Wang Yiying, Wang Yan, Gaisa Michael M, Sigel Keith, Zheng Wenxin, Liu Yuxin, Wang Yue
Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China.
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Oncol. 2020 Jan 22;2020:6352315. doi: 10.1155/2020/6352315. eCollection 2020.
People living with HIV/AIDS (PLWHA) have an increased incidence of anal squamous cell carcinoma. Since high-risk human papillomavirus (hrHPV) is the primary cause, hrHPV DNA testing may play an important role in anal cancer screening. This study aims to determine the negative predictive value (NPV) of hrHPV testing in PLWHA as well as factors that may lead to false-negative results.
Anal swabs were collected for cytology and Cobas® 4800 HPV test for 14 hrHPV types. Patients underwent concomitant high-resolution anoscopy (HRA) examination and biopsy. High-grade squamous intraepithelial lesions (HSIL, synonymous with anal intraepithelial neoplasia AIN2 and 3) detected in Cobas-negative patients were genotyped for 22 HPV types using BioPerfectus Multiplex Real-time PCR.
156 PLWHA tested negative for hrHPV on anal swab samples (i.e., Cobas-negative). HRA-guided biopsy detected HSIL/AIN3 in 13 patients (8%, NPV 92%), HSIL/AIN2 in 5 patients (3%), low-grade squamous intraepithelial lesions in 82 (LSIL, 53%), or benign findings in 56 (36%). No cancer was found. The HSIL group was similar to the LSIL/benign group regarding age, gender, race/ethnicity, clinical HIV parameters, cytological diagnoses, history of receptive anal sex, and smoking ( ≥ 0.02). Genotyping HSIL tissue derived from Cobas-negative patients revealed hrHPV (=7), possibly carcinogenic HPV53, 67, 73, 82 (=12), or absence of hrHPV (=4).
In this series, anal hrHPV DNA testing offered 92% NPV for PLWHA; in other words, a 8% risk of occult precancer remains for those who test hrHPV negative on anal swab samples.
人类免疫缺陷病毒/艾滋病（HIV/AIDS）感染者患肛门鳞状细胞癌的几率更高。由于高危型人乳头瘤病毒（hrHPV）是主要病因，hrHPV DNA检测在肛门癌筛查中可能发挥重要作用。本研究旨在确定hrHPV检测在HIV/AIDS感染者中的阴性预测值（NPV）以及可能导致假阴性结果的因素。
采集肛门拭子进行细胞学检查及针对14种hrHPV型别的Cobas® 4800 HPV检测。患者同时接受高分辨率肛门镜检查（HRA）及活检。对Cobas检测结果为阴性的患者中检测到的高级别鳞状上皮内病变（HSIL，等同于肛门上皮内瘤变AIN2和3级），使用BioPerfectus多重实时PCR对22种HPV型别进行基因分型。
156例HIV/AIDS感染者的肛门拭子样本hrHPV检测呈阴性（即Cobas检测阴性）。HRA引导下的活检在13例患者中检测到HSIL/AIN3（8%，NPV为92%），5例患者中检测到HSIL/AIN2（3%），82例患者中检测到低级别鳞状上皮内病变（LSIL，53%），56例患者中检测到良性结果（36%）。未发现癌症病例。HSIL组在年龄、性别、种族/族裔、临床HIV参数、细胞学诊断、接受肛交史及吸烟情况方面与LSIL/良性组相似（P≥0.02）。对Cobas检测阴性患者的HSIL组织进行基因分型，结果显示hrHPV阳性（n=7）、可能致癌的HPV53、67、73、82阳性（n=12）或hrHPV阴性（n=4）。
在本系列研究中，肛门hrHPV DNA检测在HIV/AIDS感染者中的NPV为92%；也就是说，肛门拭子样本hrHPV检测呈阴性的患者仍有8%的隐匿性癌前病变风险。
