Dept of Women's Health, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Dept. of Laboratory Medicine, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
PLoS One. 2019 Jun 14;14(6):e0217108. doi: 10.1371/journal.pone.0217108. eCollection 2019.
Many cervical cancers occurs among women over 65 and prevalence of HPV genotypes in this age cohort is sparingly studied. One aim of this study was to study the prevalence and distribution of HPV genotypes in women 55-59 years, with normal cytology when exiting the screening program. Secondly, HPV clearance as well as the value of HPV genotyping and/or liquid based cytology as triage tests for identifying histological dysplasia among women with persistent HPV was studied.
Women that exited the screening program with normal cytology, between the years 2012-2014, in Örebro County, Sweden, were invited to this study. A total of 2946 samples were analyzed with a broad-spectrum assay to detect both hrHPV and lrHPV in order to investigate the distribution of genotypes. In the consent group, women with a positive hrHPV test were offered a follow-up test and a cone biopsy for histological confirmation, and a follow up sample 6 months post cone.
The overall prevalence of hrHPV was 7.4% and 59% of them remained hrHPV positive in a follow-up test after 12 months. A total of 99 women had a cone biopsy done, where 19% showed histological dysplasia. HPV 53 was the most common genotype, and among women with histology confirmed LSIL or HSIL, HPV 31 was most common. A positive hrHPV result showed a PPV of 25% for LSIL+ and 12.5%for HSIL+. Using detection of HPV 16/18 genotypes as a triage test for hrHPV positive tests, indicated FNR for histological LSIL+ and HSIL+ of 94% and 87.5% respectively, whilst triage based on cervical cytology had a FNR of 69% for LSIL+ and 37.5% for HSIL+.
The most common hrHPV genotypes among women 55-59 years of age were non HPV16/18 genotypes, and in this population, these genotypes represented most of the histological verified HSIL lesions. This result does not support the proposition of a HPV 16/18 triaging test after a positive hrHPV test as a marker of histological HSIL+ cervical lesions in women over 55 years of age. Similarly, cytological triage after a positive hrHPV showed no additional benefit in this population. Specific triaging tests should be validated to follow post-menopausal women with a positive hrHPV test.
许多宫颈癌发生在 65 岁以上的女性中，该年龄段 HPV 基因型的流行情况研究甚少。本研究的目的之一是研究在退出筛查计划时细胞学正常的 55-59 岁女性中 HPV 基因型的流行率和分布。其次，研究 HPV 清除情况以及 HPV 基因分型和/或液基细胞学作为持续性 HPV 女性组织学异型增生的分流试验的价值。
2012-2014 年，瑞典厄勒布鲁郡退出筛查计划且细胞学正常的女性被邀请参加本研究。共分析了 2946 例标本，采用广谱检测方法检测高危型 HPV（hrHPV）和低危型 HPV（lrHPV），以研究基因型的分布。在知情同意组中，hrHPV 检测阳性的女性接受了随访检测和宫颈锥切术以进行组织学证实，并在锥切术后 6 个月进行了随访样本检测。
总体 hrHPV 阳性率为 7.4%，其中 59%在 12 个月后的随访检测中仍为 hrHPV 阳性。共 99 例女性进行了宫颈锥切术，其中 19%显示组织学异型增生。HPV53 是最常见的基因型，在组织学证实为低度鳞状上皮内病变（LSIL）或高度鳞状上皮内病变（HSIL）的女性中，HPV31 最常见。hrHPV 阳性结果的阳性预测值（PPV）为 LSIL+为 25%，HSIL+为 12.5%。将 HPV16/18 基因型检测作为 hrHPV 阳性检测的分流试验，提示组织学 LSIL+和 HSIL+的假阴性率（FNR）分别为 94%和 87.5%，而基于宫颈细胞学的分流试验的 LSIL+和 HSIL+的 FNR 分别为 69%和 37.5%。
55-59 岁女性中最常见的 hrHPV 基因型是非 HPV16/18 基因型，在该人群中，这些基因型代表了大多数组织学证实的 HSIL 病变。该结果不支持在 55 岁以上女性中，在 hrHPV 阳性后进行 HPV16/18 分流试验作为组织学 HSIL+宫颈病变的标志物。同样，在该人群中，hrHPV 阳性后的细胞学分流也没有额外获益。应验证特定的分流试验，以对 hrHPV 阳性的绝经后女性进行随访。
