Five-year risks of CIN 3+ and cervical cancer among women with HPV-positive and HPV-negative high-grade Pap results.
Five-year risks of CIN 3+ and cervical cancer among women with HPV-positive and HPV-negative high-grade Pap results.
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DOI：
10.1097/lgt.0b013e3182854282
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发表时间：
2013-04
影响因子：
3.7
通讯作者：
Kinney WK
中科院分区：
文献类型：
--
作者：
Katki HA;Schiffman M;Castle PE;Fetterman B;Poitras NE;Lorey T;Cheung LC;Raine-Bennett T;Gage JC;Kinney WK
High-grade Pap results (e.g., AGC, ASC-H, and HSIL) predict high cancer risks, resulting in referral to colposcopy without HPV triage. However, new guidelines recommending cotesting for women 30 and older imply that clinicians will often receive the HPV test result concurrently for high-grade Pap results. We examined whether HPV testing provides useful risk stratification in this context. From a cohort of 965,360 women age 30–64 undergoing cotesting at Kaiser Permanente Northern California, we estimated 5-year risks of cervical cancer and CIN3+ for AGC (2,074 women), ASC-H (1,647 women), and HSIL (2,019 women) according to HPV test results. HPV positivity of AGC Pap results was 25% and decreased with age (30–34: 44% vs. 60–64: 17%, p<0.0001), while HPV-positivity of ASC-H and HSIL were much higher (71% and 94% respectively) and decreased less with age. Even for these high-grade Pap results, 5-year CIN3+ risks differed substantially between HPV-positive and HPV-negative women (AGC: 33% vs. 0.93%, p<0.0001; ASC-H: 25% vs. 3.5%, p<0.0001; HSIL: 49% vs. 30%, p=0.006). However, except for AGC, cervical cancer risks differed less between HPV-positive and HPV-negative women (AGC: 9.0% vs. 0.37%, p<0.0001; ASC-H: 2.5% vs. 2.1%, p=0.8; HSIL: 6.6% vs. 6.8%, p=0.7). The risks of CIN3+ for HPV-negative high-grade Pap results were lower than for HPV-positive high-grade Pap results, especially for AGC. However, by the principle of “equal management of equal risks”, all HPV-negative high-grade Pap results had cancer risks high enough to warrant colposcopy, confirming that there is no current role for HPV triage of high-grade Pap results.
