Department of Pathology, Southern Jutland Hospital, Sønderborg, Denmark.
Acta Obstet Gynecol Scand. 2018 Jun;97(6):758-765. doi: 10.1111/aogs.13325. Epub 2018 Mar 5.
The purpose of this study was to determine the feasibility of human Papillomavirus (HPV) testing alone as a prognostic tool to predict recurrent disease within a three-year follow-up period after treatment for cervical intraepithelial neoplasia (CIN)2 .
Retrospectively, 128 women with histologically verified CIN2 who had a conization performed at Southern Jutland Hospital in Denmark between 1 January 2013 and 31 December 2013 were included. Histology, cytology and HPV test results were obtained for a three-year follow-up period.
4.7% (6/128) of the cases developed recurrent disease during follow-up. Of the cases without free margins, recurrent dysplasia was detected normal in 10.4% (5/48), whereas in the group with free margins it was 1.3% (1/80). The post-conization HPV test was negative in 67.2% (86/128) and Pap smear normal in 93.7% (120/128). Combining resection margins, cytology and HPV had sensitivity for prediction of recurrent dysplasia of 100%. Specificity was 45.8%, positive predictive value (PPV) 8.5% and negative predictive value (NPV) 100%. Using HPV test alone as a predictor of recurrent dysplasia gave a sensitivity of 83.3%, specificity 69.7%, PPV 11.9% and NPV 98.8%. Combining resection margin and HPV test had a sensitivity of 100%, specificity 45.9%, PPV 8.3% and NPV 100%.
HPV test at six months control post-conization gave an NPV of 98.8% and can be used as a solitary test to identify women at risk for recurrent disease three years after treatment for precursor lesions. Using both resection margin and HPV test had a sensitivity of 100% and NPV 100%. Adding cytology did not increase the predictive value.
本研究旨在确定人乳头瘤病毒（HPV）检测单独作为一种预后工具的可行性，以预测宫颈上皮内瘤变（CIN）2 治疗后三年内复发疾病。
回顾性纳入 2013 年 1 月 1 日至 2013 年 12 月 31 日期间在丹麦南日德兰医院接受宫颈锥切术的 128 例经组织学证实为 CIN2 的女性患者。对其进行了为期三年的随访，以获得组织学、细胞学和 HPV 检测结果。
随访期间，4.7%（6/128）的病例发生了复发疾病。在无游离边缘的病例中，10.4%（5/48）检测到复发的不典型增生，而在有游离边缘的病例中，该比例为 1.3%（1/80）。128 例患者中，67.2%（86/128）的患者在锥切术后 HPV 检测呈阴性，93.7%（120/128）的患者巴氏涂片正常。结合切缘、细胞学和 HPV 检查，对复发不典型增生的预测敏感性为 100%。特异性为 45.8%，阳性预测值（PPV）为 8.5%，阴性预测值（NPV）为 100%。单纯使用 HPV 检测作为复发不典型增生的预测因子，其敏感性为 83.3%，特异性为 69.7%，PPV 为 11.9%，NPV 为 98.8%。结合切缘和 HPV 检测的敏感性为 100%，特异性为 45.9%，PPV 为 8.3%，NPV 为 100%。
锥切术后 6 个月的 HPV 检测的 NPV 为 98.8%，可作为一种单独的检测方法，用于识别治疗前病变后三年内复发疾病的高危女性。同时使用切缘和 HPV 检测的敏感性为 100%，NPV 为 100%。增加细胞学检查并未增加预测值。
