Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68165, Mannheim, Germany.
Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Cancer Causes Control. 2023 May;34(5):469-477. doi: 10.1007/s10552-023-01677-z. Epub 2023 Feb 28.
According to the recently implemented organized cervical cancer screening program in Germany, women older than 35 years with negative cytology but persistent high-risk human papilloma virus (hrHPV) infection > 12 months should be referred to colposcopy for further evaluation. This study aimed to present and dissect colposcopic and histopathological findings with particular focus on associated hrHPV genotypes.
This study is a retrospective analysis of clinical data from 89 hrHPV positive patients with normal cytology who underwent colposcopic examination at a certified dysplasia outpatient clinic in Germany in 2021.
While 38 (43%) women had a normal colposcopic finding, 45 (51%) had minor and 6 (7%) major changes. Thirty-one (35%) of the women were HPV 16 and/or HPV 18 positive and 58 (65%) women were positive for other hrHPV only. Among patients who underwent colposcopy with biopsies (in case of an abnormal finding or type 3 transformation zone, n = 68), eight (12%) had cervical intraepithelial neoplasia (CIN) 3 and six (9%) had CIN 2. The proportion of women diagnosed with CIN 3 varied among different hrHPV genotypes (HPV 16: 11%, HPV 18: 33%, HPV 31: 27%, HPV 33: 33%, HPV 52: 33%).
Persistently hrHPV positive women with negative cytology are at increased risk of being diagnosed with CIN 3. As CIN 3 prevalence seems to differ with regard to hrHPV strain, immediate HPV genotyping for risk stratification and subsequent early referral for colposcopy might constitute a feasible strategy.
根据德国最近实施的有组织的宫颈癌筛查计划，细胞学阴性但持续高危型人乳头瘤病毒（hrHPV）感染>12 个月的>35 岁女性应转诊行阴道镜检查以进一步评估。本研究旨在介绍和剖析阴道镜和组织病理学发现，并特别关注相关的 hrHPV 基因型。
本研究是对 2021 年在德国一家经过认证的宫颈病变门诊接受阴道镜检查的 89 例细胞学正常的 hrHPV 阳性患者的临床数据进行的回顾性分析。
38 例（43%）女性阴道镜检查正常，45 例（51%）有轻微改变，6 例（7%）有严重改变。31 例（35%）女性 HPV16 和/或 HPV18 阳性，58 例（65%）女性仅感染其他 hrHPV。在接受阴道镜检查和活检的患者中（如果发现异常或 3 型转化区，n=68），8 例（12%）患有宫颈上皮内瘤变（CIN）3 级，6 例（9%）患有 CIN 2 级。不同 hrHPV 基因型的女性中诊断为 CIN3 的比例不同（HPV16：11%，HPV18：33%，HPV31：27%，HPV33：33%，HPV52：33%）。
细胞学阴性但持续 hrHPV 阳性的女性患 CIN3 的风险增加。由于 CIN3 的患病率似乎与 hrHPV 株有关，因此立即进行 HPV 基因分型进行风险分层，并随后立即转诊行阴道镜检查可能是一种可行的策略。
