Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
Centro de Investigación Biomédica en Red en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.
PLoS One. 2018 Nov 26;13(11):e0207812. doi: 10.1371/journal.pone.0207812. eCollection 2018.
Equivocal lesions (ASC-US) are common abnormalities in cervical cancer screening exams. HPV testing helps to stratify the risk of progression to high-grade squamous intraepithelial lesions or more (HSIL+). Population-based medical electronic data can be used to evaluate screening recommendations. The study uses routine electronic data from primary health centers to estimate the impact of HPV testing in a 3- and a 5-year risk of HSIL+ after an ASC-US. The study includes data derived from medical electronic information from 85,775 women who first attended a cervical cancer screening visit at the National Health System facilities of Catalonia, Spain, during 2010-11 and followed up to 2015. Included women were aged between 25-65 years old, having at least one follow-up visit, and a cervical cytology of ASC-US (N = 1,647). Women with a first result of low-grade squamous intraepithelial lesions (LSIL) (N = 945) or those with negative cytology (N = 83,183) were included for comparison. Those with a baseline HSIL+ were excluded. Incident HSIL+ was evaluated by means of Kaplan-Meier curves and multivariate regression models. HPV test results were available for 63.4% of women with a baseline ASC-US. Among all ASC-US, 70 incident HSIL+ were identified at 5 years. ASC-US HPV positive women had a high risk of HSIL+ compared to women with negative cytology (adjusted HR = 32.7; 95% CI: 23.6-45.2) and a similar risk to women with baseline LSIL (HR = 29.3; 95% CI: 22.4-38.2), whereas ASC-US HPV negative women had no differential risk to that observed in baseline negative cytology. Women with ASC-US and no HPV test had an average HSIL+ risk (HR = 14.8; 95% CI: 9.7-22.5). Population-based e-medical records derived from primary health care centers allowed monitoring of screening recommendations, providing robust estimates for the study outcomes. This analysis confirms that HPV testing improved risk stratification of ASC-US lesions. The information can be used to improve diagnosis and management of screen detected lesions.
意义不明确的病变（ASC-US）是宫颈癌筛查检查中常见的异常。HPV 检测有助于对进展为高级别鳞状上皮内病变或更高级别病变（HSIL+）的风险进行分层。基于人群的医疗电子数据可用于评估筛查建议。该研究使用来自初级保健中心的常规电子数据，估计在 ASC-US 后 3 年和 5 年内发生 HSIL+的 HPV 检测的影响。该研究包括来自西班牙加泰罗尼亚国家卫生系统设施的 85775 名首次接受宫颈癌筛查的女性的医疗电子信息数据，随访至 2015 年。纳入的女性年龄在 25-65 岁之间，至少有一次随访，宫颈细胞学检查为 ASC-US（N=1647）。纳入了首次检查结果为低级别鳞状上皮内病变（LSIL）（N=945）或细胞学检查阴性（N=83183）的女性进行比较。排除了基线 HSIL+的女性。通过 Kaplan-Meier 曲线和多变量回归模型评估新发生的 HSIL+。在基线 ASC-US 的女性中，有 63.4%的人可获得 HPV 检测结果。在所有 ASC-US 中，5 年内发现了 70 例新发生的 HSIL+。与细胞学检查阴性的女性相比，ASC-US HPV 阳性女性发生 HSIL+的风险较高（调整后的 HR=32.7；95%CI：23.6-45.2），与基线 LSIL 女性的风险相似（HR=29.3；95%CI：22.4-38.2），而 ASC-US HPV 阴性女性与基线细胞学检查阴性的女性相比，风险无差异。ASC-US 且未行 HPV 检测的女性发生 HSIL+的平均风险（HR=14.8；95%CI：9.7-22.5）。来自初级保健中心的基于人群的电子病历允许监测筛查建议，为研究结果提供了强有力的估计。该分析证实，HPV 检测提高了 ASC-US 病变的风险分层。该信息可用于改善对筛查发现的病变的诊断和管理。
