利用肛门细胞学检查、人乳头瘤病毒DNA及E6/E7信使核糖核酸检测优化对感染HIV的男男性行为者进行高分辨率肛门镜检查的转诊
Using Anal Cytology and Human Papillomavirus DNA and E6/E7 mRNA Detection to Optimize High-Resolution Anoscopy Referrals in Men Who Have Sex With Men With HIV.
作者信息
Silva-Klug Ana C, Paytubi Sònia, Torres Montserrat, Trenti Loris, Baixeras Nuria, Sanchez-Llamas Monica, Pavon Miquel A, De Sanjose Silvia, Catala Isabel, Vidal August, Poljak Mario, Alemany Laia, Podzamczer Daniel, Videla Sebastian, Saumoy Maria
机构信息
HIV and STD Unit, Infectious Diseases Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain.
Infection and Cancer Laboratory, Cancer Epidemiology Research Program, Catalan Institute of Oncology/Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain.
出版信息
Open Forum Infect Dis. 2024 Dec 27;12(1):ofae735. doi: 10.1093/ofid/ofae735. eCollection 2025 Jan.
BACKGROUND
This study was conducted to evaluate screening procedures for anal high-grade squamous intraepithelial lesions (HSILs) with anal liquid-based cytology (aLBC) and biomarkers to identify candidates for high-resolution anoscopy (HRA).
METHODS
This cross-sectional study included men who have sex with men with HIV. Participants underwent HRA, aLBC, and biomarker testing. Three screening procedures were compared with aLBC: biomarker alone, cytology and biomarker in all, and cytology and reflex biomarkers (biomarkers applied if aLBC results were atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion). Biomarkers included Linear Array (LA), LA for 14 high-risk human papillomavirus (LA 14 HR-HPV) genotypes, LA HPV-16, Hybrid Capture 2 (HC2), E6/E7 mRNA, and E6/E7 mRNA HPV-16.
RESULTS
Of 354 participants, 179 (50.6%) had atypical squamous cells of undetermined significance or worse, requiring HRA (sensitivity, 80%; specificity, 57.3%; area under the curve, 0.687; reference, biopsy-proven HSIL). Cytology and reflex biomarkers per E6/E7 mRNA, LA 14 HR-HPV, and HC2 and the biomarker-alone procedure with HC2 showed comparable accuracy (sensitivities: 71.6%, 78.8%, 73.1%, 75.7%; specificities: 73.5%, 67.9%, 76.1%, 65.5%; areas under the curve: 0.726, 0.734, 0.746, 0.706) with fewer HRA referrals (number needed to diagnose: 2.2, 2.1, 2, 2.4).
CONCLUSIONS
Our findings suggest that E6/E7 mRNA, LA 14 HR-HPV, and HC2 in the cytology and reflex biomarkers procedure, as well as HC2 in the biomarker-alone procedure, can improve anal HSIL screening effectiveness.
背景
本研究旨在评估采用肛门液基细胞学检查（aLBC）和生物标志物对肛门高级别鳞状上皮内病变（HSIL）进行筛查的程序，以确定高分辨率肛门镜检查（HRA）的候选对象。
方法
这项横断面研究纳入了男男性行为的HIV感染者。参与者接受了HRA、aLBC和生物标志物检测。将三种筛查程序与aLBC进行比较：单独使用生物标志物、同时进行细胞学和生物标志物检测、以及细胞学和反射性生物标志物检测（如果aLBC结果为意义不明确的非典型鳞状细胞或低级别鳞状上皮内病变，则应用生物标志物）。生物标志物包括线性阵列（LA）、针对14种高危人乳头瘤病毒（LA 14 HR-HPV）基因型的LA、LA HPV-16、杂交捕获2代（HC2）、E6/E7 mRNA以及E6/E7 mRNA HPV-16。
结果
在354名参与者中，179名（50.6%）有意义不明确的非典型鳞状细胞或更严重病变，需要进行HRA（敏感性为80%；特异性为57.3%；曲线下面积为0.687；对照为经活检证实的HSIL）。基于E6/E7 mRNA、LA 14 HR-HPV和HC2的细胞学和反射性生物标志物检测程序以及单独使用HC2的生物标志物检测程序显示出相当的准确性（敏感性分别为：71.6%、78.8%、73.1%、75.7%；特异性分别为：73.5%、67.9%、76.1%、65.5%；曲线下面积分别为：0.726、0.734、0.746、0.706），且需要进行HRA转诊的人数较少（诊断所需人数分别为：2.2、2.1、2、2.4）。
结论
我们的研究结果表明，在细胞学和反射性生物标志物检测程序中使用E6/E7 mRNA、LA 14 HR-HPV和HC2，以及在单独使用生物标志物检测程序中使用HC2，可提高肛门HSIL筛查的有效性。
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