Orth G, Croissant O
Unité Mixte Institut Pasteur/INSERM U190, Institut Pasteur, Paris.
Bull Acad Natl Med. 1997 Oct;181(7):1365-92; discussion 1392-4.
It is now admitted that certain genotypes of human papillomavirus (HPV), mainly HPV types 16 and 18, play an etiological role in the origin of the great majority of invasive carcinomas of the uterine cervix and their intraepithelial precursors. Such an evidence has modified our understanding of the natural history of cervical cancer and should result in new approaches for the early diagnosis and prevention of precursor lesions. Sensitive, specific and reliable HPV detection tests have been progressively designed but their use as routine tests requires multicentric studies, involving large series of women, to evaluate their usefulness in the clinical management or the screening of patients and to establish their limits and cost-effectiveness. It is already most likely that the association of HPV detection tests to cervicovaginal cytology would increase the detection rate of high-grade intraepithelial neoplasia and constitute a means for quality control in cytology. The viral origin of most cancers of the uterine cervix paves the way for their prevention by vaccination against the main oncogenic HPV genotypes and provides hope for specific immunotherapy of associated neoplasia.
现在人们承认，某些基因型的人乳头瘤病毒（HPV），主要是16型和18型HPV，在绝大多数子宫颈浸润癌及其上皮内前驱病变的发生中起着病因学作用。这一证据改变了我们对宫颈癌自然史的认识，并应带来早期诊断和预防前驱病变的新方法。已经逐步设计出敏感、特异且可靠的HPV检测试验，但将其用作常规检测需要进行多中心研究，涉及大量女性，以评估其在患者临床管理或筛查中的效用，并确定其局限性和成本效益。HPV检测试验与宫颈阴道细胞学检查相结合很可能会提高高级别上皮内瘤变的检出率，并构成细胞学质量控制的一种手段。大多数子宫颈癌的病毒起源为通过针对主要致癌HPV基因型进行疫苗接种来预防这些癌症铺平了道路，并为相关瘤变的特异性免疫治疗带来了希望。
