.5% (78/102) vs 55.6% (15/27) ; χ(2)=4.642, 0.031] among the patients with ASCUS. (3) Compared to the patients diagnosed inflammation or CINⅠ, the patients diagnosed CINⅡ and above cervical lesions had higher infection rate of HPV16, lower infection rate of HPV18, higher incidence of ASCUS, and smaller parities (all 0.05). A multifactor analysis was carried out, the results showed that HPV16 positive and ASCUS might be independent risk factors to predict the incidence of CINⅡ and above cervical lesions (0.01) . The incidence of cervical precancerous lesions is high in the women with HPV16/18 infection. Patients with HPV16 infection are more likely to have the CINⅡ and above cervical lesions than patients with HPV18 infection. Patients with HPV16/18 infection are suggested to be directly transferred to clinic of colposcopy, and then getting the histology selectively, which would be help to early detection of the cervical precancerous lesions.
探讨阴道镜检查后组织病理学诊断对高危型人乳头瘤病毒16/18（HPV16/18）阳性、细胞学阴性或意义不明确的非典型鳞状细胞（ASCUS）患者早期筛查宫颈病变的价值。对2014年1月至2016年1月期间接受阴道镜评估且在获得组织学结果前HPV16/18阳性患者的宫颈组织病理学诊断进行回顾性研究。患者的细胞学检查应为阴性或ASCUS。共纳入337例年龄在21至65岁之间的患者，其中214例细胞学检查阴性，123例为ASCUS。（1）病理结果如下：63例（18.7%）为炎症，89例（26.4%）为宫颈上皮内瘤变（CIN）Ⅰ级，182例（54.0%）为CINⅡ - Ⅲ级和原位腺癌（AIS），3例（0.9%）为微小浸润癌（Ⅰa1期）。ASCUS患者中CINⅡ及以上宫颈病变的发生率（71.5%，88/123）高于细胞学检查阴性的患者（45.3%，97/214；χ² = 24.876，P < 0.01），HPV16阳性患者中该发生率（64.4%，150/233）高于HPV18阳性患者（30.3%，27/89；χ² = 31.388，P < 0.01）。不同年龄组之间差异有统计学意义，20 - 29岁患者为69.3%（52/75），30 - 39岁患者为55.1%（75/136），40 - 49岁患者为44.8%（30/67），50岁及以上患者为47.5%（28/59；χ² = 16.512，P = 0.032）。（2）在细胞学检查阴性的患者中，HPV16阳性患者CINⅡ及以上宫颈病变的发生率高于HPV18阳性患者[54.8%（80/146）对26.0%（20/77）；χ² = 16.930，P < 0.01]。在ASCUS患者中，HPV16阳性患者的发生率也高于HPV18阳性患者[76.5%（78/102）对55.6%（15/27）；χ² = 4.642，P = 0.031]。（3）与诊断为炎症或CINⅠ级的患者相比，诊断为CINⅡ及以上宫颈病变的患者HPV16感染率更高，HPV18感染率更低，ASCUS发生率更高，产次更少（均P < 0.05）。进行多因素分析，结果显示HPV16阳性和ASCUS可能是预测CINⅡ及以上宫颈病变发生率的独立危险因素（P < 0.01）。HPV16/18感染的女性宫颈癌前病变发生率较高。HPV16感染患者比HPV18感染患者更易发生CINⅡ及以上宫颈病变。建议HPV16/18感染患者直接转诊至阴道镜门诊，然后选择性地进行组织学检查，这有助于早期发现宫颈癌前病变。
