对457例ASCUS患者进行分流管理的临床分析

目的:探讨对宫颈无明确诊断意义的不典型鳞状细胞(ASCUS)患者进行分流管理的最佳方案。方法:对筛查结果为ASCUS的457例患者进行高危型人乳头瘤病毒(hr-HPV)检测,同时均行阴道镜检查及宫颈定点、多点活检或宫颈管内膜刮取术(ECC),分析HPV检测结果、阴道镜检查结果与组织病理检查结果的关系。结果:(1)宫颈上皮内瘤变(CIN)II级以上检出率为11.16%(51/457),高发年龄为30~49岁,占73.52%(336/457),其次为20~29岁,占23.19%(106/457)。(2)hr-HPV阳性、阴性组CINII以上检出率分别为19.18%、1.89%(χ2=34.30,P0.05);hr-HPV检测方法在检出CINII以上病变的灵敏度、特异度、阳性预测值、阴性预测值分别为92.16%、51.23%、19.18%、98.11%。HPV16为最常见亚型,占46.94%(115/245),其次为HPV 52,占25.31%(62/245);HPV 16、52亚型CINII以上检出率分别为29.57%、12.90%(χ2=6.18,P0.05)。(3)阴道镜拟诊与组织病理学诊断CINⅠ、CINⅡ、CINⅢ、宫颈癌的符合率分别为34.23%(38/111)、68.75%(22/32)、88.89%(16/18)、100%(5/5)。阴道镜检查在检出CINII以上病变的灵敏度、特异度、阳性预测值、阴性预测值分别为78.18%、21.64%、12.01%、87.88%。结论:ASCUS可含有潜在的CINⅡ~Ⅲ及宫颈癌,可发生任何年龄。高危型HPV检测对CINⅡ以上阴性预测值高,在ASCUS患者分层管理中的价值优于阴道镜检查,尤其HPV16阳性需立即阴道镜检查。     

高危型人乳头瘤病毒检测在宫颈未明确诊断意义的不典型鳞状上皮细胞中的价值

目的:评价人乳头瘤病毒(HPV)分型检测在宫颈未明确诊断意义的不典型鳞状上皮细胞(ASCUS)分层处理中的临床价值。方法:对宫颈液基细胞涂片结果判读为ASCUS的351例患者行高危型HPV分型检测、阴道镜下宫颈活组织检查及宫颈管内膜诊刮术。分析ASCUS患者病理检查结果与HPV分型检测结果的关系。结果:①351例ASCUS病例中,病理证实宫颈上皮内瘤变(CIN)共69例(69/351,19.6%),其中CINⅡ及以上检出26例,占总数的7.4%(26/351)。②351例ASCUS病例中,高危型HPV阳性率为55.6%(195/351)。高危型HPV阳性及HPV感染阴性组CINⅡ及以上病变检出率分别为11.8%(23/195)、2.1%(3/142),相比差异有统计学意义(P<0.05)。高危型HPV阳性对检出CINⅡ及以上病变的敏感度、特异度、阳性预测值及阴性预测值分别为88.46%,48.00%,11.79%,98.07%。③195例高危型阳性病例中,HPV16亚型及58亚型阳性率分别为45.6%及21.0%。HPV16亚型及58亚型阳性组中CINⅡ及以上检出率分别为7.7%(15/195)、2.6%(5...     

216例宫颈细胞学为ASCUS的临床意义及处理探讨

目的：探讨宫颈细胞学诊断为意义未明的不典型鳞状细胞（ASCUS）的临床意义及处理方法。方法：2008年1月—2009年12月,对天津医科大学总医院妇科门诊的216例宫颈细胞学诊断为ASCUS的患者行阴道镜评估与镜下活检,其中140例同时接受了人乳头瘤病毒（HPV）检测。结果：①ASCUS患者宫颈上皮内瘤样病变（CIN）的发生率为44.44%,高级别CIN与宫颈癌发生率为20.37%。②高级别CIN及宫颈癌发病平均年龄为（44.57±11.23）岁,明显高于湿疣和低级别CIN者（均P＜0.05）。③发生宫颈高级别CIN及宫颈癌的ASCUS患者高危HPV亚型以16型最常见,出现概率为41.67%,HPV58、18、52型感染率排在第2～4位。④HPV阳性者CIN检出率为55.56%,明显高于HPV阴性者的31.25%和直接阴道镜检的38.16%（均P＜0.05）。⑤HPV检测高度鳞状上皮内病变（HSIL）阴性预测值为93.75%。结论：ASCUS病理类型复杂,32岁以下年轻患者发生宫颈湿疣可能性大,40岁以上特别是合并HPV16、58、18、52型感染者应警惕高级别CIN及宫颈癌的可能。ASCUS患者应先行HPV检测分流,阳性者联合阴道镜检查以提高CIN检出率,阴性者可定期重复细胞学检查。     

216例宫颈细胞学为ASCUS的临床意义及处理探讨

目的：探讨宫颈细胞学诊断为意义未明的不典型鳞状细胞（ASCUS）的临床意义及处理方法。方法：2008年1月—2009年12月,对天津医科大学总医院妇科门诊的216例宫颈细胞学诊断为ASCUS的患者行阴道镜评估与镜下活检,其中140例同时接受了人乳头瘤病毒（HPV）检测。结果：①ASCUS患者宫颈上皮内瘤样病变（CIN）的发生率为44.44%,高级别CIN与宫颈癌发生率为20.37%。②高级别CIN及宫颈癌发病平均年龄为（44.57±11.23）岁,明显高于湿疣和低级别CIN者（均P〈0.05）。③发生宫颈高级别CIN及宫颈癌的ASCUS患者高危HPV亚型以16型最常见,出现概率为41.67%,HPV58、18、52型感染率排在第2～4位。④HPV阳性者CIN检出率为55.56%,明显高于HPV阴性者的31.25%和直接阴道镜检的38.16%（均P〈0.05）。⑤HPV检测高度鳞状上皮内病变（HSIL）阴性预测值为93.75%。结论：ASCUS病理类型复杂,32岁以下年轻患者发生宫颈湿疣可能性大,40岁以上特别是合并HPV16、58、18、52型感染者应警惕高级别CIN及宫颈癌的可能。ASCUS患者应先行HPV检测分流,阳性者联合阴道镜检查以提高CIN检出率,阴性者可定期重复细胞学检查。     

TCT联合高危型HPV基因检测在绝经后妇女宫颈上皮内瘤变筛查的价值评估

目的:评价宫颈薄层液基细胞检测(TCT)联合高危型HPV基因分型检测在绝经后妇女宫颈上皮内瘤变(CIN)筛查的价值。方法:选取TCT检查结果异常,包括意义不明不典型鳞状细胞(ASCUS)、低度鳞状上皮内瘤变(LSIL)、高度鳞状上皮内瘤变(HSIL)和鳞状上皮癌(SCC)的163例绝经后妇女为研究对象,荧光定量PCR(FQ-PCR)法检测高危型人乳头状瘤病毒(HR-HPV16、18、31、33、45、52、56、58)分型,并以阴道镜下宫颈活检病理学诊断作为诊断金标准进行对比研究。结果:①不同年龄段绝经妇女TCT结果异常的类型构成比,差异无统计学意义(P>0.05)。②HPV分型检测阳性者80例,感染率49.1%,随着TCT检查宫颈病变级别的升高,HR-HPV感染率亦逐步增加,与低级别比,差异有统计学意义(P<0.05)。③163例TCT异常患者中,病理学诊断阳性51例(CINⅠ级24,CINⅡ级9例,CINⅢ级6例,宫颈浸润癌12例),阳性率31.3%(51/163)。随着TCT检查宫颈癌变级别的增高,宫颈组织病理学诊断阳性率逐步增加,差异有统计学意义(P<0.01)。④宫颈炎组中HR-HPV阳性40例,感染率35.71%,宫颈CIN阳性组中HR-HPV阳性29例,感染率74.4%(其中CIN I级70.8%,CIN II级77.8%,CIN III级83.3%),宫颈浸润癌组中HR-HPV阳性11例,感染率91.7%,随着宫颈病变病理级别的升高,HR-HPV感染率呈上升趋势(P<0.01)。⑤TCT联合HPV检测、单独HPV检测对CIN及宫颈癌筛查的敏感度均高于TCT检查,分别为96.1%、78.4%、66.7%(P<0.01)。TCT联合HPV分型检测、单独HPV检测对CIN及宫颈癌筛查的假阴性率低于TCT检测,有显著性统计学差异(P<0.01)。3种筛查方法的特异度、假阳性率比较,无统计学差异(P>0.05)。结论:TCT联合高危型HPV基因分型检测在绝经后妇女宫颈上皮内瘤变筛查中具有重要意义。     

HPV检测在宫颈未明确诊断意义的不典型鳞状上皮

目的:探讨宫颈人乳头瘤病毒(HPV)DNA检测对宫颈未明确诊断意义的不典型鳞状上皮细胞(ASCUS)患者的诊断价值.方法:对98例薄层液基细胞学(TCT)检测结果为ASCUS的患者进行高危型HPV DNA检测,根据检测结果分为HPV DNA阳性组和HPV DNA阴性组.所有患者行阴道镜检查并活检,以病理检查结果为金标准,病理检查结果为CINⅠ、CINⅡ、CINⅢ、宫颈浸润癌判定为宫颈活检阳性,并进行比较.结果:高危型HPV DNA检测阳性组中宫颈活检阳性率为58.92%,高危型 HPV DNA检测阴性组中宫颈活检阳性率为28.57%,两组比较差异有高度统计学意义(X~2=0.8906,p<0.01).结论:HPV检测对ASCUS患者行进一步诊断有临床意义.     

贵州老年女性宫颈癌筛查的分析评价

目的:评价宫颈细胞学、高危型人乳头瘤病毒(HPV)DNA检测及阴道镜检查对老年女性宫颈病变筛查的效力。方法:分析于贵州医科大学附属医院妇科阴道镜门诊行阴道镜检查并行阴道镜下病理活检的602例50岁以上老年女性的宫颈癌筛查资料,比较细胞学、高危型HPV DNA检测与阴道镜检查在老年女性宫颈病变筛查中的意义。结果:602例老年女性中,病理学诊断为宫颈高级别以上病变221例(CINII/III 133例,宫颈癌88例)占36.7%。宫颈细胞学筛查宫颈高级别以上病变,以ASCUS为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为86.7%、47.3%、43.4%和88.4%;以LSIL为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为35.2%、88.7%、59.2%和74.6%;以HSIL为分界点的灵敏度、特异度、阳性预测值和阴性预测值分别为30.5%、96.0%、78.0%和74.8%;高危型HPV DNA分型检测宫颈高级别以上病变的灵敏度、特异度、阳性预测值和阴性预测值分别为71.2%、32.3%、34.3%和69.4%;高危型HPV DNA检测联合细胞学(≥ASCUS)检查筛查宫颈高级别以上病变的灵敏度、特异度、阳性预测值和阴性预测值分别为100%、22.67%、54.7%和100%;阴道镜诊断与子宫颈病理诊断的完全符合率为63.51%,一致性检验Kappa值为0.631,阴道镜印象宫颈高级别病变及以上病变的敏感度为74.3%、阳性预测值为72.2%、阴道镜对于宫颈低级别病变及以下病变的特异度为89.4%,阴性预测值为90.4%,假阳性率为10.6%,假阴性率为25.7%。结论:对老年女性,细胞学检查是有效的宫颈癌筛查方法,细胞学联合HPV DNA筛查可使敏感度和阴性预测值提高,阴道镜检查可提高诊断率,三者结合应用将更有利于宫颈病变的科学管理。     

未明确诊断意义的不典型鳞状上皮细胞临床处理方法的探讨

目的:探讨宫颈液基细胞学检查(LCT)结果为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)的临床处理方法.方法:LCT检查结果为ASCUS的患者454例,将其随机分为3组:A组,151例,3月后复查LCT;B组,152例,随即进行高危型人乳头瘤病毒(HPV)检测:C组.151例,随即进行阴道镜检查,并在阴道镜下活检.比较3组ASCUS患者宫颈上皮内瘤变(CIN)的检出情况.结果:①A组复查LCT,细胞学异常(≥ASCUS)39例(25.83%),阴道镜下活检病理结果为宫颈炎24例,CINⅠ5例,CINⅡ9例,CINⅢ1例.95例复查LCT正常者阴道镜下活检,病理结果为宫颈炎88例,CINⅠ4例,CINⅡ2例,CINⅢ1例.②B组有60例(39.47%)高危型HPV检测阳性,其阴道镜下活检病理结果为宫颈炎32例,CINⅠ13例,CINⅡ13例,CINⅢ2例.80例HPV阴性者阴道镜下活检,病理均为宫颈炎.③C组151例ASCUS直接进行阴道镜检查及阴道镜下活检,病理结果为宫颈炎115例,CINⅠ12例,CINⅡ18例.CINⅢ6例.④复查LCT和检测高危型HPV对预测ASCUS患者中宫颈高级别病变的准确性差异无统计学意义(P＞0.05).结论:复查LCT是有效的分流ASCUS的方法.对于依从性差或高危人群,宜作高危型HPV检测进行分流,或直接行阴道镜检查及镜下活检明确诊断,随即作相应处理.     

宫颈无明确诊断意义的非典型鳞状细胞的临床意义及处理

目的:探讨宫颈无明确诊断意义的非典型鳞状细胞(ASCUS)的临床意义.方法:对22036例患者行宫颈液基细胞学检查(LPT),对其中417例被诊断为ASCUS的病例,同时用免疫组织化学法行人乳头瘤病毒(HPV)检测、阴道镜检查及宫颈活组织检查或宫颈管内膜刮出术.结果:高危型别HPV阳性率随病理学病变的严重程度而增加.而宫颈活检阳性率和阴性率的比值,高危型别HPV感染活检阳性率高于低危型别和HPV阴性患者.几个年龄段的HPV感染率差异无统计学意义.各年龄段ASCUS患者中炎症与CIN及宫颈癌的检出率差异无统计学意义.宫颈管内膜刮除术(ECC)43例,发现异常为8例(18.60%),宫颈活组织检查372例发现异常119例(31.99%),宫颈活组织检查阳性率高于ECC.结论:对ASCUS患者应重视HPV检测,特别是HPV高危型的检查,ECC可作为一种辅助宫颈活组织检查的诊断手段,细胞学异常而伴有高危型别HPV感染但是阴道镜无明显异常发现的患者,可行ECC检查提高诊断率而避免漏诊.     

子宫颈液基细胞学、高危型HPV及联合检测在子宫颈癌机会性筛查中的价值

目的评价宫颈细胞学、高危型HPV及联合检测在宫颈癌机会性筛查中的作用。方法回顾性分析2012年1月至2014年10月在北京大学人民医院妇科门诊行宫颈癌机会性筛查异常行阴道镜检查的女性3 939例的临床资料。结果 1宫颈液基细胞学异常(≥ASC-US)2 632例,阴道镜病理提示宫颈高级别及以上病变(≥CIN2)患者981例,液基细胞学对≥CIN2筛查的灵敏度为77.47%(760/981),特异度为36.71%(1086/2 958),阳性预测值为28.88%(760/2 632),阴性预测值为83.09%(1 086/1 307)。诊断符合率为46.86%(1 846/3 939)。2高危型HPV阳性3268例,阴性671例,病理提示≥CIN2患者1 070例,高危型HPV对≥CIN2筛查的灵敏度为87.66%(938/1 070),特异度为18.79%(539/2 869),阳性预测值为28.70%(938/3 268),阴性预测值为80.33%(539/671)。诊断符合率为37.50%(1 477/3 939)。3液基细胞学和高危型HPV联合检测,液基细胞学异常且高危型HPV阳性2 300例,均阴性339例,病理提示≥CIN2 749例,液基细胞学及高危型HPV均异常对≥CIN2筛查的灵敏度为97.86%(733/749),特异度为17.09%(323/1 890),阳性预测值为31.87%(733/2 300),阴性预测值为95.28%(323/339)。诊断符合率为40.02%(1 056/2 639)。结论细胞学与高危型HPV联合检测对≥CIN2筛查的灵敏度、阳性预测值及阴性预测值均为最高,假阴性率最低,建议在门诊机会性筛查宫颈病变中联合应用细胞学与高危型HPV检测。     

Risk of precancer and follow-up management strategies for women with human papillomavirus-negative atypical squamous cells of undetermined significance

OBJECTIVE: To investigate the relative performances of follow-up cytology and carcinogenic human papillomavirus (HPV) DNA testing among carcinogenic HPV-negative women with atypical squamous cells of undetermined significance (ASCUS), for detection of cervical precancer. METHODS: Twelve-month follow-up management strategies to detect cervical intraepithelial neoplasia grade 3 (CIN3) or worse using cytology or HPV testing or both were compared among women with HPV-negative ASCUS in the Atypical Squamous Cells of Undetermined Significance-Low-Grade Squamous Intraepithelial Lesion (ASCUS-LSIL) Triage Study. RESULTS: Overall only 22 of 1,559 (1.4%) HPV-negative ASCUS women developed CIN grade 3 or worse during follow-up compared with 269 of 1,767 (15.2%) HPV-positive ASCUS women (P<.001). Because of the low risk of disease among HPV-negative ASCUS women, only 7 cases of CIN3 were diagnosed between 12 and 24 months of follow-up, limiting power to distinguish meaningful differences in sensitivity among 12-month testing strategies. The specificity of HPV testing (84%) was significantly higher than cytology using an ASCUS threshold (71%) (P<.001). Cotesting with cytology and HPV testing at 12 months resulted in even lower specificity (61%). Because cases were uncommon, the positive predictive value for subsequent CIN3 or worse was low for cytology (2.6%), Hybrid Capture 2 (3.8%), and cotesting with cytology and HPV testing (2.2%). The negative predictive value for all three management strategies was very high (99.70%, 99.82%, and 100.0% for HPV testing, cytology, or cotesting, respectively.) CONCLUSION: Women with HPV-negative ASCUS have very low absolute risk of subsequently detected CIN3 or worse in the subsequent 2 years, similar to women with a negative cytology in the absence of HPV testing. The results suggest that women with HPV-negative ASCUS should return to routine screening intervals which may be longer than 1 year depending on age and screening history. However, if increased surveillance is chosen, a single HPV test for carcinogenic types at 12 months has significantly higher specificity and lower referrals than cytology.     

Usefulness of human papilloma virus testing in the screening of cervical cancer precursor lesions: a retrospective study in 314 cases

OBJECTIVE: To assess the usefulness of human papilloma virus (HPV) typing for predicting pre-malignant and malignant cervical lesions. STUDY DESIGN: 314 women, who underwent colposcopy, biopsies and high and low-risk HPV typing after a confirmed abnormal routine Pap test were studied. HPV-DNAs were typed by using PCR technique. RESULTS: We found a significant increasing rate of high-risk-HPV by the increasing severity of histology, ranging from 40% in negative cases to 86.9% in those with CIN3 lesions. The positive predictive value of high-risk-HPV ranged from 13.3% in patients with atypical squamous cells of undetermined significance (ASCUS) to 29.4% in those with HSIL. By contrast, negative predictive value was 96% in patients with ASCUS, 97.2% in low-grade squamous intraepithelial lesions (LSIL), and 71.4% in high-grade squamous intraepithelial lesions (HSIL). Sensitivity and specificity for detecting CIN2 or CIN3 was 86.0% and 41.3%, respectively. CONCLUSIONS: The high negative predictive value of high-risk HPV testing suggests that HPV negativity could be used for predicting the absence of important cervical lesions, and therefore avoiding unnecessary colposcopy in ASCUS and LSIL cases.     

Contribution of human papillomavirus testing by hybrid capture in the triage of women with repeated abnormal pap smears before colposcopy referral

OBJECTIVE: The purpose of this work was to evaluate the ability of testing for high-risk human papillomavirus (HPV) types using the hybrid capture technique to predict the presence of cervical intraepithelial neoplasia (CIN) II,III in patients with repeated atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LGSIL) on Pap smears. METHODS: Hybrid capture testing and tissue biopsy were performed on 503 consecutive women with ASCUS or LGSIL on repeated Pap smears who were referred for colposcopy. RESULTS: A highly significant association (P < 0.0001) was found between a positive test for high-risk HPV types and CIN II,III, with an 87.0% positive predictive value and a 95.7% negative predictive value. In 226 women with ASCUS on repeated Pap smears, a positive test for high-risk HPV types had a 85.7% sensitivity and a 97% specificity for CIN II,III. In 277 patients with LGSIL on repeated Pap smears, a positive test for high-risk HPV types had an 88.2% sensitivity and a 94.7% specificity for CIN I,II. Reserving colposcopy examination for women who were positive for high-risk HPV types would have reduced the number of referrals for colposcopy to 24.6% and maintained a sensitivity of 87.0% for CIN II,III. CONCLUSIONS: A positive hybrid capture test for high-risk HPV types was highly sensitive and specific for the presence of CIN II,III in patients with ASCUS and LGSIL on repeated Pap smears. We believe that improved methodology will eventually enable more selective colposcopy referrals without affecting patient safety among these women.     

High-risk HPV DNA detection by Hybrid Capture II. An adjunctive test for mildly abnormal cytologic smears in women > or = 50 years of age

OBJECTIVE: To determine whether high-risk human papillomavirus (HPV) DNA testing could improve the detection of cervical intraepithelial neoplasia (CIN) and cancer in older women (> or = 50 years old) with mildly abnormal results on conventional cytology. STUDY DESIGN: The study was based on 119 patients aged over 50 (median, 62; range, 50-78) referred for colposcopy with Pap smears reported as atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesion (LSIL) from February 1997 to September 1998. The presence of high-risk HPV DNA (including HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68) was determined with the Hybrid Capture II (Digene, Inc., Silver Spring, Maryland) microplate method. Cytologic examination by Pap smear was based on the Bethesda System and, cervical biopsy was done via colposcopy. RESULTS: High-risk HPV DNA was demonstrated in 75.6% (34/45) of patients with LSIL and 52.7% (39/74) with ASCUS. Those who were HPV positive were significantly more likely to have CIN or cancer (odds ratio, 33.40; 95% confidence interval, 11.89-93.97; P < .0001). The sensitivity of HPV assay for detection of lesions more severe than CIN 2 was 100%, specificity 64.8%, positive predictive value 66.7% and negative predictive value 100%. CONCLUSION: The addition of a high-risk HPV DNA assay to cytologic examination appears to provide excellent sensitivity and negative predictive value for early detection of high grade CIN or cancer in older women with minimally abnormal Pap smears.     

意义不明确的不典型鳞状细胞中检测高危型HPV的价值

目的探讨在意义不明确的不典型鳞状细胞（ASCUS）中检测HR-HPV,预测宫颈上皮内瘤样病变及浸润癌的诊断价值。方法对宫颈薄层液基细胞学诊断为ASCUS的248例患者分别进行HR-HPV检测、阴道镜下活组织检查。结果在ASCUS患者中,CIN发生率为41.1%（102/248）,高级别CIN（CIN2、CIN3）和浸润癌发生率为9.3%（23/248）;在HR-HPV阳性组CIN检出率为68.1%（92/135）,在HR-HPV阴性组CIN检出率为8.8%（10/113）,两组间差异有统计学意义（χ2=89.330,P〈0.001）。阳性组发生CIN和浸润癌的风险是阴性组的22.037倍[OR（95%CI）=22.037（10.479～46.342）]。HR-HPV检测CIN和浸润癌的敏感度和特异度分别为68.1%和91.2%;阳性预测值和阴性预测分别为90.1%和70.5%。阴道镜拟诊CIN和浸润癌126例,检出率为80.4%（82/102）,其中高级别CIN和浸润癌20例,检出率为87.0%（20/23）;阴道镜检测CIN和浸润癌的敏感度和特异度分别为65.1%和83.6%;阳性预测值和阴性预测分别为80.4%和69.9%,与HR-HPV检测功效相似,关联系数为r=0.833;而阴道镜检测高级别CIN和浸润癌的敏感度和特异度分别为80.0%和98.7%;阳性预测值和阴性预测值分别为87.0%和97.8%。结论 HR-HPV阳性的ASCUS患者CIN发生率高,即行阴道镜检查;HR-HPV阴性患者可不行阴道镜检查而不会增加高级别CIN和浸润癌发生风险。     

Comparison of three management strategies for patients with atypical squamous cells of undetermined significance, after six months delay: A three-year experience in an Iranian university hospital

Background: A Pap test result of atypical squamous cells of undetermined significance (ASCUS) presents a clinical challenge. Only 5–10% of women with ASCUS harbour serious cervical disease.
Methods: We screened 3619 women, who attended to Mirza Koochak Khan Hospital at Tehran University of Medical Sciences with Pap smears, of whom 100 returned with ASCUS. After six months, each subject underwent a standard cytology (conventional Pap smear), human papillomavirus (HPV) DNA testing (identifying high-risk HPV types with polymerase chain reaction) and colposcopy with multiple cervical biopsies.
Results: Mean age was 44.09 ± 8.6 years. The estimated prevalence of cervical intraepithelial neoplasia (CIN) II or higher was 4%. When histologically verified high-grade lesions (≥ CIN II) were observed, the relative sensitivity of HPV DNA testing was 100% compared with conventional Pap smear, which performed 75% versus 100% relative sensitivity, respectively, using cytological diagnosis high-grade squamous intraepithelial lesion, or low-grade squamous intraepithelial lesion (LSIL) as the cut-off. Negative and positive predictive values (NPV and PPV) of Pap test were 98.9% and 100%. The NPV and PPV of HPV DNA testing were 100%.
Conclusions: Although less complicated than colposcopy, the repeat Pap smear triage algorithm for ASCUS may underdiagnose some women with high-grade CIN, when compared with colposcopy. Considering the high sensitivity of HPV testing, it may be useful as an alternative to the current policy of six-month repeat cytology for women with ASCUS results.     

Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy

OBJECTIVE: The purpose of this study was to determine the risk of cumulative cervical intraepithelial neoplasia (CIN) grade 2 or 3 according to initial colposcopy and directed biopsy results among women with low-grade squamous intraepithelial lesions (LSIL) or human papillomavirus (HPV) DNA positive atypical squamous cells of undetermined significance (ASCUS). STUDY DESIGN: A 2-year follow-up of 897 cases of LSIL and 1193 cases of HPV DNA positive ASCUS from the ASCUS/LSIL Triage Study was used to simulate American Society for Colposcopy and Cervical Pathology Consensus Conference recommendations. Women with CIN grade 1 or less were followed up for 2 years by semiannual cytologic examination, with universal exit colposcopy. The clinical end point was a cumulative clinical center histologic diagnosis of CIN grade 2 or 3. RESULTS: The cumulative risk of CIN grade 2 or 3 was equivalent for LSIL (27.6%) and HPV positive ASCUS (26.7%). After excluding the women with a diagnosis of CIN grade 2 or 3 at initial colposcopy and directed biopsy (17.9%), the remaining women were at nearly identical risk for subsequent CIN grade 2 or 3 regardless of initial colposcopy result (completely negative colposcopy-11.3%; negative colposcopically directed biopsy-11.7%; and CIN grade 1 biopsy-13.0%). CONCLUSION: LSIL and HPV positive ASCUS are clinically equivalent. Initial colposcopic detection of obviously prevalent CIN grade 2 or 3 reduces risk. However, for the remaining women who have CIN grade 1 or less on colposcopy and directed biopsy, the risk for subsequent CIN grade 2 or 3 (whether missed, prevalent, or truly incident) is approximately 12% over 2 years. This risk does not vary meaningfully by initial distinction of histologic CIN grade 1 from negative colposcopy and biopsy.     

Role of human papillomavirus (HPV) testing in the follow-up of patients after treatment for cervical precancerous lesions

OBJECTIVE: To evaluate the role of human papillomavirus (HPV) testing in post-treatment follow-up of patients after therapeutic excision of the cervix due to positive screening tests. STUDY DESIGN: A hospital-based retrospective analysis was performed with prospective collection of patient data of women screened for cervical cancer at a Gynecologic Outpatient Clinic. Patients after therapeutic excision due to positive screening results were identified and followed up with HPV testing and serial cytology. RESULTS: After 61 treatment for cervicalis intraepithelialis neoplasia (CIN), high-risk HPV infection was detected during the post-treatment follow-up at 18 cases (29.5%), 10 of them had persisting cytological atypia (positive predictive value (PPV): 56%), 5 developed CIN (PPV: 28%). When the HPV test was negative (43 patients) in the post-treatment period, neither CIN nor persisting cytological atypia developed (negative predictive value (NPV): 100%) during 1201 patient months (median 26 months). CONCLUSIONS: A negative HPV test eliminates the risk of recurrent disease after treatment for CIN.     

Clinical validation of high risk HPV DNA testing versus ThinPrep cytology for primary cervical cancer screening

Objective(s)To compare the validity of the high risk HPV DNA testing using the hybrid capture II technique (HC-II) to ThinPrep cytology for primary cervical cancer screening.DesignCross sectional pilot study.SettingDepartment of Obstetrics and Gynecology, Taiba Hospital, Sabah Al Salem, Kuwait.MethodsConsecutive 1923 cervical smear samples were taken for ThinPrep cytological screening and hr-HPV DNA testing using HC-II assay. Histological diagnoses were obtained from a total of 426 women who had positive results on screening and a group of women with negative screening and suspicious cervix underwent colposcopy and directed biopsies, and those with cervical precancerous lesions or cancer received appropriate treatment.Main outcome measuresSensitivity, specificity, positive predictive value and negative predictive value of screening methods.ResultsHPV was found positive in 15.5% of cases. 19/22 cases (86.4.1%) with a biopsy diagnosis of CIN2+ had a HC-II positive test. For CIN3, HC-II was positive in all cases (100%). Assuming a similar specificity level, the relative sensitivity of the HC-II test was higher when histologically confirmed high grade lesions (CIN2+ or CIN3+) were observed. HC-II test had the best sensitivity when defining cases as CIN2+ or CIN3+ (98.7% and 100%, respectively). When using the ASCUS+ cytological cutoff, the differences in CIN2+ and CIN3+ sensitivity between HC-II test and ThinPrep cytology were statistically not significant. Specificity of the ThinPrep cytology for any low and high grade histological lesions was clearly >95% when cytological diagnosis LSIL+ cutoff was used and nearly 100% when HSIL+ cutoff was used. All these specificity estimates were high compared with HC-II test. The specificity of the ThinPrep cytology decreased with about 10% when ASCUS+ was the cutoff. At cutoff ASCUS+, specificity of HC-II was comparable or only slightly lower than with ThinPrep ASCUS+ cytology with no statistically significant differences.ConclusionsThinPrep smears and hr-HPV DNA detection by HC-II performed very well with regard to identifying high grade lesions. HPV DNA testing is a promising new technology for cervical cancer prevention and can be used for primary screening in conjunction with cervical cytology for women aged 30 years and older.     

宫颈细胞学检查为ASCUS的临床意义及处理探讨

目的:探讨宫颈细胞学检查为ASCUS(不典型鳞状细胞-意义不明)的临床意义和处理方法。方法:2005年3月至2007年9月,对上海市第十人民医院妇科就诊的218例细胞学检查报告为ASCUS患者行阴道镜评估与镜下活检,其中100例患者同时进行了高危HPV-DNA检测。结果:218例ASCUS患者中宫颈上皮内瘤变(CIN)的发生率为49.54%,高级别CIN及浸润癌的发生率为17.43%,阴道镜拟诊≥CINⅡ40例,与病理结果相符29例,符合率72.5%(29/40)。高危HPV阳性组CIN检出率为66.67%,明显高于阴性组的36.96%。高级别CIN(CINⅡ、CINⅢ)17例中16例高危HPV-DNA检测阳性,仅1例CINⅡ为阴性。鳞癌3例,高危HPV检测均为阳性。结论:细胞学报告为AS-CUS时,阴道镜下病理活检结果相差大,而且可能是发现高度CIN的第一个信号,需引起重视。高危HPV-DNA检测是一种有效的ASCUS分流管理手段,能提高CIN的检出率。