Guo Zhen, Jia Man-Man, Chen Qiong, Chen Hong-Min, Chen Pei-Pei, Zhao Dong-Mei, Ren Ling-Yan, Sun Xi-Bin, Zhang Shao-Kai
Central Laboratory, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
Department of Gynecological Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
Front Oncol. 2019 Apr 3;9:202. doi: 10.3389/fonc.2019.00202. eCollection 2019.
The purpose of this study was to evaluate the effect of different combination models of high-risk human papilloma viruses (HPV) genotyping in triaging Chinese women with atypical squamous cells of undetermined significance (ASCUS). We established a screening cohort of 3,997 Chinese women who underwent cervical cytology and HPV genotyping test. Women with ASCUS cytology underwent punch biopsy under colposcopy/endocervical curettage. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different combination models of HR-HPV genotyping calculated that cervical intraepithelial neoplasia 2 or higher (CIN2+) on histology were endpoints. Of the full sample, 393 women had ASCUS. Among ASCUS women with a CIN2 lesion, the prevalence for HPV were 40.0% (type 16), 10.0% (type 18), 0.0% (type 33), 30.0% (type 52), 40.0% (type 58), and 30.0% (other nine types). For ASCUS women with a CIN3 lesion, the prevalence for HPV were 68.4% (type 16), 15.8% (type 18), 10.5% (type 33), 31.6% (type 52), 15.8% (type 58), and 36.8% (other nine types). Combination model including HPV16/18/33/52/58 for predicting CIN2+ lesion in women with ASCUS had relatively higher sensitivity [93.1% (78.0, 98.1)], specificity [75.8% (71.2, 79.9)], PPV [23.5% (16.7, 32.0)], and NPV [99.3% (97.4, 99.8)] than other combination models. Moreover, the referral rate of HPV16/18/33/52/58 (29.3%) was lower than HR-HPV (36.1%). The study demonstrates that specific HR-HPV types HPV16/18/33/52/58 may be an effective strategy in ASCUS triage. This improves the subsequent selection of ASCUS patients.
本研究的目的是评估高危型人乳头瘤病毒（HPV）基因分型的不同组合模式在对中国意义未明的非典型鳞状细胞（ASCUS）女性进行分流时的效果。我们建立了一个由3997名接受宫颈细胞学和HPV基因分型检测的中国女性组成的筛查队列。ASCUS细胞学检查的女性在阴道镜检查/宫颈管刮除术下行活检。以组织学确诊的宫颈上皮内瘤变2级或更高（CIN2+）为终点，计算HR-HPV基因分型不同组合模式的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。在全部样本中，393名女性有ASCUS。在有CIN2病变的ASCUS女性中，HPV的感染率分别为40.0%（16型）、10.0%（18型）、0.0%（33型）、30.0%（52型）、40.0%（58型）和30.0%（其他九种类型）。在有CIN3病变的ASCUS女性中，HPV的感染率分别为68.4%（16型）、15.8%（18型）、10.5%（33型）、31.6%（52型）、15.8%（58型）和36.8%（其他九种类型）。用于预测ASCUS女性CIN2+病变的包括HPV16/18/33/52/58的组合模式，其敏感性[93.1%（78.0，98.1）]、特异性[75.8%（71.2，79.9）]、PPV[23.5%（16.7，32.0）]和NPV[99.3%（97.4，99.8）]均高于其他组合模式。此外，HPV16/18/33/52/58的转诊率（29.3%）低于HR-HPV（36.1%）。该研究表明，特定的HR-HPV类型HPV16/18/33/52/58可能是ASCUS分流的有效策略。这改善了ASCUS患者后续检查的选择。
