Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan.
Saga Health Promotion Foundation, Saga, Japan.
J Obstet Gynaecol Res. 2023 Dec;49(12):2860-2867. doi: 10.1111/jog.15784. Epub 2023 Sep 4.
In Japan, primary human papilloma virus (HPV) testing has not been introduced for cervical cancer screening due to concerns that HPV-negative lesions may be missed and a lack of Japanese data. The purpose of this study was to evaluate the validity of primary HPV testing in Japan by analyzing cervical intraepithelial neoplasia 2 (CIN2) or more/high-risk HPV- (CIN2+/hrHPV-) cases in cervical cancer screening.
Data from 35 525 cervical cancer screenings with HPV testing and cervical cytology from 2011 to 2019 in Saga City, Japan, were reviewed. The cases with low-grade squamous intraepithelial lesion (LSIL+)/hrHPV- were analyzed in detail.
The results of the 35 525 examinees were as follows: 31 123 were negative for intraepithelial lesion or malignancy (NILM)/hrHPV-, 2612 were NILM/hrHPV+, 262 were atypical squamous cells of undetermined significance (ASC-US)/hrHPV-, 213 were ASC-US/hrHPV+, 291 were LSIL+/hrHPV-, and 1024 were LSIL+/hrHPV+. Of the 256 LSIL+/hrHPV- examinees for whom histology was available, CIN2+ were CIN2 9.4% (24/256), CIN3 3.9% (10/256), cervical adenocarcinoma 0.4% (1/256), uterine corpus cancer 1.2% (3/256), and uterine sarcoma 0.4% (1/256). Overall, the rate of LSIL+/hrHPV- was 0.82% (291/35.525), 0.1% (36/35525) of which were cervical lesions with CIN2+. Only one cervical adenocarcinoma was detected, but gastric-type adenocarcinoma was not included.
HPV-negative CIN2+ or cervical adenocarcinoma is not a concern for the introduction of primary HPV screening in Japan. Primary HPV testing in cervical cancer screening is considered a feasible method that can be used in Japan, although an algorithm suitable for Japan and a national-level management system need to be established.
在日本，由于担心可能会漏诊 HPV 阴性病变以及缺乏日本数据，尚未将原发性人乳头瘤病毒（HPV）检测用于宫颈癌筛查。本研究旨在通过分析宫颈癌筛查中宫颈上皮内瘤变 2 级（CIN2）或更高级别/高危型 HPV（CIN2+/hrHPV-）病例，评估日本在原发性 HPV 检测中的有效性。
回顾分析了 2011 年至 2019 年在日本佐贺市进行的 35525 例 HPV 检测和宫颈细胞学宫颈癌筛查数据。对低级别鳞状上皮内病变（LSIL+）/hrHPV-病例进行了详细分析。
35525 名受检者的结果如下：31123 名为上皮内病变或恶性肿瘤阴性（NILM）/hrHPV-，2612 名为 NILM/hrHPV+，262 名为非典型鳞状细胞意义不明确（ASC-US）/hrHPV-，213 名为 ASC-US/hrHPV+，291 名为 LSIL+/hrHPV-，1024 名为 LSIL+/hrHPV+。在 256 名 LSIL+/hrHPV-受检者中，有组织学结果的 24 名为 CIN2+（9.4%），10 名为 CIN3（3.9%），1 名为宫颈腺癌（0.4%），3 名为子宫体癌（1.2%），1 名为子宫肉瘤（0.4%）。总的来说，LSIL+/hrHPV-的检出率为 0.82%（291/35525），其中 0.1%（36/35525）为 CIN2 级以上的宫颈病变。仅发现 1 例宫颈腺癌，但不包括胃型腺癌。
HPV 阴性的 CIN2+或宫颈腺癌不是日本开展原发性 HPV 筛查的关注点。在日本，宫颈癌筛查中采用原发性 HPV 检测被认为是一种可行的方法，尽管需要建立适合日本的算法和国家级管理系统。
