Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium.
Int J Cancer. 2021 Aug 1;149(3):684-691. doi: 10.1002/ijc.33519. Epub 2021 Feb 25.
Human papillomavirus (HPV)-based cervical screening is a globally recommended health policy. Different HPV types have different risk for cervical cancer. For optimal HPV screening, the sensitivity and specificity for each HPV type at different viral loads should be known in a screening setting. HPV test results in about 1 million cervical samples analyzed during 2006 to 2014 were compared for 319 women who had developed invasive cervical cancer up to 8.5 years later and for 1911 matched control women. Detection including low viral loads resulted in markedly increased sensitivity for cervical cancer only for HPV types 16 and 18. Testing for HPV types 31, 33, 45 and 52 also increased the sensitivity for prediction of cervical cancer, but for these viruses, detection of low viral load did not further increase sensitivity. HPV types 35, 39, 51, 56, 58, 59, 66 and 68 only predicted occasional additional cervical cancer cases. Testing for HPV16/18 at low viral load plus testing for HPV31, 33, 45 and 52 at >3000 copies/μL predicted 86.5% of cancers occurring within a year after testing, similar to the 89.4% that were predicted by testing for 14 HPV types. By contrast, the type and viral load-restricted testing greatly increased specificity: 6.3% of healthy women tested positive as compared to 11.7% of healthy women testing positive for the 14 HPV types commonly screened for today. Adequate HPV screening sensitivity, with considerable increase in specificity, can be obtained by testing only for HPV16/18/31/33/45/52, with detection of low viral load required only for HPV16/18.
人乳头瘤病毒（HPV）为基础的宫颈癌筛查是全球推荐的卫生政策。不同的 HPV 类型对宫颈癌的风险不同。为了达到最佳的 HPV 筛查效果，在筛查环境中应该了解不同病毒载量下每种 HPV 类型的敏感性和特异性。比较了 2006 年至 2014 年期间分析的约 100 万例宫颈样本的 HPV 检测结果，共涉及 319 名 8.5 年内发展为浸润性宫颈癌的妇女和 1911 名匹配的对照妇女。包括低病毒载量在内的检测结果仅显著增加了 HPV 16 和 18 型宫颈癌的敏感性。HPV 31、33、45 和 52 型的检测也增加了宫颈癌预测的敏感性，但对于这些病毒，低病毒载量的检测并不能进一步提高敏感性。HPV 35、39、51、56、58、59、66 和 68 型仅预测偶发性额外的宫颈癌病例。HPV16/18 低病毒载量检测加 HPV31、33、45 和 52 高病毒载量（>3000 拷贝/μL）检测可预测检测后一年内发生的 86.5%的癌症，与检测 14 种 HPV 型预测的 89.4%相似。相比之下，基于病毒类型和病毒载量限制的检测大大提高了特异性：14 种 HPV 型中检测到的 11.7%的健康女性呈阳性，而仅针对 HPV16/18/31/33/45/52 检测的健康女性中，阳性率为 6.3%。通过仅针对 HPV16/18/31/33/45/52 检测，同时仅针对 HPV16/18 检测低病毒载量，可以获得足够的 HPV 筛查敏感性，并大大提高特异性。
