Department of Medical Epidemiology and Biostatistics, Karolinska Institute, and Department of Obstetrics and Gynecology, Falun Hospital, Falun, Sweden.
Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Swedish National Cervical Screening Registry, Stockholm, Sweden; Cancer Screening Unit, Regional Cancer Center, Stockholm, Sweden.
Am J Obstet Gynecol. 2020 Mar;222(3):253.e1-253.e8. doi: 10.1016/j.ajog.2019.09.039. Epub 2019 Oct 1.
Human papillomavirus-based screening has a higher sensitivity for precursors of cervical cancer compared with cytology-based screening. However, more evidence is needed on optimal management of human papillomavirus-positive women.
The objective of the study was to compare the risk of histopathologically confirmed cervical intraepithelial lesions grade 2 or worse after 1 and 3 years of human papillomavirus persistence, respectively, and evaluate the clinical management of human papillomavirus-positive women in the 56-60 year age group.
This was a randomized health care policy offering human papillomavirus screening to 50% of resident women aged 56-60 years in the Stockholm/Gotland region of Sweden during January 2012 through May 2014. Women who were human papillomavirus positive/cytology negative at baseline were referred for a repeat test after 1 or 3 years. In case of human papillomavirus persistence, women were referred for colposcopy, including biopsies and endocervical sampling.
The human papillomavirus prevalence was 5.5% (405 women of 7325 attending). Among the 405 human papillomavirus-positive women, 313 were reflex test cytology negative at baseline and were referred for a repeat human papillomavirus test, 176 women after 1 year and 137 women after 3 years. After 1 year, 91 of 176 (52%) were persistently human papillomavirus positive and after 3 years 55 of 137 (40%) (P = .042). In repeat cytology, 10 of the 91 (12%) were positive after 1 year and 15 of 55 (33%) after 3 years (P = .005). The attendance rates for colposcopy were similar: 82 of 91 (90%) in the 1 year group and 45 of 55 (82%) in the 3 year group. All women attending colposcopy were postmenopausal, and endocervical sampling and punch biopsies were performed to facilitate colposcopic management, with a positive predictive value of 43-50% and 28-31%, respectively. Histopathologically confirmed cervical intraepithelial lesions grade 2 or worse was found in 19 of 82 women (23%) and 9 of 45 women (20%) in the 1 year and 3 year groups, respectively, and registry linkage follow-up found no cancers in either group. Human papillomavirus genotyping was predictive of cervical intraepithelial lesions grade 2 or worse, and human papillomavirus 16 was the most common genotype at human papillomavirus persistence, occurring in 18% of the cases in the 1 year group and 20% in the 3 year group.
It was safe to postpone repeat human papillomavirus tests for 3 years in postmenopausal women attending the organized cervical screening program. There was a high risk for cervical intraepithelial lesions grade 2 or worse at follow-up and noteworthy yields from human papillomavirus genotyping as well as endocervical sampling and random biopsies in the absence of visible colposcopic lesions.
与细胞学筛查相比，人乳头瘤病毒（HPV）筛查对宫颈癌前病变具有更高的敏感性。然而，我们需要更多的证据来确定 HPV 阳性女性的最佳管理方案。
本研究旨在比较 HPV 持续感染 1 年和 3 年后分别经组织病理学证实的宫颈上皮内瘤变 2 级或更高级别病变的风险，并评估 56-60 岁年龄组 HPV 阳性女性的临床管理。
这是一项随机卫生保健政策研究，在 2012 年 1 月至 2014 年 5 月期间，向瑞典斯德哥尔摩/哥德堡地区 56-60 岁的 50%常住女性提供 HPV 筛查。基线时 HPV 阳性/细胞学阴性的女性在 1 或 3 年后接受重复检测。如果 HPV 持续存在，女性将接受阴道镜检查，包括活检和宫颈管取样。
HPV 流行率为 5.5%（7325 名就诊者中有 405 名 HPV 阳性）。在 405 名 HPV 阳性女性中，313 名在基线时为反射性细胞学阴性，被转介进行重复 HPV 检测，176 名在 1 年后，137 名在 3 年后。1 年后，176 名中有 91 名（52%）持续 HPV 阳性，3 年后有 55 名（40%）（P=.042）。在重复细胞学检查中，1 年后有 10 名（12%）阳性，3 年后有 15 名（33%）阳性（P=.005）。阴道镜检查的出勤率相似：1 年组有 82 名（90%），3 年组有 45 名（82%）。所有接受阴道镜检查的女性均已绝经，并进行了宫颈管取样和经皮穿刺活检，以利于阴道镜管理，其阳性预测值分别为 43%-50%和 28%-31%。在 1 年组的 82 名女性中有 19 名（23%）和 3 年组的 45 名女性中有 9 名（20%）经组织病理学证实为宫颈上皮内瘤变 2 级或更高级别病变，且两组均未发现癌症。HPV 基因分型可预测宫颈上皮内瘤变 2 级或更高级别病变，HPV 16 是 HPV 持续感染中最常见的基因型，在 1 年组中有 18%的病例和 3 年组中有 20%的病例。
在参加有组织的宫颈癌筛查项目的绝经后女性中，将 HPV 重复检测推迟 3 年是安全的。在随访中，宫颈上皮内瘤变 2 级或更高级别病变的风险较高，HPV 基因分型以及在没有明显阴道镜下病变的情况下进行宫颈管取样和随机活检具有较高的阳性预测值。
