HPV genotyping for triage of women with abnormal cervical cancer screening results: a multicenter prospective study
HPV genotyping for triage of women with abnormal cervical cancer screening results: a multicenter prospective study
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DOI：
10.1007/s10147-015-0789-4
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发表时间：
2015-10-01
影响因子：
3.3
通讯作者：
Yoshikawa, Hiroyuki
中科院分区：
文献类型：
--
作者：
Nakamura, Yuko;Matsumoto, Koji;Yoshikawa, Hiroyuki
在宫颈癌筛查项目中，细胞学异常的妇女被推荐进行阴道镜检查以进行组织学评估。我们研究了人乳头瘤病毒（HPV）基因分型检测是否可以用于识别因宫颈上皮内瘤变3级或更坏（CIN3+）风险低而不需要立即阴道镜检查和活检的妇女。我们前瞻性评估了2种致癌HPV基因型（HPV16/18）、8种（HPV16/18/31/33/35/45/52/58）和13种（HPV16/18/31/33/35/ 51/52/56/58/59/68）对427例阴道镜筛查阳性女性的组织学CIN3+结果的预测。研究对象包括214例低级别鳞状上皮内病变（LSIL）， 184例高级别鳞状上皮内病变（HSIL）， 29例非典型鳞状细胞，不能排除HSIL （ASC-H）。在LSIL细胞学检查的女性中，HPV16/18阳性为29.4%，8种类型的HPV16/18阳性为58.9%，13种类型的HPV16/18阳性为74.8% （P < 0.001）。对于HPV16/18检测阴性的女性，CIN3+活检结果的风险仍为7.9%，但对于至少8种HPV （HPV16/18/31/33/35/45/52/58）检测阴性的女性，CIN3+活检结果的风险降至0.0%。尽管HPV基因分型结果使HSIL/ASC-H细胞学的女性有了额外的风险分层，但在8种或更多类型检测为阴性的女性中，组织学CIN3+诊断的风险仍然足够高（bbb35 %），需要立即转诊阴道镜检查。对于患有LSIL细胞学检查的女性，那些至少8种高危型HPV （HPV16/18/31/33/35/45/52/58）检测呈阴性的女性可能不需要立即进行阴道镜检查和活检。这将减少约40%的阴道镜检查转诊。然而，HPV基因分型检测不太可能改变女性HSIL/ASC-H的临床管理。
In cervical cancer screening programs, women with abnormal cytology are referred for colposcopy for histological evaluation. We examined whether a human papillomavirus (HPV) genotyping assay could be used to identify women who do not need immediate colposcopy and biopsy because of low risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+).We prospectively evaluated test performance for 2 carcinogenic HPV genotypes (HPV16/18), for 8 types (HPV16/18/31/33/35/45/52/58), and for 13 types (HPV16/18/31/33/35/45/51/52/56/58/59/68) for prediction of histological CIN3+ results among 427 screen-positive women referred for colposcopy. The study subjects consisted of 214 women with low-grade squamous intraepithelial lesion (LSIL), 184 with high-grade squamous intraepithelial lesion (HSIL), and 29 with atypical squamous cells, cannot exclude HSIL (ASC-H).Among women with LSIL cytology, HPV16/18 positivity was 29.4 % and increased to 58.9 % for 8 types and to 74.8 % for 13 types (P < 0.001). The risk of CIN3+ biopsy results was still 7.9 % for women testing negative for HPV16/18, but decreased to 0.0 % for those testing negative for at least eight types of HPV (HPV16/18/31/33/35/45/52/58). Although HPV genotyping results enabled additional risk stratification among women with HSIL/ASC-H cytology, the risk of histological CIN3+ diagnosis among women testing negative for eight types or more was still sufficiently high (> 35 %) to warrant immediate colposcopy referral.Of women with LSIL cytology, those testing negative for at least eight of the highest-risk types of HPV (HPV16/18/31/33/35/45/52/58) may not need immediate colposcopy and biopsy. This would reduce the number of colposcopy referrals by approximately 40 %. However, the HPV genotyping assay is not likely to alter the clinical management of women with HSIL/ASC-H.