Effects of age and human papilloma viral load on colposcopy triage: Data from the randomized atypical squamous cells of undetermined significance low-grade squamous intraepithelial lesion triage study (ALTS)
Effects of age and human papilloma viral load on colposcopy triage: Data from the randomized atypical squamous cells of undetermined significance low-grade squamous intraepithelial lesion triage study (ALTS)
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DOI：
10.1093/jnci/94.2.102
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发表时间：
2002-01-16
期刊：
影响因子：
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通讯作者：
Cox, JT
中科院分区：
文献类型：
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作者：
Sherman, ME;Schiffman, M;Cox, JT
背景资料：在1.0-pg/mL阈值下检测致癌人乳头瘤病毒（HPV）DNA是一种有希望的方法，可用于阴道镜分类意义不明的非典型鳞状细胞（ASCUS），但不适用于低度鳞状上皮内病变（LSIL）。考虑年龄或病毒载量可以改善阴道镜分类。研究方法：我们确定了1996年11月至1998年12月参加ALTS的2198名ASCUS妇女和848名LSIL妇女检测宫颈上皮内瘤变3（CIN 3）和癌症的敏感性，以及使用HPV检测和重复薄层细胞病理学检查进行阴道镜检查的转诊百分比。我们分析了年龄和HPV载量和重复细胞病理学的两个阈值的结果。结果如下：对于ASCUS，1.0 pg/mL HPV检测的总体灵敏度为96.1%（95%置信区间[CI] = 92.8至99.5%），随年龄变化最小（范围，93.9%至97.8%）。HPV检测在这一阈值将涉及31.2%（95% CI = 28.0%至34.3%）的29岁或以上的女性，而超过65%的年轻女性。在29岁或29岁以上的ASCUS女性中，转诊进行ASCUS重复细胞病理学检查的敏感性为90.9%（95% CI = 81.1%至100.0%），转诊率为50.1%（95% CI = 46.7%至53.5%）。在所有ASCUS中，使用10.0-pg/mL阈值的HPV检测将敏感性降低至91.5%，转诊率降低至41.7%。超过63%的LSIL将被引用使用任何策略实现90%的敏感性。结论：对于患有ASCUS的女性，HPV检测对于检测CIN 3和癌症具有高度敏感性，老年女性的转诊数量显着减少。无论是单一的HPV检测还是重复的细胞病理学检查都不能为LSIL女性提供有用的分流。
Background: Testing for oncogenic human papillomavirus (HPV) DNA at a 1.0-pg/mL threshold represents a promising approach for colposcopy triage of atypical squamous cells of undetermined significance (ASCUS), but not for low-grade squamous intraepithelial lesions (LSIL). Considering age or viral load could improve colposcopy triage. Methods: We determined the sensitivity for detecting Cervical Intraepithelial Neoplasia 3 (CIN3) and cancer and the percentage of referrals for colposcopy using HPV testing and repeat thin-layer cytopathology in 2198 women with ASCUS and in 848 women with LSIL enrolled in ALTS from November 1996 through December 1998. We analyzed results by age and at two thresholds for HPV load and repeat cytopathology. Results: For ASCUS, the overall sensitivity of HPV testing at 1.0 pg/mL was 96.1 % (95 % confidence interval [CI] = 92.8 to 99.5%) and varied minimally with age (range, 93.9% to 97.8%). HPV testing at this threshold would refer 31.2% (95% CI = 28.0% to 34.3%) of women aged 29 years or older as compared with more than 65% of younger women. Among women aged 29 years or older with ASCUS, referral for repeat cytopathology of ASCUS had a sensitivity of 90.9 % (95 % CI = 81.1 % to 100.0 %) and would refer 50.1 % (95% CI = 46.7 to 53.5%). Among all ASCUS, HPV testing using a 10.0-pg/mL threshold decreased sensitivity to 91.5% and referrals to 41.7%. More than 63% of LSIL would have been referred using any strategy achieving 90% sensitivity. Conclusion: For women with ASCUS, HPV testing was highly sensitive for detecting CIN3 and cancer with dramatically fewer referrals of older women. Neither a single HPV test nor repeat cytopathology provides useful triage for women with LSIL.