Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Pathology, University of Rochester Medical Center, Rochester, New York.
J Am Soc Cytopathol. 2020 Nov-Dec;9(6):550-555. doi: 10.1016/j.jasc.2020.04.010. Epub 2020 May 6.
High risk (hr) human papillomavirus (HPV) testing has been proposed as a possible replacement for Papanicolaou (Pap) cytology for cervical screening. The aim of the present study was to assess the hrHPV detection rates using 3 available Food and Drug Administration-approved HPV assays in patients with high-grade squamous intraepithelial lesion (HSIL) cytology results and to correlate the cervical screening test results with the immediate histopathologic findings.
Cases with positive HSIL ThinPrep cytology findings, concurrent hrHPV testing results, and histopathologic follow-up results obtained within 6 months of the Pap/HPV co-testing were identified from July 2010 to April 2018.
A total of 943 HSIL Pap tests were identified with adjunctive hrHPV co-testing, and hrHPV was detected in 883 (93.6%) of these 943 cases. Cervical intraepithelial neoplasia ≥2 (CIN2+) lesions were diagnosed in 71.5% of patients, including 3.2% with invasive squamous cell carcinoma (SCC). In all hrHPV testing platforms, the detection rate for CIN2+ was significantly greater for the patients with positive HPV testing (72.7%) than for those with negative HPV testing (53.4%). However, CIN2+ lesions, including 3 cases of SCC, were found in 24 of 45 women (53.4%) with HSIL Pap and negative HPV testing results.
The risk of CIN2+ histopathologic findings was significantly greater for patients with hrHPV-positive HSIL results. However, a subset of patients with HPV-negative HSIL results were found to have CIN2+ lesions, including SCC. The long-term effects of primary HPV screening on cervical cancer incidence, stage, and prognosis remain uncertain.
高危型（hr）人乳头瘤病毒（HPV）检测已被提议作为巴氏涂片（Pap）细胞学宫颈筛查的替代方法。本研究旨在评估在高级别鳞状上皮内病变（HSIL）细胞学结果阳性的患者中使用 3 种已获得美国食品和药物管理局批准的 HPV 检测方法检测 hrHPV 的检出率，并将宫颈筛查检测结果与即时组织病理学发现进行相关性分析。
从 2010 年 7 月至 2018 年 4 月，筛选出同时进行了阳性 HSIL ThinPrep 细胞学检查结果、hrHPV 检测结果以及在 Pap/HPV 联合检测后 6 个月内获得的组织病理学随访结果的病例。
共发现 943 例 HSIL Pap 检测结果与辅助性 hrHPV 联合检测结果相关，其中 883 例（93.6%）检测到 hrHPV。71.5%的患者诊断为宫颈上皮内瘤变≥2 级（CIN2+）病变，包括 3.2%的浸润性鳞状细胞癌（SCC）患者。在所有 hrHPV 检测平台中，HPV 检测阳性患者的 CIN2+检出率（72.7%）明显高于 HPV 检测阴性患者（53.4%）。然而，在 45 例 HSIL Pap 和阴性 HPV 检测结果的女性中，有 24 例（53.4%）发现了 CIN2+病变，包括 3 例 SCC。
对于 HRHPV 阳性 HSIL 结果的患者，CIN2+组织病理学发现的风险显著增加。然而，一部分 HPV 阴性 HSIL 结果的患者也发现了 CIN2+病变，包括 SCC。HPV 初筛对宫颈癌发病率、分期和预后的长期影响仍不确定。
