Biomarkers in cervical cancer screening.
Biomarkers in cervical cancer screening.
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DOI：
10.1155/2007/678793
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
von Knebel Doeberitz M
中科院分区：
文献类型：
--
作者：
Wentzensen N;von Knebel Doeberitz M
在工业化国家，使用巴氏试验的人群广泛的细胞学筛查计划已导致宫颈癌的发病率大幅降低。尽管取得了明显的成功，但依赖于巴氏染色细胞学样本的筛查程序有几个局限性。首先，许多可疑或轻度异常的检测结果需要通过重复检测或直接阴道镜检查和活检进行昂贵的检查，因为一定比例的需要立即治疗的高级别病变隐藏在这些不明确的检测结果中。这种轻度异常或可疑细胞学检查的工作消耗了宫颈癌筛查总成本的大量资金。改进这些样本的分类可能会大大降低成本。宫颈癌是由致癌的人乳头瘤病毒（HPV）持续感染引起的。虽然HPV感染是一个不可或缺的因素，但它不足以导致癌症。大多数急性HPV感染诱导低级别前体病变，在超过90%的病例中，这些病变在几个月后自发清除，只有不到10%的病例最终进展为高级别病变或浸润性癌症。进展的特征在于病毒癌基因E6和E7在感染的基底细胞和副基底细胞中的表达失调。允许监测组织学或细胞学标本中这些基本分子事件的新型生物标志物可能改善在初级筛查和分诊设置中具有高进展风险的病变的检测。在这篇综述中，我们将讨论宫颈癌筛查的潜在生物标志物，重点是支持其在精细宫颈癌筛查计划中作为新型标志物应用的临床证据水平。
In industrialized countries, population wide cytological screening programs using the Pap test have led to a substantial reduction of the incidence of cervical cancer. Despite this evident success, screening programs that rely on Pap-stained cytological samples have several limitations. First, a number of equivocal or mildly abnormal test results require costly work up by either repeated retesting or direct colposcopy and biopsy, since a certain percentage of high grade lesions that require immediate treatment hide among these unclear test results. This work up of mildly abnormal or equivocal cytological tests consumes a large amount of the overall costs spent for cervical cancer screening. Improved triage of these samples might substantially reduce the costs. Cervical cancer is induced by persistent infections with oncogenic human papilloma viruses (HPV). While HPV infection is an indispensable factor, it is not sufficient to cause cancer. The majority of acute HPV infections induce low grade precursor lesions that are cleared spontaneously after several months in more than 90% of cases, and less than 10% eventually progress to high grade lesions or invasive cancer. Progression is characterized by the deregulated expression of the viral oncogenes E6 and E7 in infected basal and parabasal cells. Novel biomarkers that allow monitoring these essential molecular events in histological or cytological specimens are likely to improve the detection of lesions that have a high risk of progression in both primary screening and triage settings. In this review, we will discuss potential biomarkers for cervical cancer screening with a focus on the level of clinical evidence that supports their application as novel markers in refined cervical cancer screening programs.
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