Outcomes in Women With Cytology Showing Atypical Squamous Cells of Undetermined Significance With vs Without Human Papillomavirus Testing
Outcomes in Women With Cytology Showing Atypical Squamous Cells of Undetermined Significance With vs Without Human Papillomavirus Testing
复制标题
细胞学显示意义不明的非典型鳞状细胞与未进行人乳头瘤病毒检测的妇女的结局
DOI：
10.1001/jamaoncol.2017.1040
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发表时间：
2017-10-01
期刊：
影响因子：
28.4
通讯作者：
Wheeler, Cosette M.
中科院分区：
文献类型：
--
作者：
Cuzick, Jack;Myers, Orrin;Wheeler, Cosette M.
高级别宫颈上皮内瘤变(CIN)的长期转移率以及HPV对活检率和治愈率的影响我们知之甚少。ASCUS细胞学分类显示有未确定意义的非典型鳞状细胞(以下简称ASC-US细胞学)。目的为了检查ASC-US细胞学检查后5年的结果。设计、设置和参与这项观察性研究的所有妇女从2007年1月1日至2012年12月31日获得宫颈细胞学和HPV检测报告，并与病理报告相联系。分析的日期为2015年5月4日至2017年1月13日。HPV检测对疾病产率、组织学确诊时间以及活检或电环切除手术的影响的主要结果和指标。结果2008至2012年间，共有457 317名接受筛查测试的女性(平均年龄39.8[12.5]岁)，其中20 677例(4.5%)首次细胞学结果报告为ASC-US。接受HPV检测的女性CIN 3级或更严重(CIN3+)病变的发生率为2.49%，而未检测HPV的女性为2.15%(P=0.23)。进行HPV检测的患者检测到CIN3+的时间比未检测的患者短得多(中位数，103天比393天；P<；.001)。在进行HPV检测的女性中，11.6%的人检测到CIN 1级，而未进行检测的女性中，有6.6%的人检测到CIN 1级(相对危险度，1.76；95%可信区间，1.56-2.00；P<；.001)。在接受HPV检测的患者中，5年内环状电切率高出20.0%，导致CIN2+和CIN3+的检出更多。结论和相关性人乳头瘤病毒检测使宫颈疾病的诊断更快、更全面，但环状电切术的活检和环状电切手术分别增加了55.8%和20.0%。在那些接受测试的人中，几乎所有的高级别疾病都发生在43.1%的HPV阳性妇女身上，这使得临床资源能够集中在最需要它们的妇女身上。这些数据为宫颈筛查指南和公共卫生政策提供了基本信息。
IMPORTANCE Little is known about the long-term yield of high-grade cervical intraepithelial neoplasia (CIN) and the influence on biopsy and treatment rates of human papillomavirus (HPV) triage of cytology showing atypical squamous cells of undetermined significance (hereafter ASC-US cytology).OBJECTIVE To examine 5-year outcomes after ASC-US cytology with vs without HPV testing.DESIGN, SETTING, AND PARTICIPANTS In this observational study, all cervical cytology and HPV testing reports from January 1, 2007, to December 31, 2012, were obtained for women throughout New Mexico and linked to pathology reports. The dates of the analysis were May 4, 2015, to January 13, 2017.MAIN OUTCOMES AND MEASURES Influence of HPV testing on disease yield, time to histologically confirmed disease, and biopsy or loop electrosurgical excision procedure rates.RESULTS A total of 457 317 women (mean [SD] age, 39.8 [12.5] years) with a screening test were recorded between 2008 and 2012, and 20 677 (4.5%) of the first cytology results per woman were reported as ASC-US. CIN grade 3 or more severe (CIN3+) lesions were detected in 2.49% of women with HPV testing vs 2.15% of women without HPV testing (P = .23). Time to CIN3+ detection was much shorter in those with HPV testing vs those without testing (median, 103 vs 393 days; P < .001). CIN grade 1 was detected in 11.6% of women with HPV testing vs 6.6% without testing (relative risk, 1.76; 95% CI, 1.56-2.00; P < .001). Loop electrosurgical excision procedure rates within 5 years were 20.0% higher in those who underwent HPV testing, resulting in more CIN2+ and CIN3+ detection.CONCLUSIONS AND RELEVANCE Human papillomavirus testing led to faster and more complete diagnosis of cervical disease, but 55.8% more biopsies and 20.0% more loop electrosurgical excision procedures were performed. In those tested, virtually all high-grade disease occurred in the 43.1% of women who were HPV positive, allowing clinical resources to be focused on women who need them most. These data provide essential information for cervical screening guidelines and public health policy.