Prediction of high-grade cervical disease with human papillomavirus detection in women with glandular and squamous cytologic abnormalities

The objective of this study was to assess whether human papillomavirus (HPV) detection with hybrid capture II (HC II) can help predict the presence and the nature, glandular or squamous, of histologic cervical lesions in women referred due to atypical glandular cells (AGC) or high-grade squamous intraepithelial lesion (HSIL). A total of 247 women were included. Referral Pap smears comprised AGC (51 cases), AGC plus HSIL (28 cases), adenocarcinoma in situ (10 cases), and HSIL (158 cases). All patients were tested for high-risk HPV with HC II and had a histologic assessment of their cervix. Histologic analysis showed 38 women with (15.3%) cervicitis, 194 with (75.5%) squamous lesions, and 15 with (9.2%) glandular neoplasia. The overall rate of high-risk HPV detection was 77%. Almost 70% of AGC-HPV-negative patients did not have a pathologically proven cervical neoplasia, whereas 76% of women with AGC-HPV-positive result were diagnosed with a squamous or glandular neoplasia. Most (95%) of the lesions in patients with AGC-HSIL were of squamous nature, and HPV detection did not contribute to their differentiation from glandular lesions. We conclude that in women with AGC, HPV positivity strongly correlated with the presence of glandular or squamous cervical lesion but did not help distinguishing women with squamous from those with glandular neoplasia.     

The distribution and differential risks of human papillomavirus genotypes in cervical preinvasive lesions: a Taiwan Cooperative Oncologic Group Study

To clarify the distribution and relative risk of different human papillomavirus (HPV) genotypes in cervical preinvasive lesions, 1246 women with abnormal Papanicolaou smear including atypical squamous cell of unknown significance (ASCUS), atypical glandular cell of unknown significance (AGUS), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL) were enrolled in a multicenter, cross-sectional study. Colposcopy and HPV tests with hybrid capture 2 and polymerase chain reaction-reverse line blot were performed. The prevalences of HPV in ASCUS/AGUS-negative histology, ASCUS/AGUS, LSIL, HSIL, and invasive cancer were 33.8%, 38.3%, 74.9%, 84.3% and 100%, respectively, with an overall positive rate of 68.8%. The most common HPV types were HPV 16 (18.5%), 52 (16.5%), 58 (13.2%), 33, 51, 53, 18, 39, 59, 66, MM8, and 31. In comparing the relative risk of HPV infection in different disease status, LSIL and HSIL/carcinoma had a 4.64 (95% CI: 2.98-7.24) and 10.53 (95% CI: 6.69-16.58) folds of risk of high-risk HPV infection than the negative group. The same was true in mixed HPV infection, but not in low-risk type infection. Looking into each high-risk HPV type, the relative infection risks for LSIL and HSIL/carcinoma, in comparison with the negative group, were 1.67 (0.63-4.43) and 8.67 (3.46-21.70), 2017 (1.01-4.68) and 3.04 (1.42-6.47), and 1.40 (0.52-3.77) and 5.22 (2.07-13.19) for HPV type 16, 52 and 58, respectively. The study confirmed the high prevalence and risky nature of HPV 52 and 58 in Taiwanese population and conveyed the need to include these HPV types in vaccine development.     

应用TERC基因检测子宫颈病变的临床研究

目的 探讨TERC基因作为宫颈病变筛查指标的临床意义.方法 选取在北京大学人民医院和北京大学深圳医院妇科门诊进行官颈病变筛杳的715例患者为研究对象,对其宫颈脱落细胞行液基细胞学榆查,并行第2代杂交捕获试验(HC-II)检测高危型人乳头状瘤病毒(HPV),必要时行阴道镜活榆及病理检查.荧光原位杂交(FISH)技术检测细胞内TERC基因的异常扩增情况.以病理检查结果为"金标准",将TERC基因异常扩增结果与液基细胞学检查和高危型HPV检测结果进行比较.结果 在宫颈液基细胞学检查结果为正常、未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、不除外高度病变的不典型鳞状上皮细胞(ASC-H)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)和不典型腺细胞(AGC)中,TERC基因异常扩增率分别为5.8%、22.2%、30.8%、27.8%、86.4%和1/1,正常、ASCUS、ASC-H和LSIL者均明显低于HSIL者(P<0.01).在病理检查结果为官颈上皮内瘤变(CIN)I、CIN Ⅱ～Ⅲ和浸润癌中,TERC基冈异常扩增率分别为9.3%、77.8%和96.7%,CIN I明显低于后两者(P<0.01).HPV检测结果为阳性患者的TERC基因扩增阳性率明显高于HPV阴性者(分别为33.5%和5.2%,P<0.01).TERC基因异常扩增诊断CIN Ⅱ及以上病变的敏感度为81.88%,明显高于细胞学检查的36.96%(P<0.01);其特异度(93.32%)明显高于HPV 检测的33.93%(P<0.01);阳性预测值(81.29%)与细胞学检查(86.44%)相似(P>0.05);而阴性预测值(93.56%)低于HPV检测(97.06%,P<0.05).结论 随着宫颈病变程度的加重,TERC基因异常扩增率增加,且其扩增与HPV感染有关.应用FISH技术检测TERC基因异常扩增作为分子遗传学指标,可以辅助细胞学榆查和HPV检测,协助筛出CIN Ⅱ及以上的高度病变和宫颈癌.     

Differential viral loads of human papillomavirus 16 and 58 infections in the spectrum of cervical carcinogenesis

Human papillomavirus (HPV) load was reported to be related to the severity of cervical neoplasia but with controversy. The viral load-disease severity relationship was showed in HPV 16, but no study was made in HPV 58, the second most prevalent HPV in cervical cancer in East Asia. We studied cervical HPV loads in HPV 16- and HPV 58-infected cases of normal, low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and invasive cervical cancer (CC) by using quantitative polymerase chain reaction (Q-PCR) with type-specific primers in defined cell number. With the exception of HPV 16 infection in normal, viral loads varied greatly in each disease regardless of genotypes. The load of HPV 16 differed significantly among disease severities, with a dramatic increase from normal (1.14 +/- 2.25 copies/cell) to LSIL, HSIL, and CC (1599 +/- 2301, 7489 +/- 24,087 and 1878 +/- 2979 copies/cell, respectively) (P < 0.01). No significant difference was noted among different HPV 58 infections, with loads in normal, LSIL, HSIL, and CC of 503 +/- 641, 7951 +/- 27,557, 353 +/- 744, and 1139 +/- 2895 copies/cell, respectively. In comparison with HPV 16, HPV 58 subclinical infection confers a significant higher load (P < 0.01). Different HPV types behave differentially in the spectrum of cervical carcinogenesis. Unlike HPV 16, the infection load of HPV 58 does not correlate to the clinical severity. The wide variation of HPV loads among different HPV types and among squamous intraepithelial lesions and CC makes the viral load test unrealistic in differentiating different severities of cervical neoplasia.     

子宫颈低级别鳞状上皮内病变的规范化处理及随访

子宫颈低级别鳞状上皮内病变（LSIL）是一种继发于急性HPV感染的组织学改变,总体预后良好。在排除更严重病变的前提下,LSIL的处理原则以随访为主。但对于既往细胞学结果为不能排除高级别鳞状上皮内病变不典型鳞状细胞（ASC-H）、高级别鳞状上皮内病变（HSIL）的LSIL,需注意排除隐匿性HSIL,必要时诊断性锥切以减少误诊。持续性或反复性LSIL的处理应综合评估,制定个体化方案。     

人乳头瘤病毒L1壳蛋白在筛查宫颈鳞状上皮内病变中的应用

目的:探讨人乳头瘤病毒(HPV)L1壳蛋白筛查HPV阳性妇女宫颈脱落细胞中宫颈鳞状上皮内病变的应用价值。方法:选取2012年5月至2014年12月就诊于温州市人民医院的妇女212例,收集宫颈脱落细胞并行HPV L1壳蛋白检测、HPV DNA分型、TCT(液基细胞学)及阴道镜下活检,比较HPV阳性妇女的宫颈脱落细胞中HPV L1壳蛋白的表达情况。结果:212例细胞学标本中HPV L1壳蛋白阳性率为33.9%,其中未见上皮内病变/恶性细胞组(NILM)、无明确诊断意义的鳞状上皮细胞病变组(ASCUS)、低度鳞状上皮内病变组(LSIL)、不能排除高度鳞状上皮内病变组(ASC-H)、高度鳞状上皮内病变组(HSIL)中阳性率分别为47.1%、35.1%、54.2%、29.2%、16.1%,各组比较差异有统计学意义(P0.05);两两比较,HSIL组与LSIL组和NILM组比较,差异均有统计学意义(P均0.005);进行数据合并后,LSIL/ASCUS组与ASC-H/HSIL组比较差异有统计学意义(P=0.001)。178例宫颈细胞学异常患者中,宫颈低级别病变和宫颈高级别病变的HPV L1壳蛋白阳性率比较,在ASCUS组(P=0.000)、LSIL组(P=0.004)中均有差异,在ASC-H组(P=0.127)、HSIL组(P=0.515)中均无差异。HPV 16/18感染患者的HPV L1壳缺失同宫颈高级别病变有更紧密的关系(P=0.003)。结论:子宫颈脱落细胞HPV L1壳蛋白检测在HPV阳性妇女的子宫颈病变筛查中具有一定的价值,可能成为一种合适的分流方法。     

Human papillomavirus DNA detection and histological findings in women referred for atypical glandular cells or adenocarcinoma in situ in their Pap smears

OBJECTIVE: To evaluate the association between high-risk human papillomavirus (HPV) DNA detection and histological diagnosis in women referred for atypical glandular cells (AGC) or adenocarcinoma in situ (AIS) at Pap smear. METHODS: In this cross-sectional study, 146 women referred for AGC (124), AGC with high-grade squamous intraepithelial lesion (HSIL) (15), or AIS (7) were tested for HPV DNA using Hybrid Capture II (HC II). All women underwent colposcopic examination, and cervical biopsy was performed for 95 patients. Fifty-one women referred due to AGC with normal colposcopy and normal second Pap smear were scheduled for control visits every 4 months. RESULTS: The overall prevalence of HPV DNA was 38%. HPV DNA was detected in 93% of the women with HSIL associated with AGC and in 71% of women with AIS Pap smear, being significantly higher when compared with the prevalence (29%) in women with AGC alone. Forty-five women (30.8%) had clinically significant histological lesions (CIN 2 or worse). High-risk HPV DNA was detected in only 16% of the women without significant abnormalities in biopsy, in contrast to 96% of those who had CIN 2 or CIN 3 and 75% of women with AIS. Eighty-five percent of women with invasive cervical carcinoma (squamous or adenocarcinoma) tested positive for HPV DNA. HPV DNA detection was significantly associated with histological diagnosis of CIN 2 or worse, with an odds ratio (OR) = 51.8 (95% CI 14.3-199.9). CONCLUSION: HPV DNA detection was strongly associated with the severity of cervical lesion (CIN 2 or worse) in women referred for AGC or AIS in their Pap smear. These data implicate the use of HPV testing in triage of women with AGC Pap smears.     

Cervical parakeratosis/hyperkeratosis as an important cause for false negative results of Pap smear and human papillomavirus test

Like any screening method, Pap and HPV tests are subject to false negative results.
Aim: We investigated the possible relationship between cervical parakeratosis/hyperkeratosis and a false negative result for both Pap and human papillomavirus (HPV) testing.
Methods: A total of 551 cases with diagnostically adequate cervical biopsies and Pap tests performed concurrently were examined.
Results: The vast majority of the cases (75.5%) were of concordance in diagnosis. Among the 135 discordant diagnoses were 98 with low-grade squamous intraepithelial lesion (LSIL) biopsy and negative Pap test and 34 with negative biopsy and LSIL Pap test. With rare exceptions, no significant discordance between concurrent biopsy and Pap test was found in the cases of high-grade squamous intraepithelial lesion (HSIL). Cervical parakeratosis/hyperkeratosis was noted in 87.8% of the LSIL biopsies with concurrent negative Pap tests. An 83.3% HPV-negative rate was also observed in this group. By comparison, parakeratosis/hyperkeratosis was less frequent (62.6%) in the SIL biopsies with concordant concurrent SIL Pap tests and usually seen focally when present. The negative HPV rates for these concordant LSIL and HSIL groups were 12.7% and 0.0%, respectively.
Conclusion: Cervical parakeratosis/hyperkeratosis is an important cause for the negative results of Pap and HPV tests in LSIL, and practising gynaecologist and pathologist should be aware of this possible diagnostic dilemma.     

子宫颈高级别鳞状上皮内病变的规范化处理及随访

子宫颈高级别鳞状上皮内病变（high-grade squamous intraepithelial lesion,HSIL）多为高危型HPV持续感染所致,属于子宫颈癌前病变。子宫颈锥切术为目前治疗子宫颈HSIL的主要手段,需根据规范制定切除范围。术后标本切缘阳性者不等同于病灶残留,应全面评估以制定后续个体化策略;年轻女性、妊娠期子宫颈HSIL排除浸润性病变后,治疗趋于保守。子宫颈HSIL治疗后复发/进展的发生率5倍于正常人群,故治疗后应长期随访。     

液基薄层细胞学ASCUS发生宫颈高级别上皮内病变的高危因素分析

目的:探讨宫颈细胞学不能明确意义的非典型鳞状细胞(ASCUS)发生宫颈高级别上皮内病变(HSIL)及以上的高危因素.方法:选取2018年7月至2019年11月就诊于郑州大学人民医院妇科的1074例患者,患者宫颈液基细胞学为ASCUS、高危型人乳头瘤病毒(HPV)阳性,且均行阴道镜检查+宫颈活检术,统计分析患者的临床资料...     

Underlying pathology of women with "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" smears, in a region with a high incidence of cervical cancer

AIM: To evaluate the histopathology of women who had "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions" (ASC-H) on cervical cytology in a region with high incidence of cervical cancer. METHODS: This study was conducted at Chiang Mai University Hospital, Chiang Mai, Thailand. All women with ASC-H, who had undergone colposcopic and histolopathologic evaluation between October 2004 and January 2007, were recruited. Similar cohorts with other squamous cell abnormalities on a Pap-smear, who had undergone colposcopy during the same period, were included as comparative groups. RESULTS: During the study period, 85 women who had ASC-H smears underwent colposcopic and histopathologic evaluation. The mean age was 45.3 years (range, 20-64 years). The histopathologic results of these 85 women were as follows: cervical intraepithelial neoplasia (CIN) II-III, 52 (61.2%); invasive cancer, 7 (8.2%); CIN I, 6 (7.1%); and no lesions, 20 (23.5%). The incidence of underlying CIN II or higher in an ASC-H smear (69.4%) was intermediate between atypical squamous cell of undetermined significance (22.7%), low-grade squamous intraepithelial lesion (44.7%) and high-grade squamous intraepithelial lesion (90.5%) smears. There was no statistically significant difference in the incidence of CIN II or higher between women who were 40 years old or more and those who were younger (68.7% and 71.4%, respectively, P=0.81), or between pre-menopausal and post-menopausal women (71.4% and 63.6%, respectively, P=0.49). CONCLUSION: Reporting ASC-H cytology in our population is strongly associated with significant cervical pathology, particularly invasive cancer that is possibly at a rate higher than previously reported. Women who have ASC-H smears should therefore be referred for immediate colposcopy regardless of age and menopausal status.     

子宫颈液基细胞学检查异常的涂片中人乳头状瘤病毒L1蛋白的表达及其意义

目的 探讨人乳头状瘤病毒(HPV)L1蛋白在官颈液基细胞学检查异常涂片中的表达及其意义.方法 选择2006年9月-2008年9月间,在中日友好医院就诊的官颈液基细胞学检查诊断为≥未明确诊断意义的不典型鳞状上皮细胞(ASCUS),且其第2代杂交捕获试验(HC-Ⅱ)榆测HPV DNA结果均为阳性,同时有组织病理学诊断的患者共274例.其中,宫颈液基细胞学检查诊断为ASCUS 105例、低度鳞状上皮内病变(LSIL)119例、不除外高度病变的不典型鳞状上皮细胞(ASC-H)9例、高度鳞状上皮内病变(HSIL)36例、官颈鳞癌5例;组织病理学检查(作为金标准)诊断为炎症96例、宫颈上皮内瘤变(CIN)Ⅰ 85例、CIN Ⅱ 55例、CIN Ⅲ 32例、官颈鳞癌6例.对此274例患者的官颈涂片,采用伞反应抗体的免疫细胞化学染色进行HPV L1蛋白的榆测,分析其对官颈病变进展的预测价值.结果 274例患者中,组织病理学检杏诊断为炎症的组织中HPV L1蛋白阳性表达率为69.8%(67/96),CIN Ⅰ为83.5%(71/85),CIN Ⅱ为41.8%(23/55),CIN Ⅲ为3.1%(1/32),宫颈鳞癌为0(0/6),除CIN Ⅲ与官颈鳞癌比较,差异无统计学意义(P>0.05)外,其他不同病变问比较,差异均有统计学意义(P<0.01);细胞学检查诊断为LSIL的细胞中HPV L1蛋白阳件表达率(75.6%,90/119)最高,其次为ASCUS细胞(63.8%,67/105)和HSIL+宫颈鳞癌细胞(9.8%,4/41),3者问比较,差异有统计学意义(P<0.01).71例未经治疗的ASCUS、LSIL患者中,55例HPV L1蛋白阳性表达者中无一例疾病进展,16例HPV L1蛋白阴性表达者疾病进展的发生率为19%(3/16),两者比较,差异有统计学意义(P<0.01).结论 HPV L1蛋白在宫颈液基细胞学检查异常涂片中的表达情况可以帮助了解宫颈的病变程度,预测宫颈病变的发展趋势,尤其对细胞学检查诊断为ASCUS和LSIL的患者可协助指导临床处理.     

Atypical glandular cells and adenocarcinoma in situ according to the Bethesda 2001 classification: cytohistological correlation and clinical implications

BACKGROUND: The objective of this study was to evaluate the correlation between the 2001 Bethesda classification of endocervical glandular abnormalities and histological diagnosis. STUDY DESIGN: A series of 155 women with endocervical glandular abnormalities on cervical smears were included: 91 with atypical glandular cells (AGC) not otherwise specified (NOS), 15 with AGC-favor neoplastic (FN); 35 with AGC associated with high-grade squamous intraepithelial lesion (HSIL) as combined diagnosis and 14 with adenocarcinoma in situ (AIS). RESULTS: Histological outcome of squamous neoplasias (CIN 2 or worse) and adenocarcinoma were significantly associated with AGC-FN and AIS, taking as reference AGC-NOS, and more associated with AIS than AGC-FN. Similar associations were observed for histological outcome of adenocarcinoma, but no association was observed for only squamous neoplasia. Histological outcome of CIN2 or worse was strongly associated with AGC when HSIL was also present, but no association was observed with only for adenocarcinoma histological outcome. CONCLUSIONS: AGC-NOS, AGC-FN and AIS cytological diagnosis represent a progressively increasing association with neoplastic diagnosis, due to progressively increasing association with adenocarcinoma. Histological outcome of squamous neoplasia is frequent but does not differ with these cytological interpretations. The presence of HSIL associated with AGC represents greater probability of squamous neoplasia but not adenocarcinoma.     

绝经后子宫颈高级别病变妇女子宫颈锥切术后病理升级为癌的影响因素分析#br#

【Abstract】?Objective?To investigate the related influencing factors of upgraded pathology after cervical conization of high-grade squamous intraepithelial lesions in postmenopausal women. Methods?Clinical data of 424 postmenopausal women with high-grade squamous intraepithelial lesions who underwent cervical conization in the First Affiliated Hospital of Zhengzhou University between June 2017 and November 2018 were retrospectively analyzed. According to whether the pathology was upgraded after conization,they were divided into upgraded group(68 cases)and non-upgraded group (356 cases), and the influencing factors of updated pathology were analyzed. Results?Among the 424 postmenopausal patients, 68 cases(16.0%) had updated pathological result after cervical conization.Univariate analysis showed that HPV16/18 infection, cytology with HSIL, typeⅢtransformion zone(TZ), atypical vessels, visible lesion size, number of biopsy, ECC, glandular involvement and immunosuppression status were significantly related to upgrade pathology after cervical conization (P＜0.05). Multivariate logistic analysis found that HPV16/18 infection, glandular involvement, atypical vessels and visible lesion size were independent risk factors for predicting postoperative updated patholog result (P＜0.05). Conclusion?HPV16/18 infection, glandular involvement, atypical vessels and visible lesion size are independent risk factors for predicting postoperative pathological upgrading in postmenopausal women.Patients with these risk factors should be given high attention.     

Persistent papillomavirus type-31 and type-45 infections predict the progression to squamous intraepithelial lesion

ObjectiveHuman papillomavirus (HPV) has been recognized as the major etiologic agent of cervical squamous cell carcinoma. However, it has been demonstrated that HPV infection is usually a self-limited process and does not lead to significant epithelial lesions or cancer. Recent data indicate that persistent high-risk HPV (HR-HPV) infections have a significantly increased risk of developing incident high-grade cervical intraepithelial neoplasia and cervical cancer. Our aim, therefore, was to assess whether there exist HPV genotypes whose persistence can be considered powerful surrogates of a progressive disease. We retrospectively selected all patients with a negative cytological diagnosis or with atypical squamous cells of undetermined significance, with a positive test for HR-HPV, different from HPV types 16 and 18, and assessed the significance of the risk of progression based on the persistence of the specific HR-HPV.Materials and methodsWe retrospectively queried the database of our Colposcopy Clinic for all patients with a negative cytological diagnosis or with atypical squamous cells of undetermined significance and a positive test for HR-HPV, and we calculated the incidence of progression to lesions greater than or equal to low-grade squamous intraepithelial lesions after 6 months, according to the HPV type.ResultsA progression rate of 48.27% was found in patients tested positive for HPV-31 (Group 1), 38.46% in patients tested positive for HPV-45 (Group 2), and 5.73% in patients tested positive for HPV types other than HPV-16, HPV-18, HPV-31, and HPV-45 (Group 3).ConclusionOur data demonstrate that the persistence of HPV-31 and HPV-45 is strongly associated with the occurrence of squamous intraepithelial lesion.     

Prevalence and genotype distribution of human papillomavirus in women with cervical cancer or high-grade precancerous lesions in Chengdu, western China

Objective

To study the prevalence and genotype distribution of human papillomavirus (HPV) among women with cervical cancer or high-grade squamous intraepithelial lesions (HSIL) in western China.

Methods

Cervical cast-off cells from 144 women with cervical cancer and 63 women with HSIL were tested for HPV genotypes using an oligonucleotide microarray.

Results

The overall HPV prevalence was 80.6% in cases of carcinoma and 61.9% in cases of HSIL. The most common genotypes were HPV-16 (carcinoma, 68.1%; HSIL, 34.9%) and HPV-58 (carcinoma, 8.3%; HSIL, 17.5%). Other high-risk types included HPV-18, -31, -33, -35, -45, and -52, with HPV-18 more common in adenocarcinomas than in squamous cell carcinomas (21.4% vs 3.1%; P < 0.02). The HPV prevalence was lower among patients older than 49 years (P < 0.02).

Conclusion

The prevalence of HPV-16 and HPV-58 was high. This finding may help to improve HPV vaccination and cervical cancer prevention programs in western China.     

Human papillomavirus infection and cervical disease in human immunodeficiency virus-1-infected women

OBJECTIVE: To report on the natural history of high-risk human papillomavirus (HPV) infection and cervical disease in human immunodeficiency virus (HIV)-1-infected women living in Cape Town, South Africa. METHODS: This was a prospective study of 400 untreated, HIV-1-infected women who underwent high-risk HPV DNA testing, cytology, colposcopy, histology, and CD4 count testing every 6 months for 36 months. Human immunodeficiency virus viral loads and HPV type distribution were determined at entry and after 18 months. RESULTS: Sixty-eight percent of the women were high-risk HPV DNA positive at entry, 35% had a cytologic diagnosis of low-grade squamous intraepithelial lesion (LSIL), and 13% had high-grade squamous intraepithelial lesion (HSIL). There were no cancers. Abnormal cytology and high-risk HPV positivity were strongly correlated with low CD4 counts and high HIV viral loads. The most prevalent types of HPV were HPV-16, -52, -53, -35, and -18. Incident high-risk HPV infection occurred in 22%, and of those infected with high-risk HPV, 94% of infections persisted over an 18-month period, and 6% cleared their infections. Cytologic progression to SIL from normal/atypical squamous cells of undetermined significance cytology occurred in 17% of cases, but only 4% of cases of LSIL progressed to HSIL. CONCLUSION: There is a high level of high-risk HPV infection in HIV-1 infected women, but progression to HSIL over 36 months occurred in the minority of cases. We recommend an initial colposcopy for an abnormal test, and if no high-grade lesion is identified, triennial screening would be appropriate. Human papillomavirus type 16 was the commonest, and HPV-18 was the fifth commonest, suggesting that vaccination against these two types would have a significant effect. LEVEL OF EVIDENCE: II.     

子宫颈上皮内瘤变筛查方法的综合评价

目的　对宫颈上皮内瘤变 (CIN)筛查方法即宫颈涂片自动检测系统 (papnetcytologycomputertechnology ,CCT)和新柏氏程控超薄细胞检测系统 (thinpreppaptest,TPT)两种细胞学检查方法进行综合评价。方法　对因细胞学检查异常而行阴道镜下多点活组织检查 (活检 )及病理检查的 374例患者的临床资料进行回顾性分析。结果　细胞学检查诊断为炎症者 9 1% ,低度鳞状上皮内瘤变(LSIL) 4 3 3% ,高度鳞状上皮内瘤变 (HSIL) 2 0 3% ,可疑癌 1 9% ;经阴道镜下多点活检及病理检查 ,诊断为炎症者增加到 5 3 5 % ,CINⅠ减少到 17 9% ,CINⅡ、CINⅢ、原位癌占 2 5 4 % ,可疑早期浸润癌和浸润癌增加到 3 2 %。 2 5 4 %的细胞学不能明确诊断意义的不典型鳞状上皮病变中 ,5 2 6 % (5 0 /95 )为炎症或未见异常 ,4 7 4 % (45 /95 )为CINⅠ以上的病变。 374例患者中 ,行CCT检查者 188例 ,TPT检查者 186例 ,两种细胞学检查结果分别与阴道镜检查结果相比 ,TPT的符合率显著高于CCT(P<0 0 1)。细胞学检查诊断为LSIL及以下病变的符合率 (79 7% )显著高于诊断为HSIL以及癌变者的符合率 (2 0 3% ) ,两者比较 ,差异有显著性 (P <0 0 1) ,而两种细胞学检查方法间无差别。人乳头状瘤病毒 (HPV)感染的发生率为 34 0 % ,阴道镜检查的     

妊娠相关宫颈细胞形态学特点及其临床处理

目的 探讨妊娠相关宫颈细胞形态学特点及其处理方法.方法 回顾性分析2006年8月至2010年1月间,在中日友好医院行产前检查并分娩的妊娠期(含早、中、晚期妊娠)及产后42 d妇女5152例的宫颈液基细胞学(LCT)涂片,采用Bethesda分类系统(TBS)进行诊断,对诊断为上皮细胞异常者均随访至产后3个月,观察其变化.对诊断为高度鳞状上皮内病变(HSIL)和鳞状细胞癌(SCC)者孕期进行阴道镜下活检,对不典型腺细胞(AGC)者产后6周进行宫颈管活检;并与活检组织病理学结果进行对比分析.结果 (1)妊娠相关细胞学改变:5152例中检出舟状细胞3215例(62.40%),蜕膜细胞783例(15.20%),反应性腺细胞369例(7.16%),滋养叶细胞55例(1.07%).(2)LCT结果:5152例中未见异常者4125例(80.07%);感染性病变542例(10.52%);上皮细胞异常485例(9.41%),其中不典型鳞状细胞(ASC)291例(5.65%),低度鳞状上皮内病变(LSIL)153例(2.97%),HSIL 33例(0.64%),SCC 1例(0.02%),AGC 7例(0.14%).(3)组织病理学结果:对HSIL和SCC妇女行阴道镜检查及活检,病理结果为宫颈上皮内瘤变(CIN)Ⅱ～Ⅲ28例,腺鳞癌1例.对AGC妇女行宫颈管活检,病理结果均为阴性.细胞学与组织病理学结果的总符合率为71%(29/41).(4)随访:485例上皮细胞异常者均随诊至产后3个月.HSIL、SCC、AGC临床处理后LCT随访均无异常;ASC和LSIL未活检,LCT随访病变消退者占72.3%(321/444).结论 妊娠期和产后妇女宫颈细胞学特点是以舟状细胞为主,部分改变极易与恶性病变相混淆,应仔细甄别,避免过度诊断或误诊.应密切随诊异常涂片,适当放宽阴道镜活检的指征.

Abstract：

Objective To investigate characteristics of cervical cytology and management in pregnant women. Methods From Aug. 2006 to Jan. 2010, 5152 pregnant women who received antenatal and postpartum examination underwent cervical cytological screening by liquid-based cytological test (LCT)in China-Japan Friendship Hospital. The cytological diagnosis was in accordance with the Bethesda system (TBS) 2001 diagnosis and classification system.The abnormal LCT results were followed up at 3 months after postpartum. The diagnosis of high-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) were based on colposcopic examination and biopsy during pregnant. The diagnosis of atypical glandular cells(AGC) was based on curettage and biopsy at postpartum 6 weeks. The histopathology of biopsy were compared and analyzed. Results ( 1 ) Cervical cytological changes related with pregnancy:among 5152 cases, it was found navicular cells in 3215 cases (62. 40% ), decidual cells in 783 cases ( 15.20% ), reactive glandular cells in 369 cases (7. 16% ), and trophoblastic cells in 55 cases (1.07%). (2) LCT results: among 5152 cases, the normal samples were 4125 cases (80.07%), the inflammatory samples were 542 cases (10.52%), and the samples of abnormal epithelial cells were 485cases (9.41%). Among those abnormal cases, 291 cases (5.65%) were in atypical squamous cells (ASC), 153 cases (2. 97%) were in low-grade squamous intraepithelial lesions (LSIL), 33 cases (0. 64%) were in HSIL, 1 case ( 0. 02% ) were in SCC and 7 cases (0. 14% ) were in AGC. (3)Histological pathology results: all women with HSIL and SCC underwent colposcopic examination and biopsy,it was found 28 cases in cervical intraepithelial neoplasia (CIN) Ⅱ - Ⅲ, 1 cases in adenosquamous carcinoma. 7 women underwent curettage and biopsy at postpartum 6 weeks which were diagnosed by AGC,the histopathological diagnosis was all negative. The concordance rate of cytopathologic and histopathologic diagnosis was 71%(29/41). (4) Follow-up: 485 women with abnormal LCT results were all followed up to 3 months at postpartum. Women with HSIL, SCC and AGC undergoing biopsy showed normal LCT results during follow-up. Those women with ASC and LSIL did not undergo colposcopic examination and biopsy. The regression rate was 72.3% (321/444) at postpartum 3 months. Conclusions The navicular cells were primarily morphological characteristics of cytology during pregnant and postpartum women. Some changes were easily confused with malignant lesions. It should be careful discrimination, and avoid excessively diagnosis and misdiagnosis. It suggested that we should follow up those women closely and expand the indication of colposcopic biopsy.