Department of Obstetrics and Gynecology, Professor Polydoro Ernani of Sao Thiago University Hospital of the Federal University of Santa Catarina, Florianópolis, Florianópolis, Brazil.
Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Brazil.
Cytopathology. 2024 Jan;35(1):122-130. doi: 10.1111/cyt.13320. Epub 2023 Oct 23.
To compare the sensitivity and specificity of DNA ploidy with cytology, human papillomavirus (HPV) testing and colposcopy in diagnosis of high-grade cervical intraepithelial neoplasia (CIN) and to assess the role of aneuploidy in cervical lesions with the worst prognosis. A prospective observational cohort study was conducted on 254 women with altered colpocytology.
Colposcopy, biopsy, DNA-ICM and HPV examinations were applied to cervical cytological and histological samples. Participants were evaluated every 6 months and divided into two groups: 'Harm' and 'No-harm'. Logistic regression and multivariate COX model were used to identify independent risk factors for diagnosis and prognosis of high-grade CIN, and ROC curve to assess the sensitivity and specificity of methods.
Variables 'age greater than or equal to 30 years', 'lesion size greater than 20%', 'aneuploidy' and 'HPV 16' were associated with diagnosis of high-grade CIN and 'aneuploidy' and 'women living with HIV', with a worse prognosis. Agreement for colposcopy was good, with a sensitivity of 79.3% and specificity of 94.4%; DNA-ICM and cytology were moderate, with sensitivity of 74.6% and 72.3% and specificity of 85.3% and 76.1%, respectively. High-risk HPV and HPV 16 tests were weak, with sensitivity of 75.0% and 43.75% and specificity of 50.0% and 88.64%, respectively.
In relation to high-grade CIN diagnosis, DNA-ICM presented similar sensitivity and specificity to cytology and high-risk HPV test when associated with HPV 16. Regarding prognosis, this research certifies that aneuploidy is considered a predictor of more severe cervical injury.
比较 DNA 倍体分析与细胞学、人乳头瘤病毒（HPV）检测和阴道镜检查在诊断高级别宫颈上皮内瘤变（CIN）中的敏感性和特异性，并评估非整倍体在预后最差的宫颈病变中的作用。对 254 例宫颈细胞学异常的女性进行了一项前瞻性观察性队列研究。
对宫颈细胞学和组织学样本进行阴道镜检查、活检、DNA-ICM 和 HPV 检查。每 6 个月对参与者进行评估，并分为“有害”和“无害”两组。采用逻辑回归和多变量 COX 模型来确定高级别 CIN 诊断和预后的独立危险因素，并采用 ROC 曲线来评估方法的敏感性和特异性。
“年龄大于或等于 30 岁”、“病变大小大于 20%”、“非整倍体”和“HPV16”等变量与高级别 CIN 的诊断相关，“非整倍体”和“HIV 感染者”与预后不良相关。阴道镜检查的一致性良好，敏感性为 79.3%，特异性为 94.4%；DNA-ICM 和细胞学检查为中度，敏感性分别为 74.6%和 72.3%，特异性分别为 85.3%和 76.1%。高危型 HPV 和 HPV16 检测的敏感性分别为 75.0%和 43.75%，特异性分别为 50.0%和 88.64%。
在高级别 CIN 的诊断方面，当与 HPV16 联合使用时，DNA-ICM 与细胞学和高危型 HPV 检测具有相似的敏感性和特异性。就预后而言，本研究证实非整倍体被认为是宫颈损伤更严重的预测因子。
