Herrington C S, Evans M F, Gray W, McGee J O
University of Oxford, Nuffield Department of Pathology and Bacteriology, England, UK.
Hum Pathol. 1995 Sep;26(9):951-5. doi: 10.1016/0046-8177(95)90083-7.
Human papillomavirus (HPV) analysis of cytological material has been advocated for determining those patients with low-grade cervical cytological abnormalities who have current high-grade squamous intraepithelial lesions (SILs). In this study, we analyzed concurrent cervical smears and biopsies from 167 patients with Papanicolaou (Pap) smears showing persistent atypical squamous cells of uncertain significance (ASCUS) or low grade SILs (1) to compare the detection of HPV by nonisotopic in situ hybridization (NISH) on matched smears and biopsies; (2) to analyze the type and distribution of NISH signal within lesions; and (3) to define further the ability of NISH techniques to distinguish between patients with low- and high-grade SIL. Whether present in cervical smears or biopsies, high-risk HPV types (16, 18, 31, 33, and related types) were significantly associated with high-grade SILs (P < .001) but were found in 15% of low-grade SILs. Ninety percent of high grade lesions were directly infected by these HPV types, and good concordance (92.2%) was found between NISH analysis of matched cervical smears and biopsies, indicating accurate colposcopic targetting of biopsies and excision specimens. Punctate signal morphology, which correlates with viral integration, was associated with high-grade SILs but was also observed in two low-grade SILs. Although the presence of high-risk HPV types in low-grade SILs limits the predictive ability of HPV testing by this means in this group of patients, those patients with high-risk HPV infection of low-grade SILs may be a greater risk of progression to high-grade SIL or invasive carcinoma. If this were the case, HPV testing would be of potential value in the management of patients with low-grade cytological abnormalities.
有人主张对细胞学材料进行人乳头瘤病毒（HPV）分析，以确定那些患有低度宫颈细胞学异常但目前存在高级别鳞状上皮内病变（SIL）的患者。在本研究中，我们分析了167例巴氏涂片显示意义不明确的持续性非典型鳞状细胞（ASCUS）或低级别SIL的患者的同期宫颈涂片和活检组织，目的如下：（1）比较在配对的涂片和活检组织上通过非同位素原位杂交（NISH）检测HPV的情况；（2）分析病变内NISH信号的类型和分布；（3）进一步明确NISH技术区分低级别和高级别SIL患者的能力。无论在宫颈涂片还是活检组织中，高危HPV类型（16、18、31、33及相关类型）均与高级别SIL显著相关（P < 0.001），但在15%的低级别SIL中也有发现。90%的高级别病变直接被这些HPV类型感染，配对的宫颈涂片和活检组织的NISH分析显示出良好的一致性（92.2%），表明活检和切除标本的阴道镜靶向定位准确。与病毒整合相关的点状信号形态与高级别SIL相关，但在两个低级别SIL中也观察到。虽然低级别SIL中存在高危HPV类型限制了通过这种方法进行HPV检测在该组患者中的预测能力，但低级别SIL伴有高危HPV感染的患者进展为高级别SIL或浸润癌的风险可能更高。如果是这样，HPV检测在管理低度细胞学异常患者方面可能具有潜在价值。
