宫颈癌筛查项目中的细胞学和高危型人乳头瘤病毒检测：一所学术机构的3年随访结果

Cytology and high risk HPV testing in cervical cancer screening program: Outcome of 3-year follow-up in an academic institute.

作者信息

Yang Jack, Nolte Fredrick S, Chajewski Olga S, Lindsey Kathryn G, Houser Patricia M, Pellicier Jalidsa, Wang Qun, Ehsani Laleh

机构信息

The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina.

出版信息

Diagn Cytopathol. 2018 Jan;46(1):22-27. doi: 10.1002/dc.23843. Epub 2017 Oct 19.

DOI:10.1002/dc.23843

PMID:29048733

Abstract

BACKGROUND

Combination of cervical cytology and high-risk human papillomavirus (HR-HPV) testing, co-testing, has been increasingly used in screening cervical cancers. The present study summarized the outcome of co-testing by reviewing 3-year clinical and pathological follow-up information.

METHODS

Patients were retrospectively identified via computerized search and were grouped based on the cytologic diagnosis and HR-HPV status as negative for intraepithelial lesion or malignancy (NILM)/HPV-, NILM/HPV+, atypical squamous cells of undetermined significance (ASC-US)/HPV-, ASC-US/HPV+, low grade squamous intraepithelial lesion (LSIL)/HPV-, LSIL/HPV+, atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion (ASC-H)/HPV-, ASC-H/HPV+, high grade squamous intraepithelial lesion (HSIL)/HPV-, and HSIL/HPV+. The patients' pertinent past medical history and follow-up information were analyzed.

RESULTS

During 3-year follow-up period, histologically proven HSIL was found in 5 of 1565 (0.3%) patients with NILM/HPV-, 7 of 141 (5.0%) with NILM/HPV+, 2 of 502 (0.4%) with ASC-US/HPV-, 30 of 274 (10.9%) with ASC-US/HPV+, 1 of 81 (1.2%) with LSIL/HPV-, 28 of 159 (17.6%) with LSIL/HPV+, 3 of 18 (16.7%) with ASC-H/HPV-, 34 of 69 (49.3%) with ASC-H/HPV+, 7 of 7 (100%) with HSIL/HPV-, and 35 of 56 (62.5%) HSIL/HPV+. In reviewing 12 HSIL cases that were originally diagnosed as NILM, 7 remained as NILM, and the other 5 were reclassified as 1 HSIL, 1 ASC-H, and 3 ASC-US, respectively. In 18 HSIL cases with negative HR-HPV, 12 patients had a prior history of positive HR-HPV testing and/or positive p16 IHC stain in the follow-up cervical biopsy.

CONCLUSION

HR-HPV testing plays an important role in cervical cancer screening by identifying HSIL in patients with ASC-US, LSIL, and NILM. Co-testing is an optimal method to identifying the patients with higher risk for developing cervical abnormalities.

摘要

背景

宫颈细胞学检查与高危型人乳头瘤病毒（HR-HPV）检测相结合的联合检测，已越来越多地用于宫颈癌筛查。本研究通过回顾3年的临床和病理随访信息，总结了联合检测的结果。

方法

通过计算机检索对患者进行回顾性识别，并根据细胞学诊断和HR-HPV状态进行分组，分为上皮内病变或恶性肿瘤阴性（NILM）/HPV-、NILM/HPV+、意义不明确的非典型鳞状细胞（ASC-US）/HPV-、ASC-US/HPV+、低级别鳞状上皮内病变（LSIL）/HPV-、LSIL/HPV+、非典型鳞状细胞，不能排除高级别鳞状上皮内病变（ASC-H）/HPV-、ASC-H/HPV+、高级别鳞状上皮内病变（HSIL）/HPV-和HSIL/HPV+。分析患者的相关既往病史和随访信息。

结果

在3年的随访期间，1565例NILM/HPV-患者中有5例（0.3%）经组织学证实为HSIL，141例NILM/HPV+患者中有7例（5.0%），502例ASC-US/HPV-患者中有2例（0.4%），274例ASC-US/HPV+患者中有30例（10.9%），81例LSIL/HPV-患者中有1例（1.2%），159例LSIL/HPV+患者中有28例（17.6%），18例ASC-H/HPV-患者中有3例（16.7%），69例ASC-H/HPV+患者中有34例（49.3%），7例HSIL/HPV-患者中有7例（100%），56例HSIL/HPV+患者中有35例（62.5%）。在回顾最初诊断为NILM的12例HSIL病例时，7例仍为NILM，另外5例分别重新分类为1例HSIL、1例ASC-H和3例ASC-US。在18例HR-HPV阴性的HSIL病例中，12例患者在后续宫颈活检中有HR-HPV检测阳性和/或p16免疫组化染色阳性的既往史。