University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
University of Bristol, Bristol, UK.
Br J Cancer. 2022 Jan;126(1):91-99. doi: 10.1038/s41416-021-01539-y. Epub 2021 Oct 29.
Twenty percent of women referred to colposcopy have a type 3 transformation zone-where colposcopic assessment for high-grade dysplasia (CIN2+) is not possible. This study examines the effectiveness of HPV biomarkers and genotyping in combination with techniques that sample an endocervical TZ.
A prospective diagnostic accuracy study. Women booked for large-loop excision (LLETZ) with squamous dyskaryosis, high-risk HPV and a TZ3 were recruited. Immediately prior to LLETZ samples were collected for p16/Ki-67 dual-stained cytology, HPV genotyping and H&E, p16- and Ki-67-stained endocervical curettings.
In women with low-grade screening (n = 64), 35.9% had CIN2+; dual-stained cytology had the greatest effect on the PPV of routine screening (76.1% vs 35.9%) and perfectly predicted the absence of CIN2+. In women with a high-grade screening result (n = 37); 75.6% had CIN2+ and dual-stained curettings improved the PPV (96.5 vs 75.6%).
With high-grade screening and a TZ3, LLETZ appears safest as three quarters have CIN2+ . Women with low-grade screening and a TZ3 have a twofold increased risk of CIN2+ when compared to women where the TZ is visible. The use of dual-stained cytology may help identify those women who can be safely offered surveillance and those who require treatment.
20%接受阴道镜检查的女性存在 3 型转化区-在这种情况下，无法对高级别上皮内瘤变（CIN2+）进行阴道镜评估。本研究旨在评估 HPV 生物标志物和基因分型联合采样技术在评估 3 型转化区中的有效性。
一项前瞻性诊断准确性研究。招募了因宫颈鳞状上皮内病变、高危型 HPV 和 3 型转化区而预约行大圈电切术（LLETZ）的女性。在进行 LLETZ 前，立即采集 p16/Ki-67 双重染色细胞学、HPV 基因分型和 H&E 以及 p16 和 Ki-67 染色的宫颈管刮片样本。
在低级别筛查的女性（n=64）中，35.9%患有 CIN2+；双重染色细胞学对常规筛查的阳性预测值（PPV）影响最大（76.1% vs 35.9%），并能准确预测不存在 CIN2+。在高级别筛查结果的女性（n=37）中，75.6%患有 CIN2+，而双重染色刮片可提高 PPV（96.5% vs 75.6%）。
对于高级别筛查和 3 型转化区，LLETZ 似乎是最安全的选择，因为四分之三的患者患有 CIN2+。与可见转化区的女性相比，低级别筛查和 3 型转化区的女性患有 CIN2+的风险增加两倍。双重染色细胞学的使用可能有助于识别那些可以安全接受监测的女性和需要治疗的女性。
