Chen Q, Du H, Wang C, Tang J L, Wu R F
Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, China.
Zhonghua Fu Chan Ke Za Zhi. 2018 Mar 25;53(3):172-177. doi: 10.3760/cma.j.issn.0529-567X.2018.03.006.
To explore the human papilomavirus (HPV) genotypes and epithelial thickness of invisible cervical intraepithelial neoplasia Ⅲ (CIN Ⅲ) under colposcopy. One hundred and sixty-nine biopsies from 93 patients with a final diagnosis of CIN Ⅲ were extracted from the Shenzhen cervical cancer screening trial Ⅱ (SHENCCAST Ⅱ) . The SHENCCAST Ⅱ was conducted from 2009 to 2010. All the cervical blocks from these patients were re-cut and placed on 6 slides, i.e. sandwich model, with the top and bottom sections being stained with HE, the top second be processed for other studies, 3 sections for HPV genotypes by matrix-assisted laser desorption ionization-time of flight-mass spectrometry (MALDI-TOF-MS) assay. The thickness of squamous epithelium of CIN Ⅲ was measured by a microscope (×10) after re-cut. Colposcope directed CIN Ⅲ biopsies positively was defined as visible CIN Ⅲ, while random CIN Ⅲ biopsies positively was defined as invisible CIN Ⅲ. HPV16 positivity was 37.2% (16/43) and 55.6% (70/126) between invisible and visible CIN Ⅲ biopsies, respectively (χ(2)=4.318, =0.038) . Forty-nine cases of the 93 CIN Ⅲ patients were HPV16 positive, while 44 of them non-HPV16 positive. The proportion of patients with ≥45 years of age for other non-HPV16 positive 40.9% (18/44) was significantly higher than that HPV16 positive 20.4% (10/49; χ(2)=4.630, =0.031) . Patients with HPV16 positive were more likely to have lesions ≥1 quadrant (χ(2)=7.786, =0.005) than other non-HPV16 positive. Compared the average epithelium thickness of invisible CIN Ⅲ tissue (140±12) μm, the average epithelium thickness of visible CIN Ⅲ tissue (161±9) μm was thicker. There was statistical difference between two groups (=4.383, =0.038). The mean average epithelial thickness of CIN Ⅲ with HPV16 positive (172±11) μm was thicker than that the mean average epithelial thickness of CIN Ⅲ with non-HPV16 positive (130±10) μm (=4.784, =0.031) . Invisible lesions is difficult to identify under colposcopy and is related to non-HPV16 positive, small lesion size and thinner squamous epithelium. For non-HPV16 positive or older women should be performed colposcope directed biopsies and randomly multi-sites biopsies by colopscopy, which may be helpful to improve the detection of CIN Ⅲ and to reduce miss diagnosis.
探讨阴道镜下不可见宫颈上皮内瘤变Ⅲ级（CINⅢ）的人乳头瘤病毒（HPV）基因型及上皮厚度。从深圳宫颈癌筛查试验Ⅱ（SHENCCASTⅡ）中提取93例最终诊断为CINⅢ患者的169份活检标本。SHENCCASTⅡ于2009年至2010年开展。将这些患者的所有宫颈组织块重新切片并置于6张载玻片上，即夹心模型，顶部和底部切片用苏木精-伊红（HE）染色，顶部第二层用于其他研究，3个切片用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF-MS）法检测HPV基因型。重新切片后，用显微镜（×10）测量CINⅢ鳞状上皮的厚度。阴道镜下活检阳性的CINⅢ定义为可见CINⅢ，而随机活检阳性的CINⅢ定义为不可见CINⅢ。不可见和可见CINⅢ活检标本中HPV16阳性率分别为37.2%（16/43）和55.6%（70/126）（χ²=4.318，P=0.038）。93例CINⅢ患者中49例HPV16阳性，44例非HPV16阳性。其他非HPV16阳性患者中≥45岁的比例为40.9%（18/44），显著高于HPV16阳性患者中的20.4%（10/49；χ²=4.630，P=0.031）。HPV16阳性患者比其他非HPV16阳性患者更易出现≥1个象限的病变（χ²=7.786，P=0.005）。不可见CINⅢ组织的平均上皮厚度为（140±12）μm，可见CINⅢ组织的平均上皮厚度为（161±9）μm，后者更厚。两组间有统计学差异（t=4.383，P=0.038）。HPV16阳性CINⅢ的平均上皮厚度为（172±11）μm，高于非HPV16阳性CINⅢ的平均上皮厚度（130±10）μm（t=4.784，P=0.031）。不可见病变在阴道镜下难以识别，且与非HPV16阳性、病变较小及鳞状上皮较薄有关。对于非HPV16阳性或年龄较大的女性，应进行阴道镜引导下活检及阴道镜多点随机活检，这可能有助于提高CINⅢ的检出率并减少漏诊。
