Cuzick J, Szarewski A, Terry G, Ho L, Hanby A, Maddox P, Anderson M, Kocjan G, Steele S T, Guillebaud J
Department of Mathematics, Statistics, and Epidemiology, Imperial Cancer Research Fund, London, UK.
Lancet. 1995 Jun 17;345(8964):1533-6. doi: 10.1016/s0140-6736(95)91086-7.
Several studies have examined the role of tests for human papillomavirus (HPV) in screening for cervical cancer but as yet the relevance is unclear. We looked at HPV testing for types 16, 18, 31, and 33 on material taken at the time of a cervical smear in 2009 eligible women having routine screening. Women with any degree of dyskaryosis or high levels of one of these HPV types were referred for colposcopy. 44% of the cervical intraepithelial neoplasia (CIN) lesions of grade 2/3 detected had negative cytology and were found only by HPV testing. A further 22% of the CIN 2/3 lesions were positive for HPV but showed only borderline or mild cytological changes. The positive predictive value of HPV testing was 42%, which was similar to that for moderate dyskaryosis. HPV types 16 and 31 were more sensitive and specific for CIN 2/3 than were types 18 or 33. However, 25% of the CIN 2/3 lesions were not detected by these four HPV tests. We suggest that HPV testing could usefully augment but not replace conventional cytology. These results should stimulate a much larger randomised trial to assess the impact of these improved CIN 2/3 detection rates on the subsequent incidence of invasive cancer.
多项研究探讨了人乳头瘤病毒（HPV）检测在宫颈癌筛查中的作用，但目前其相关性尚不清楚。我们对2009年接受常规筛查的符合条件的女性进行宫颈涂片检查时所取样本，检测了其中HPV 16、18、31和33型。有任何程度的细胞发育异常或这些HPV类型之一水平较高的女性被转诊进行阴道镜检查。检测出的2/3级宫颈上皮内瘤变（CIN）病变中，44%的病例细胞学检查呈阴性，仅通过HPV检测发现。另外22%的CIN 2/3病变HPV检测呈阳性，但仅显示临界或轻度细胞学改变。HPV检测的阳性预测值为42%，与中度细胞发育异常的阳性预测值相似。HPV 16和31型对CIN 2/3的敏感性和特异性高于18或33型。然而，这四种HPV检测未检测出25%的CIN 2/3病变。我们认为，HPV检测可有效辅助但不能取代传统细胞学检查。这些结果应促使开展规模更大的随机试验，以评估这些提高的CIN 2/3检出率对后续浸润性癌发病率的影响。
