Kaufman R H, Adam E, Icenogle J, Lawson H, Lee N, Reeves K O, Irwin J, Simon T, Press M, Uhler R, Entman C, Reeves W C
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
Am J Obstet Gynecol. 1997 Jan;176(1 Pt 1):87-92. doi: 10.1016/s0002-9378(97)80017-8.
To evaluate the utility of human papillomavirus detection in identifying women with abnormal Papanicolaou smears who can be safely followed up with cytologic study only, we conducted a study to determine the sensitivity, specificity, and negative and positive predictive values of a Food and Drug Administration-approved human papillomavirus test kit for detection of cervical intraepithelial neoplasia in colposcopically directed biopsy specimens.
We enrolled women with abnormal Papanicolaou smears referred to a colposcopy clinic serving indigent patients. All 1128 women had a referral Papanicolaou smear, a clinic Papanicolaou smear, and a sample for human papillomavirus deoxyribonucleic acid test; 1075 underwent colposcopically directed biopsies and endocervical curettage. We used the HPV Profile kit for human papillomavirus testing.
Of 486 women with low-grade squamous intraepithelial lesions on Papanicolaou smear, 35.4% had high-risk human papillomavirus deoxyribonucleic acid detected, and of 592 with high-grade lesions, 44.4% had high-risk human papillomavirus detected. Among 527 women with biopsy specimens showing cervical intraepithelial neoplasia and in 267 with cervical intraepithelial neoplasia grades 2 or 3, 38.7% and 56.2% had high-risk human papillomavirus deoxyribonucleic acid detected. However, the sensitivity of human papillomavirus deoxyribonucleic acid detection to identify biopsy-confirmed cervical intraepithelial neoplasia grades 2 or 3 was 55.7%, and the positive predictive value of the test was only 34.9%.
Human papillomavirus appears to be causally associated with cervical cancer but human papillomavirus screening does not appear to be of value to identify women with abnormal Papanicolaou smears who can be safely followed up with cytologic study alone.
为评估人乳头瘤病毒检测在识别巴氏涂片异常且仅通过细胞学检查即可安全随访的女性中的效用，我们开展了一项研究，以确定一种经美国食品药品监督管理局批准的人乳头瘤病毒检测试剂盒在阴道镜引导下活检标本中检测宫颈上皮内瘤变的敏感性、特异性、阴性预测值和阳性预测值。
我们纳入了转诊至为贫困患者服务的阴道镜诊所的巴氏涂片异常的女性。所有1128名女性均进行了转诊巴氏涂片、诊所巴氏涂片及人乳头瘤病毒脱氧核糖核酸检测样本；1075名女性接受了阴道镜引导下活检及宫颈管刮术。我们使用HPV Profile试剂盒进行人乳头瘤病毒检测。
在486名巴氏涂片显示低度鳞状上皮内病变的女性中，35.4%检测到高危人乳头瘤病毒脱氧核糖核酸；在592名有高度病变的女性中，44.4%检测到高危人乳头瘤病毒。在527名活检标本显示宫颈上皮内瘤变的女性以及267名宫颈上皮内瘤变2级或3级的女性中，分别有38.7%和56.2%检测到高危人乳头瘤病毒脱氧核糖核酸。然而，人乳头瘤病毒脱氧核糖核酸检测识别活检确诊的宫颈上皮内瘤变2级或3级的敏感性为55.7%，该检测的阳性预测值仅为34.9%。
人乳头瘤病毒似乎与宫颈癌存在因果关联，但人乳头瘤病毒筛查对于识别巴氏涂片异常且仅通过细胞学检查即可安全随访的女性似乎并无价值。
