Department of Pathology, University of Virginia, Charlottesville, Virginia.
Cancer Cytopathol. 2018 Aug;126(8):533-540. doi: 10.1002/cncy.22027. Epub 2018 Jul 5.
In situ hybridization for human papillomavirus (HPV) messenger RNA (HPV RNA ISH) recently was introduced as an ancillary tool in the diagnosis of cervical squamous intraepithelial lesions, and can aid in the distinction between low-grade squamous intraepithelial lesions (LSILs) versus reactive/negative biopsies. Prior work has shown that up to one-half of cases originally diagnosed as LSIL are reclassified as negative/reactive by expert consensus review of morphology, and negative HPV RNA ISH results most often correlate with an expert diagnosis of negative/reactive. Given that LSIL overdiagnoses on biopsy may result in the erroneous clinical impression that a cervical lesion has been sampled appropriately, the authors proposed that HPV RNA ISH can inform cytology-histology correlation for challenging LSIL biopsies.
A total of 92 cervical biopsies originally diagnosed as LSIL were reviewed by 3 gynecologic pathologists and reclassified based on consensus opinion of morphology. ISH was performed for high-risk and low-risk HPV E6/E7 mRNA. Prior/concurrent cytology results were collected.
Based on expert consensus morphologic review, 49% of biopsies (45 of 92 biopsies) originally diagnosed as LSIL were reclassified as negative, 6.5% (6 of 92 biopsies) were reclassified as high-grade squamous intraepithelial lesion, and 44.5% (41 of 92 biopsies) were maintained as LSIL. The majority of LSIL biopsies reclassified as negative (80%; 36 of 45 biopsies) were HPV RNA negative, whereas 93% of LSIL biopsies (39 of 41 biopsies) and 100% of high-grade squamous intraepithelial lesion biopsies were HPV RNA positive.
LSIL often is overdiagnosed by morphology on biopsy, potentially leading to the false impression that a lesion identified on cytology has been sampled. Performing RNA ISH on biopsies decreases histologic LSIL overdiagnosis, and potentially can prompt further sampling when there is cytology-histology discordance. Cancer (Cancer Cytopathol) 2018. © 2018 American Cancer Society.
人乳头瘤病毒（HPV）信使 RNA（HPV RNA ISH）原位杂交最近被引入宫颈鳞状上皮内病变的辅助诊断工具，可以帮助区分低级别鳞状上皮内病变（LSIL）与反应性/阴性活检。先前的研究表明，多达一半最初诊断为 LSIL 的病例通过形态学的专家共识重新分类为阴性/反应性，并且阴性 HPV RNA ISH 结果通常与专家诊断为阴性/反应性相关。鉴于活检中 LSIL 的过度诊断可能导致错误的临床印象，即宫颈病变已经被适当取样，因此作者提出 HPV RNA ISH 可以为具有挑战性的 LSIL 活检提供细胞学-组织学相关性信息。
对 92 例最初诊断为 LSIL 的宫颈活检进行回顾性研究，由 3 名妇科病理学家进行复查，并根据形态学的共识意见进行重新分类。进行高危型和低危型 HPV E6/E7 mRNA 的原位杂交。收集之前/同期的细胞学结果。
根据专家共识形态学复查，49%（92 例活检中的 45 例）最初诊断为 LSIL 的活检被重新分类为阴性，6.5%（92 例活检中的 6 例）被重新分类为高级别鳞状上皮内病变，44.5%（92 例活检中的 41 例）保持为 LSIL。大多数重新分类为阴性的 LSIL 活检（80%；45 例活检中的 36 例）HPV RNA 阴性，而 93%的 LSIL 活检（41 例活检中的 39 例）和 100%的高级别鳞状上皮内病变活检 HPV RNA 阳性。
LSIL 在活检中经常被形态学过度诊断，这可能导致对细胞学上发现的病变已经取样的错误印象。对活检进行 RNA ISH 可减少组织学 LSIL 的过度诊断，并且在细胞学-组织学不一致时，可能会促使进一步取样。癌症（癌症细胞病理学）2018。©2018 美国癌症协会。
