Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, N6A 5C1, ON, Canada.
Department of Otolaryngology-Head and Neck Surgery, Victoria Hospital B3-400, 800 Commissioners Rd E, London, N6A 5W9, ON, Canada.
J Otolaryngol Head Neck Surg. 2018 Jan 30;47(1):8. doi: 10.1186/s40463-018-0255-1.
HPV-related head and neck cancer rates have been increasing in recent years, with the tonsils being the most commonly affected site. However, the current rate of HPV infection in the pediatric population remains poorly defined. The objective of this study was to systematically review and evaluate the prevalence and distribution of HPV in the tonsils of pediatric patients undergoing routine tonsillectomy.
The literature was searched using PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and ProQuest Dissertations & Theses Global databases (inception to December 2017) by two independent review authors. Inclusion criteria included articles which evaluated the prevalence of HPV in a pediatric cohort without known warts or recurrent respiratory papillomatosis, those which used tonsil biopsy specimens for analysis, and those with six or more subjects and clear outcomes reported. Eleven studies met the inclusion criteria. Using the Oxford Clinical Evidence-based Medicine (OCEBM) guidelines, two reviewers appraised the level of evidence of each study, extracted data, and resolved discrepancies by consensus. The systematic review identified 11 articles (n = 2520). Seven studies detected HPV in the subject population, with prevalence values ranging from 0 to 21%. The level of evidence for all included studies was OCEBM Level 3.
HPV may be present in pediatric tonsillectomy specimens; however, the largest included study demonstrated a prevalence of 0%. Future testing should be performed using methods with high sensitivities and specificities, such as reverse transcript real-time PCR or digital droplet PCR.
近年来，HPV 相关的头颈部癌症发病率不断上升，扁桃体是最常受影响的部位。然而，目前儿童人群中 HPV 感染的发生率仍未得到明确界定。本研究的目的是系统地回顾和评估行常规扁桃体切除术的儿科患者扁桃体中 HPV 的流行率和分布情况。
两名独立的审查作者使用 PubMed、EMBASE、Scopus、CINAHL、 Cochrane 图书馆和 ProQuest Dissertations & Theses Global 数据库（从创建到 2017 年 12 月）检索文献。纳入标准包括评估无已知疣或复发性呼吸道乳头瘤病的儿科患者人群中 HPV 流行率的文章、使用扁桃体活检标本进行分析的文章，以及纳入 6 例或以上患者并有明确结局报道的文章。有 11 项研究符合纳入标准。两名审查者使用牛津临床循证医学（OCEBM）指南评估每项研究的证据水平，提取数据，并通过共识解决分歧。系统综述共确定了 11 篇文章（n=2520）。7 项研究在研究人群中检测到 HPV，流行率范围为 0 至 21%。所有纳入研究的证据水平均为 OCEBM 3 级。
HPV 可能存在于儿科扁桃体切除术标本中；然而，最大的纳入研究显示流行率为 0%。未来的检测应使用具有高灵敏度和特异性的方法进行，如逆转录实时 PCR 或数字液滴 PCR。
