Kurokawa Tetsuji, Yoshida Yoshio, Iwanari Osamu, Oishi Tetsuro, Kasai Tokuzo, Hamada Masao, Fujita Hiromasa, Fujiwara Hiroyuki, Yokoyama Masatoshi, Sakuragi Noriaki, Kigawa Junzo, Suzuki Mitsuaki
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan.
Department of Obstetrics and Gynecology, Shimane Prefectural Central Hospital, Izumo, Shimane 693-8555, Japan.
Mol Clin Oncol. 2020 Oct;13(4):22. doi: 10.3892/mco.2020.2092. Epub 2020 Jul 16.
Cervical cancer screening has been shifting from primary cytology to primary HPV testing worldwide as primary HPV testing is more sensitive than primary cytology. To the best of our knowledge, the current study is the first in Japan to examine the feasibility of primary HPV testing. One of the disadvantages of this shift is that hrHPV-/≥LSIL/CIN2+ (high-risk HPV negative cancers or pre-cancerous lesions with abnormal cytology results) can be missed. The objectives of the present study are to clarify in detail CIN2+ missed by this shift and to evaluate the feasibility of primary HPV testing in Japan. Data from 115,273 women who underwent co-testing with cytology and HPV testing in cancer screening were used in the current study. The cases with hrHPV-/≥LSIL ('hrHPV-/≥L-SIL' include CIN2-, in contrast, 'hrHPV-/≥L-SIL/CIN2+' doesn't include CIN2-) were analysed in detail. Women with hrHPV-/≥LSIL comprised 0.3% of the total. The prevalence of CIN2, CIN3, SCC or cervical adenocarcinomas in the lesions with HPV-/≥LSIL was 0.03% in the cancer screening group. Only one case of 14 cervical adenocarcinomas in ≥LSIL was hrHPV-. The prevalence of cancer missed by the shift in patients >50 years of age was significantly higher compared with patients younger than 49 years. In conclusion, the prevalence of CIN2+, which might be missed by the shift from primary cytology to primary HPV testing, was remarkably low in this Japanese cancer screening. The data indicated that primary HPV testing, which was more sensitive for CIN2+ than primary cytology, was a feasible method that can be used in Japan. In particular, primary HPV testing should be introduced for women <50 years old.
在全球范围内，宫颈癌筛查已从最初的细胞学检查转向最初的人乳头瘤病毒（HPV）检测，因为最初的HPV检测比最初的细胞学检查更敏感。据我们所知，本研究是日本首个探讨最初HPV检测可行性的研究。这种转变的一个缺点是，高危型HPV阴性/≥低度鳞状上皮内病变（LSIL）/宫颈上皮内瘤变2级及以上（CIN2+，即高危型HPV阴性癌症或细胞学结果异常的癌前病变）可能会被漏诊。本研究的目的是详细阐明因这种转变而漏诊的CIN2+情况，并评估在日本进行最初HPV检测的可行性。本研究使用了115273名在癌症筛查中同时接受细胞学和HPV检测的女性的数据。对高危型HPV阴性/≥LSIL的病例（“高危型HPV阴性/≥LSIL”包括CIN2-，相比之下，“高危型HPV阴性/≥LSIL/CIN2+”不包括CIN2-）进行了详细分析。高危型HPV阴性/≥LSIL的女性占总数的0.3%。在癌症筛查组中，HPV阴性/≥LSIL病变中CIN2、CIN3、鳞状细胞癌（SCC）或宫颈腺癌的患病率为0.03%。在≥LSIL的14例宫颈腺癌中，只有1例高危型HPV阴性。50岁以上患者因这种转变而漏诊癌症的患病率明显高于49岁以下患者。总之，在这项日本癌症筛查中，从最初的细胞学检查转向最初的HPV检测可能漏诊的CIN2+的患病率非常低。数据表明，对CIN2+比最初的细胞学检查更敏感的最初HPV检测是一种可在日本使用的可行方法。特别是，应针对50岁以下的女性采用最初的HPV检测。
