Wright T C, Lorincz A, Ferris D G, Richart R M, Ferenczy A, Mielzynska I, Borgatta L
Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, New York 10032, USA.
Am J Obstet Gynecol. 1998 May;178(5):962-6. doi: 10.1016/s0002-9378(98)70531-9.
The study examined interrelationships between sensitivity and specificity of "reflex human papillomavirus deoxyribonucleic acid testing" from liquid-based cervical cytologic specimens by means of receiver operator characteristics curves.
A cohort study was performed on 265 women evaluated by colposcopy because of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion found on Papanicolaou smear.
At a positive threshold of 0.2 pg/ml (1000 copies of human papillomavirus per test), human papillomavirus deoxyribonucleic acid testing detected 86% of women with cervical intraepithelial neoplasia and 93% of women with high-grade cervical intraepithelial neoplasia with a specificity of 30%. Decreasing the sensitivity of the human papillomavirus test to 1 pg/ml (5000 copies of human papillomavirus per test) improved the specificity of a positive result to 44% but decreased the clinical sensitivity to 78% for cervical intraepithelial neoplasia grade 2 or 3. Relationships between sensitivity and specificity were influenced by patient age and referral diagnosis. For example, limiting the analysis to only women with a referral for atypical squamous cells of undetermined significance found on Papanicolaou smear and a positive human papillomavirus test threshold of 0.5 pg/ml produced a sensitivity of 90% for cervical intraepithelial neoplasia grade 2 or 3 and a test specificity of 55%.
Human papillomavirus deoxyribonucleic acid testing of residual cellular material from liquid cytologic specimens appears to be more appropriate for older women (>30 years old) and women with atypical squamous cells of undetermined significance, as opposed to low-grade squamous intraepithelial lesion, on their Papanicolaou smears.
本研究通过绘制受试者工作特征曲线，探讨液基宫颈细胞学标本中“反射性人乳头瘤病毒脱氧核糖核酸检测”的敏感性与特异性之间的相互关系。
对265名因巴氏涂片检查发现意义不明确的非典型鳞状细胞或低级别鳞状上皮内病变而接受阴道镜检查的女性进行了队列研究。
在阳性阈值为0.2 pg/ml（每次检测1000份人乳头瘤病毒拷贝）时，人乳头瘤病毒脱氧核糖核酸检测可检测出86%的宫颈上皮内瘤变女性和93%的高级别宫颈上皮内瘤变女性，特异性为30%。将人乳头瘤病毒检测的敏感性降至1 pg/ml（每次检测5000份人乳头瘤病毒拷贝）可将阳性结果的特异性提高至44%，但对于2级或3级宫颈上皮内瘤变，临床敏感性降至78%。敏感性与特异性之间的关系受患者年龄和转诊诊断的影响。例如，仅对因巴氏涂片检查发现意义不明确的非典型鳞状细胞且人乳头瘤病毒检测阳性阈值为0.5 pg/ml而转诊的女性进行分析，对于2级或3级宫颈上皮内瘤变，敏感性为90%，检测特异性为55%。
对液基细胞学标本中的残留细胞物质进行人乳头瘤病毒脱氧核糖核酸检测，对于年龄较大（>30岁）且巴氏涂片检查发现意义不明确的非典型鳞状细胞而非低级别鳞状上皮内病变的女性似乎更为合适。
