Costa S, Sideri M, Bucchi L, Schettino F, Maini I, Spinaci L, Bovicelli L, Terzano P
Department II of Obstetrics and Gynecology, St. Orsola Hospital, Bologna, Italy.
Gynecol Oncol. 1998 Dec;71(3):404-9. doi: 10.1006/gyno.1998.5183.
Cervicography and HPV DNA testing have been proposed as intermediate triage techniques for the management of patients with Pap smear showing minor-grade atypia. The aims of the present study of 221 patients with positive Pap smear (ages 16-65) were (1) to evaluate the association of cervicography and HPV DNA test with the probability of biopsy and final histology diagnosis of CIN2 or worse, (2) to identify the combinations of results on cervicography and HPV DNA test associated with the absence of such lesions, and (3) to estimate the cost of a potential triage protocol for patients with HPV-CIN1 smear. The probability of biopsy showed a univariate association with the severity of the smear result and the cervicography classification but not the HPV DNA test. In the multivariate analysis, only the cervicography result was a significant predictor of biopsy. The final histology diagnosis showed a univariate association with each of the three tests and a multivariate association with the degree of cytology positivity and the cervicography result. Among patients with HPV-CIN1 smears, only a negative cervicography (with any HPV DNA test result) was always associated with the absence of severe histologic lesions. This pattern accounted only for 7% of such patients. The additional costs of a potential triage protocol based on cervicography were estimated to exceed the savings resulting from the reduced colposcopy rate.
宫颈涂片检查和人乳头瘤病毒（HPV）DNA检测已被提议作为对巴氏涂片显示轻度不典型增生患者进行管理的中间分流技术。本研究纳入了221例巴氏涂片阳性患者（年龄16 - 65岁），目的如下：（1）评估宫颈涂片检查和HPV DNA检测与活检概率以及CIN2或更严重病变最终组织学诊断的相关性；（2）确定宫颈涂片检查和HPV DNA检测结果的组合与不存在此类病变的相关性；（3）估算针对HPV - CIN1涂片患者的潜在分流方案的成本。活检概率在单因素分析中与涂片结果的严重程度和宫颈涂片检查分类相关，但与HPV DNA检测无关。在多因素分析中，只有宫颈涂片检查结果是活检的显著预测因素。最终组织学诊断在单因素分析中与这三项检测中的每一项都相关，在多因素分析中与细胞学阳性程度和宫颈涂片检查结果相关。在HPV - CIN1涂片患者中，只有宫颈涂片检查结果为阴性（无论HPV DNA检测结果如何）始终与不存在严重组织学病变相关。这种模式仅占此类患者的7%。基于宫颈涂片检查的潜在分流方案的额外成本估计超过了因阴道镜检查率降低而节省的费用。
