Detection of precancerous cervical lesions is differential by human papillomavirus type.
Detection of precancerous cervical lesions is differential by human papillomavirus type.
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DOI：
10.1158/0008-5472.can-08-4192
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发表时间：
2009-04-15
期刊：
影响因子：
11.2
通讯作者：
Castle PE
中科院分区：
文献类型：
--
作者：
Safaeian M;Schiffman M;Gage J;Solomon D;Wheeler CM;Castle PE
流行病学研究报告称，与这些 HPV 类型引起的宫颈癌比例相比，由人乳头瘤病毒 (HPV) 18 型和 45 型 (HPV18/45) 引起的宫颈癌前病变的代表性不足。我们使用 ASCUS-LSIL 分类研究 (ALTS) 的数据调查了组织学宫颈上皮内瘤变 3 级或更严重 (CIN3+) 的诊断时机。在 2,725 名接受阴道镜检查的女性中，在 2 年 ALTS 持续时间内诊断出组织学 CIN3+ 的 472 名女性中，有 412 名 (87.3%) 可以被分配到 HPV 类型或类型组，并纳入本分析。 84% 的 HPV16 阳性 CIN3+ 在入组时被诊断出，而 HPV18/45 阳性 CIN3+ 的诊断率为 57%，其他致癌 HPV 类型的 CIN3 阳性的诊断率为 58%。相比之下，只有 8% 的 HPV16 阳性 CIN3+ 在研究退出时被诊断出来，而 31% 的 HPV18/45 阳性，22% 在研究退出时其他致癌类型呈阳性 (p<0.001)。这些结果表明 HPV18/45 在癌前病变中的代表性不足，而 HPV16 相关的 CIN3+ 的诊断要早得多。 18/45 的代表性不足是否可能是由于隐匿病理学所致，需要进一步调查。
Epidemiologic studies have reported the under-representation of cervical precancerous lesions caused by human papillomavirus (HPV) types 18 and 45 (HPV18/45) compared to the proportion of cervical cancers attributed to these HPV types. We investigated the timing of diagnosis of histologic cervical intraepithelial neoplasia grade 3 or worse (CIN3+) using data from the ASCUS-LSIL Triage Study (ALTS). Of the 2,725 women who underwent enrollment colposcopy 412 of 472 (87.3%) diagnosed with histologic CIN3+ over the 2-year duration of ALTS could be assigned to a HPV type or group of types and were included in this analysis. Eighty-four percent of HPV16-positive CIN3+ were diagnosed at enrollment, compared with 57% of HPV18/45-positive CIN3+, and 58% of CIN3 positive for other carcinogenic HPV types at enrollment. In contrast, only 8% of HPV16-positive CIN3+ were diagnosed at exit, while 31% were HPV18/45-positive and 22% were positive for other carcinogenic types at study exit (p<0.001).. These results indicate the under-representation of HPV18/45 in pre-cancers while HPV16-associated CIN3+ is diagnosed much earlier. Whether the under-representation of 18/45 may be due to occult pathology needs further investigation.