Östensson Ellinor, Belkić Karen, Ramqvist Torbjörn, Mints Miriam, Andersson Sonia
Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.
Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.
Oncol Lett. 2021 Apr;21(4):240. doi: 10.3892/ol.2021.12501. Epub 2021 Jan 31.
Women treated for high-grade cervical-intraepithelial-neoplasia (CIN) require long-term follow-up with high-risk human-papillomavirus (HPV) testing. Self-sampling for HPV is well-accepted among these patients, but its role in follow-up for this group requires investigation. The present study examined how well HPV findings from self-sampled vaginal (VSS) and urine specimens correctly identified women from this cohort with recurrent CIN2+ compared with samples collected by clinicians. At 1st post-conization follow-up, 531 patients (99.8% participation) gave urine samples, performed VSS, underwent colposcopy with punch biopsy of visible lesions and clinician-collected cervical sampling for HPV analysis and liquid-based cytology. A total of 113 patients with positive HPV and/or abnormal cytology at 1st follow-up underwent 2nd follow-up. At 1st follow-up, all patients with recurrent CIN3 had positive HPV results by all methods. Clinician sampling and VSS revealed HPV16 positivity in 50% of recurrent cases and urine sampling revealed HPV16 positivity in 25% of recurrent cases. At 2nd follow-up, all 7 newly-detected CIN2/3 recurrences were associated with HPV positivity on VSS and clinician-samples. Only clinician-collected samples detected HPV positivity for two adenocarcinoma-in-situ recurrences, and both were HPV18 positive. A total of 77 patients had abnormal cytology at 1st follow-up, for which HPV positivity via VSS yielded highest sensitivity. The HPV findings were positive from VSS in 12 patients with high-grade squamous-intraepithelial-lesions (HSIL), and 11 patients with HSIL had positive HPV findings in clinician-collected and urine samples. All methods for assessing HPV presence yielded significant age-adjusted odds ratios for predicting abnormal lesions at 1st follow-up. For overall HPV results, Cohen's kappa revealed substantial agreement between VSS and clinician sampling, and moderate agreement between urine and clinician sampling. Clinician sampling and VSS were highly concordant for HPV16. Insofar as the pathology was squamous (not glandular), VSS appeared as sensitive as clinician sampling for HPV in predicting outcome among the present cohort. Since VSS can be performed at home, this option can maximize participation in the required long-term follow-up for these women at high-risk.
接受高级别宫颈上皮内瘤变（CIN）治疗的女性需要通过高危型人乳头瘤病毒（HPV）检测进行长期随访。HPV自我采样在这些患者中很容易被接受，但其在该组患者随访中的作用仍需研究。本研究探讨了与临床医生采集的样本相比，自我采集的阴道样本（VSS）和尿液样本中的HPV检测结果对该队列中复发性CIN2+女性的识别准确性。在锥切术后首次随访时，531例患者（参与率99.8%）提供了尿液样本、进行了VSS，接受了阴道镜检查并对可见病变进行了活检，同时临床医生采集了宫颈样本用于HPV分析和液基细胞学检查。共有113例在首次随访时HPV阳性和/或细胞学异常的患者接受了第二次随访。在首次随访时，所有复发性CIN3患者的所有检测方法HPV结果均为阳性。临床医生采样和VSS显示，50%的复发病例HPV16阳性，尿液采样显示25%的复发病例HPV16阳性。在第二次随访时，所有7例新检测到的CIN2/3复发均与VSS和临床医生样本中的HPV阳性相关。只有临床医生采集的样本检测到2例原位腺癌复发的HPV阳性，且均为HPV18阳性。共有77例患者在首次随访时细胞学异常，其中通过VSS检测HPV阳性的敏感性最高。12例高级别鳞状上皮内病变（HSIL）患者的VSS检测HPV结果为阳性，11例HSIL患者的临床医生采集样本和尿液样本检测HPV结果为阳性。所有评估HPV存在的方法在预测首次随访时的异常病变方面均产生了显著的年龄调整优势比。对于总体HPV结果，Cohen's kappa显示VSS与临床医生采样之间有高度一致性，尿液与临床医生采样之间有中度一致性。临床医生采样和VSS在HPV16方面高度一致。就病理类型为鳞状（而非腺性）而言，在预测本队列患者的预后方面，VSS在检测HPV方面与临床医生采样一样敏感。由于VSS可以在家中进行，这种方式可以最大限度地提高这些高危女性参与所需长期随访的比例。
