Department of General Surgery and Medical Surgery Specialities, Gynecological Clinic of the University of Catania, Policlinico, Via S. Sofia, 78, Catania, Italy.
Virol J. 2019 Mar 28;16(1):39. doi: 10.1186/s12985-019-1145-5.
The aim of our study was to determine which diagnostic course is best to identify women at risk of CIN2+ among post-menopausal women with cytological diagnosis of ASCUS METHODS: We selected women who had been post-menopausal for at least one year , and who had completed the entire diagnostic-therapeutic course that they had undertaken. The sample was divided into two arms: in the first arm, we considered 146 ASCUS positive women who had undergone the HPV test, colposcopy and then underwent more detailed diagnostics by means of LEEP or a scraping of the cervical canal. The second arm was made up of 124 ASCUS positive women who had undergone a vaginal administration of estriolo, the HPV test and colposcopy. Estriol was administered for 5 weeks: the first week one vaginal suppository every evening, the other four weeks the administration was twice a week. Then, the patients underwent colposcopy. In cases of positivity a biopsy was carried out, the patients positive for CIN2+ at the biopsy underwent excisional therapy using LEEP and were followed up. The patients, who were negative at colposcopy or with histological diagnosis of CIN1, were examined again at 1 year.
In the first arm the HPV test had an SE of 94%, an SP of 68%, NPV of 99%, and PPV of 28%. The PPV is very low because of the elevated percentage of false positives that the HPV test gave (71%). In the second arm the HPV test maintained its high SE (100%), an SP of 74%, a NPV of 100%, and a PPV of 43%. The use of estrogen increased the specificity of the test.
It is important to say that the second arm indicates the use of local estrogen therapy only for ASCUS/HPV positive postmenopausal women. Therefore, the HPV test should be used as the first diagnostic possibility in cases of ASCUS in post-menopausal women, associating local estrogen therapy only with HPV positive women.
我们研究的目的是确定哪种诊断方法最适合识别绝经后妇女中细胞学诊断为 ASCUS 的妇女中患有 CIN2+的风险。
我们选择了绝经至少一年且已完成所接受的整个诊断治疗过程的妇女。该样本分为两个组：在第一组中，我们考虑了 146 名 ASCUS 阳性的妇女，她们接受了 HPV 测试、阴道镜检查，然后通过 LEEP 或宫颈刮片进行更详细的诊断。第二组由 124 名 ASCUS 阳性的妇女组成，她们接受了阴道雌激素治疗，HPV 测试和阴道镜检查。雌激素治疗持续 5 周：第一周每晚阴道给药一次，其余四周每周两次给药。然后，患者接受阴道镜检查。如果阳性，则进行活检，如果活检阳性为 CIN2+，则使用 LEEP 进行切除治疗并进行随访。阴道镜检查阴性或组织学诊断为 CIN1 的患者在 1 年后再次进行检查。
在第一组中，HPV 测试的 SE 为 94%，SP 为 68%，NPV 为 99%，PPV 为 28%。由于 HPV 测试产生的假阳性率较高（71%），因此 PPV 非常低。在第二组中，HPV 测试保持了其高 SE（100%），SP 为 74%，NPV 为 100%，PPV 为 43%。雌激素的使用提高了测试的特异性。
需要指出的是，第二组仅表明绝经后妇女中 ASCUS/HPV 阳性时仅使用局部雌激素治疗。因此，在绝经后妇女中出现 ASCUS 时，HPV 测试应作为首选诊断方法，仅将局部雌激素治疗与 HPV 阳性妇女联系起来。
