年龄和高危型人乳头瘤病毒（hrHPV）状态对持续性 hrHPV 阳性、细胞学阴性筛查样本中高级别宫颈上皮内瘤变（CIN2+）患病率的影响：一项前瞻性队列研究。

The impact of age and high-risk human papillomavirus (hrHPV) status on the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women with persistent hrHPV-positive, cytology-negative screening samples: a prospective cohort study.

机构信息

Department of Gynaecological Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

出版信息

BJOG. 2020 Sep;127(10):1260-1267. doi: 10.1111/1471-0528.16250. Epub 2020 May 3.

DOI:10.1111/1471-0528.16250

PMID:32279427

Abstract

OBJECTIVE

To establish the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women referred to colposcopy with persistent high-risk human papillomavirus (hrHPV) cytology-negative screening sample according to hrHPV genotype, age at referral and colposcopic performance.

DESIGN

Prospective cohort study.

SETTING

Single colposcopy clinic linked to a population-based screening programme.

POPULATION

Women referred with persistent hrHPV cytology-negative routine screening samples.

METHODS

Prospective study with descriptive statistics from a single colposcopy unit between June 2014 and July 2019.

MAIN OUTCOME MEASURES

Prevalence of hrHPV genotypes and CIN2+, positive predictive value for colposcopic impression, and inadequate colposcopic examinations.

RESULTS

A total of 3107 women were referred. Prevalence of CIN2+ was highest for persistent HPV16 infections (10.7%) compared with HPV18 (3.6%) or HPVO (4.7%). Prevalence of CIN2+ declined with age (25-34 years 14.2% to 55-64 years 1.1%) whereas the percentage of women with an inadequate colposcopic examination increased (25-34 years 0.9% to 55-64 years 29.5%). High-grade colposcopic impression fell over time during the study from 16.1 to 5.1%. The positive predictive value for colposcopic impression of CIN2+ was affected by hrHPV genotype (57.3% for HPV16 versus 32.1% for nonHPV16). The adjunctive use of electrical impedance spectroscopy detected an extra 42 cases of CIN2+, which was irrespective of hrHPV genotype.

CONCLUSIONS

Primary hrHPV cervical screening increases detection of CIN2+; however, low specificity results in more women being referred to colposcopy with a low prevalence of CIN2+. Colposcopy performs poorly in some groups, particularly with HPVO infections and women over 50 years of age. An appropriate threshold for referral to colposcopy in primary hrHPV screening has not been established.

TWEETABLE ABSTRACT

Low prevalence of CIN2+ in HPV-positive negative cytology samples. HPV genotype, age and prevalence of CIN2+ affect colposcopic performance.

摘要

目的

根据高危型人乳头瘤病毒（hrHPV）基因型、转诊年龄和阴道镜表现，确定持续 hrHPV 细胞学阴性筛查样本转诊行阴道镜检查的女性中高级别宫颈上皮内瘤变（CIN2+）的流行率。

设计

前瞻性队列研究。

设置

与基于人群的筛查计划相关联的单一阴道镜诊所。

人群

持续 hrHPV 细胞学阴性常规筛查样本转诊的女性。

方法

2014 年 6 月至 2019 年 7 月，在单一阴道镜单位进行前瞻性研究，采用描述性统计方法。

主要观察指标

hrHPV 基因型和 CIN2+的流行率、阴道镜印象的阳性预测值以及不充分的阴道镜检查。

结果

共转诊 3107 名女性。与 HPV18（3.6%）或 HPV0（4.7%）相比，持续 HPV16 感染的 CIN2+患病率最高（10.7%）。CIN2+的患病率随年龄下降（25-34 岁为 14.2%，55-64 岁为 1.1%），而不充分阴道镜检查的女性比例增加（25-34 岁为 0.9%，55-64 岁为 29.5%）。在研究期间，高级别阴道镜印象的百分比随时间下降，从 16.1%降至 5.1%。CIN2+阴道镜印象的阳性预测值受 hrHPV 基因型的影响（HPV16 为 57.3%，非 HPV16 为 32.1%）。电阻抗光谱学的辅助使用检测到额外的 42 例 CIN2+病例，与 hrHPV 基因型无关。