宫颈上皮内瘤变累腺深度与锥切范围的研究

目的:测量中重度宫颈上皮内瘤变(CINⅡ/Ⅲ)病灶长度及累及腺体深度,以为要求保留生育功能患者选择恰当的锥切范围提供依据。方法:测量行全子宫切除术患者HE染色切片中宫颈鳞状上皮处CIN病灶长度、正常腺体垂直和水平深度以及CIN病变浸润腺体垂直和水平深度。结果:(1)宫颈鳞状上皮处CIN病灶长度中位数3.80mm,第99百分位数(P99)9.79mm。正常宫颈腺体垂直深度平均18.18mm,99%可信限上限25.40mm;水平深度中位数3.50mm,P999.55mm。CIN病变浸润腺体垂直深度平均9.06mm,99%可信限上限19.50mm;水平深度中位数1.10mm,P99为5.00mm。累及腺体垂直和水平深度百分比平均值分别为51%和35%,最大值均为100%。(2)不同垂直深度CIN累及腺体的水平深度差异无统计学意义(P>0.05)。结论:考虑制片时组织缩水的因素,建议为CIN累腺患者行锥切术的范围应是帽状的:即宫颈阴道部切除范围根据阴道镜检查或碘染色标记决定,宫颈管周围切除范围纵向深度24～30mm,水平深度6～12mm,并根据患者年龄作出选择。     

宫颈上皮内瘤变宫颈环形电切术后2098例标本切缘阳性的临床病理分析

目的:探讨宫颈上皮内瘤变(CIN)宫颈环形电切(LEEP)术后切缘阳性的相关临床病理因素。方法:分析2098例CINⅠ～ⅢLEEP标本切缘阳性与患者年龄、HPV感染、病变程度、病变累及腺体及病灶数量的关系。结果:2098例LEEP术后标本中共有238例切缘阳性,占11.34%,其病理检查诊断均为鳞状上皮高度病变。>40岁患者LEEP术后标本切缘阳性率(13.20%)高于≤40岁年龄组(9.82%),差异有统计学意义(χ2=5.91,P<0.05);HPV阳性组LEEP术后标本切缘阳性率(12.17%)高于HPV阴性组(4.72%),差异有高度统计学意义(χ2=11.43,P<0.01);病变累及腺体组切缘阳性率(12.37%)高于未累及腺体组(9.43%),差异有统计学意义(χ2=4.11,P<0.05);多发病灶组切缘阳性率(13.41%)明显高于单发病灶组(9.74%),差异有高度统计学意义(χ2=6.93,P<0.01)。结论:LEEP术后标本切缘阳性主要存在于鳞状上皮高度病变组,其与年龄大于40岁、HPV感染、病变累及腺体及多点病灶有关。     

宫颈环形电刀切除术治疗212例宫颈上皮内瘤变价值探讨

目的:探讨宫颈环形电刀切除术(LEEP)治疗宫颈上皮内瘤变(CIN)的价值。方法:回顾分析2000年3月至2004年10月212例CIN患者在阴道镜辅助下行宫颈环形电切术的治疗情况。结果:阴道镜下宫颈异常结构处取活检病理结果为CIN者212例行宫颈环形电切术(LEEP),LEEP术后病理检查:宫颈粘膜慢性炎症13例(6.1%)、CINⅠ90例(42.5%)、CINⅡ77例(36.3%)、CINⅢ24例(11.3%),原位癌累及腺体伴早期浸润癌8例(3.8%)。术后195例(92.0%)宫颈标本边缘病理学检查未见CIN病变;术后降级者70例(33.0%),等级者122例(57.5%),升级者20例(9.4%);治愈率达89.2%。结论:LEEP治疗CIN安全有效、简单易行、并发症少、避免了二次手术和过度治疗,能保留患者的生育能力,在治疗的同时能进行诊断。但术后仍需定期和规范的随访以防止宫颈癌的发生和发展。     

锥切术后早期阴道镜检查对处理切缘阳性患者的临床价值

目的:通过对高级别宫颈上皮内瘤变(CIN)锥切后切缘阳性的患者术后4~6周行阴道镜检查,探讨阴道镜检查对处理切缘阳性患者的临床价值。方法:选取2012年1月至2012年12月在南京医科大学第一附属医院宫颈病中心就诊并行宫颈环形电切术(LEEP)的CINⅡ~Ⅲ且切缘阳性的80例患者,术后4~6周均行阴道镜检查(接受活检或颈管掻刮),其中未发现异常者71例(研究组),9例≥CINⅠ病变残留;切缘阴性者137例(对照组)。研究组与对照组均于LEEP术后6个月复诊以评估病变残留。结果:(1)切缘阳性的80例患者中,锥切术后初次阴道镜检查发现9例≥CINⅠ病变残留,接受再次锥切或全子宫切除,最终发现3例CINⅠ、5例CINⅡ~Ⅲ及1例宫颈浸润癌。(2)术后6个月HR-HPV检测阳性47例中,病变残留6例;宫颈细胞学检查≥ASCUS 18例中,病变残留3例;HR-HPV、宫颈细胞学检测病变残留的敏感性分别为100%、50%,特异性为79.70%、91.35%。(3)对照组、研究组的病变残留率分别为2.19%(3/137)、4.23%(3/71),两组比较差异无统计学意义(P0.05)。(4)锥切术后4~6周行阴道镜检查对切缘阳性患者病灶残留的阴性预测值为95.77%(68/71),且无一例病理升级或浸润癌的发现。结论:术后早期阴道镜检查对锥切切缘阳性者具有可行性及实用性,不仅能及时发现病变残留并得以及时处理,且有较高的阴性预测价值,检查结果阴性者随访安全性高。     

妊娠合并宫颈病变的分析

目的 了解妊娠合并宫颈病变——宫颈上皮内瘤变(cervical intraepithelial neoplasia，CIN)及宫颈原位癌(carcinoma in situ，CIS)的诊断、处理及妊娠结局。方法 回顾性分析1998年1月-2003年10月间我院15例妊娠期宫颈病变患者的诊断及治疗。结果 15例孕妇中11例经阴道镜下活检证实为由CIN-宫颈癌Ⅰa1期，其中10例每8周左右复查阴道镜，病情无进展，均足月分娩；1例宫颈原位癌累及腺体的孕妇于早孕期终止妊娠。足月分娩者中4例(CINⅡ期、CINⅢ期、宫颈原位癌及宫颈癌Ⅰa1期各1例)病情稳定，产后宫颈活检病理结果与孕期相同。3例孕期活检为CINⅠ期者，产后活检为炎症。1例孕期活检为原位癌累腺者，产后活检为CINⅡ～Ⅲ期。1例孕期活检为CINⅢ期者，产后锥切结果为原位癌累腺。1例孕期为原位癌累及腺体的产妇产后失访。结论 妊娠期宫颈病变(CIN-Ⅰa1期)很少产后恶化，在孕期可予观察，定期行宫颈细胞学及阴道镜检查，必要时做活检，产后2月复查，根据病理结果制定治疗原则。将一年内未进行防癌普查的孕妇纳入产前检查常规，可提高孕期宫颈病变的检出率。     

子宫颈锥切术切缘阳性的相关因素分析

目的 分析宫颈锥切术后切缘阳性的相关因素.方法 回顾性分析2000年1月至2008年2月经阴道镜宫颈活检诊断为宫颈上皮内瘤变(CIN)并接受宫颈锥切术的患者1699例,对患者年龄、病变程度、病变范围、手术方式及是否绝经与宫颈锥切术切缘阳性率作单因素和多因素分析.结果 1699例宫颈锥切术患者中,切缘阳性者238例,阳性率为14.01%.切缘阳性者平均年龄(39±9)岁,切缘阴性者平均年龄(39±8)岁,两者比较,差异无统计学意义(P>0.05).行冷刀锥切术者788例,切缘阳性率8.63%(68/788);行环形电极切除术(LEEP)者911例,切缘阳性率18.66%(170/911),两者比较,差异有统计学意义(P<0.01).CIN Ⅰ者90例,CIN Ⅱ者339例,CIN Ⅲ者1113例[其中重度不典型增生972例,原位癌(CIS)141例],宫颈癌Ⅰ al期87例,Ⅰ a2期及以上70例,切缘阳性率分别为1.11%(1/90)、3.83%(13/339)、10.70%(104/972)、26.24%(37/141)、35.63%(31/87)和74.29%(52/70),CIN Ⅰ与CINⅡ者比较,差异无统计学意义(P>0.05);将CIN Ⅰ与CINⅡ者合并计算,并与CIN Ⅲ、宫颈癌Ⅰ a1期、Ⅰ a2期及以上者之间比较,差异均有统计学意义(P<0.05).未绝经者1569例,切缘阳性率为13.38%(210/1569);已绝经者130例,切缘阳性率为21.54%(28/130);两者比较,差异有统计学意义(P=0.010).多因素logistic回归分析发现,手术方式、病变程度、病变范围、宫颈外观、是否绝经是与切缘阳性高度相关的因素,相对危险度分别为5.147、3.048、1.271、1.905和1.860.结论宫颈病变程度严重、病变范围大、LEEP、绝经后是宫颈锥切术切缘阳性的高危因素,在制定宫颈锥切手术方式时应予以重视.     

宫颈上皮内瘤变患者行宫颈锥切术后持续病变或复发的危险因素分析

目的研究宫颈上皮内瘤变(CIN)患者行宫颈锥切术后病变残留或复发的危险因素,为临床干预提供参考。方法选取2013年5月至2015年6月河南省新乡市中心医院收治的CIN患者60例为研究对象。患者均行宫颈锥切术治疗,术后随访2年。观察术后病变残留或复发情况,对相关影响因素(年龄、孕次、产次、颈管腺体累及、术后病理切缘阳性、术后HPV持续感染)行单因素分析,并行进一步多因素分析。结果60例患者随访期间出现病变残留3例(5%);复发6例(10%)。单因素分析显示,CIN患者术后病变残留或复发与产次、颈管腺体累及、术后病理切缘阳性、术后HPV持续感染因素存在相关性(均P0.05);而与年龄、孕次因素无关(P0.05)。多因素Logistic回归分析显示,产次、颈管腺体累及、术后病理切缘阳性、术后HPV持续感染均不属于CIN宫颈锥切术后病变残留或复发的独立危险因素。结论行宫颈锥切术的CIN患者出现术后病变残留或复发的因素多样,临床可行针对性干预,降低术后病变残留率及复发率,促使患者预后改善。     

宫颈环形电切术治疗宫颈上皮内瘤变的价值

目的 探讨宫颈环形电切术(LEEP)治疗宫颈上皮内瘤变(CIN)的价值.方法 回顾性分析2004年1月至2007年5月在重庆医科大学附属第一医院宫颈疾病门诊接受LEEP术的452例患者(CIN 420例,原位癌32例)的相关资料,对患者一般情况、术前阴道镜定位活检、术中情况、术后病检结果和随访资料进行统计分析.结果 (1)所有患者均于月经干净后3～7d手术,手术时间5～20min,术中出血量平均为14.6mL,患者反应轻.(2)术前、术后宫颈环切组织病理结果比较:病变分级一致者270例(59.73%);级别下降者132例(29.20%);其余50例(11.06%)级别上升,其中5例术前为CIN Ⅰ而术后证实为CIN Ⅲ(不包括原位癌).25例术后病检发现切缘有病变累及者(其中CIN 18例,原位癌7例),8例随后行全子宫切除,3例行二次LEEP术.(3)对所有患者定期随访至2007年8月,CIN治愈387例(92.14%),病变残留33例(7.86%).CIN中2例(0.48%)术后12个月复发,6～18个月后复发病变自然消退.(4)切缘无病变累及者术后CIN病变残留复发率为6.22%(25/402),切缘阳性者CIN术后病变残留复发率高达44.44%(8/18),二者比较差异有统计学意义.结论 LEEP术治疗CIN治愈率高,病变残留复发率低.术后切缘累及情况是CIN残留复发的影响因素之一,切缘阳性者病变残留复发率高.     

宫腔镜电凝辅助宫颈冷刀锥切术诊治CIN 130例临床分析

目的探讨宫腔镜电凝辅助宫颈冷刀锥切术在宫颈上皮内瘤样病变(CIN)诊治中的临床价值。方法回顾性分析因宫颈上皮内瘤样病变而行宫腔镜电凝辅助宫颈冷刀锥切术治疗的130例患者的临床资料。结果宫腔镜辅助宫颈冷刀锥切术和阴道镜多点活检病理符合者70例(53.8%);不符合者60例(46.2%),其中升级者38例(29.3%),降级者22例(16.9%)。结论宫腔镜电凝辅助宫颈冷刀锥切术在诊治宫颈上皮内瘤样病变中具有重要价值,可以提高宫颈上皮内瘤样病变诊断的准确率。     

荧光原位杂交技术检测宫颈上皮内瘤变及宫颈癌中TERC基因的扩增及临床意义

目的:应用荧光原位杂交(FISH)技术检测宫颈上皮内瘤变(CIN)及宫颈癌中TERC基因的扩增,探讨其在宫颈病变筛查中的意义.方法:筛选门诊就诊宫颈疾病患者宫颈脱落细胞标本120例,其中液基细胞学检查正常者20例,病理学检查CIN Ⅰ、CINⅡ、CINⅢ及宫颈癌各25例.采用双色间期FISH技术检测宫颈脱落细胞TERC基因扩增,以正常标本的检测结果建立阈值.结果:①CIN Ⅰ、CINⅡ、CINⅢ及宫颈癌中每例的异常细胞百分率均大于阈值(P<0.05),异常细胞百分率随病理学分级病变严重程度增高而增高(P<0.01).②2:3、2:4、2:5和4:4以上类型在CIN Ⅰ、CINⅡ、CINⅢ及宫颈癌所占百分率比较,差异有高度统计学意义(均P<0.01),其中宫颈癌与CIN Ⅰ比较,2:3类型所占比例明显下降(P<0.001),2:4、2:5和4:4以上类型所占比例明显升高(JP<0.001).③不同细胞学分级中,异常细胞百分率随其病变严重程度增高而增高(P<0.01),2:3、2:5和4:4以上类型在ASCUS、LSIL和HSIL中的百分率差异有高度统计学意义(均P<0.01),其中HSIL与ASCUS比较,2:3类型所占比例明显下降(P<0.01),2:5和4:4类型所占比例明显升高(P<0.01).④在低级别及高级别CIN中,细胞学LSIL及HSIL检出率分别为10例(40.00%,10/25)及31例(62.00%,31/50),FISH技术检测出低级别与高级别CIN的敏感度均明显高于细胞学检查(P<0.05).结论:CIN Ⅰ、CINⅡ、CINⅢ及宫颈癌均有TERC基因扩增,其拷贝数随病理学及细胞学分级严重程度增加而增加.应用FISH技术检测宫颈脱落细胞TERC基因扩增对宫颈病变筛查及对病变进展预测具有一定价值.     

Laser CO2 vaporization for high-grade cervical intraepithelial neoplasia: a long-term follow-up series

OBJECTIVE: The goal of this study was to evaluate the effectiveness of laser CO(2) vaporization for conservative treatment of ectocervical high-grade cervical intraepithelial neoplasia (CIN) particularly by the evaluation of the reappearance risk of disease in long-term follow-up. METHODS: One hundred fifty-nine patients were submitted to CO(2) laser vaporization for high-grade CIN and followed up for a minimum of 5 years. Selection of cases, depth of ablation, complications, and cure rate (percentage of treated patients in whom there was no recurrent/persistent high-grade CIN at the 5-year follow-up examination) were retrospectively evaluated. RESULTS: Selected cases for colposcopy were submitted to a 6-mm mean depth of vaporization without intra- or postoperative complications. The cure rate for a single treatment was 97.5% and a satisfactory colposcopic follow-up was possible in 99.4% of treated patients. No case of invasive carcinoma occurred after a mean follow-up of 7.1 years. Four cases (2.5%) were high-grade CIN persistence observed after a mean time of 3.75 months, suggesting incomplete destruction of the deepest part of the lesion involving the glandular crypt base. CONCLUSIONS: Long-term follow-up proves that laser CO(2) vaporization still has a place in the treatment of CIN. In selected cases it represents a safe alternative for conization in the treatment of high-grade CIN, but colposcopic expertise is essential for adequate preoperative selection of cases.     

Minimum extension and appropriate topographic position of tissue destruction for treatment of cervical intraepithelial neoplasia

Minimum extension and topographic position of tissue destruction for treatment of cervical intraepithelial neoplasia (CIN) is determined by the extension and the localization of the pathologic epithelium. In 65 cone specimens, we studied the depth of CIN II crypt involvement and the linear extent and topographic position of the CIN III lesions. The topographic position of the CIN III lesion was related to a reference point R, the most caudal point of the ectocervix. The mean maximum depth of CIN III crypt involvement appeared to be 1.6 +/- 1.0 mm, and the mean linear extent of the CIN III lesion was 7.4 +/- 3.7 mm. The distal border of the CIN III lesion was located at a mean distance of 8.2 +/- 4.4 mm from the reference point R, and the proximal border at a mean distance of 13.3 +/- 3.7 mm. Taking the mean + 2 SD values as directives (97.7% of the population) suggests that in almost all patients, the depth of crypt involvement did not exceed 3.6 mm; the linear extent of the CIN III did not exceed 14.8 mm. Furthermore, this implies that in almost all patients, the CIN III lesion was located between 0.6 mm distally (mean - 2 SD) and 20.7 mm proximally (mean + 2 SD) from the reference point R. Based on these results, we conclude that minimum local tissue destruction for treatment of CIN should have a depth of 4 mm over a distance of 15 mm, and should be localized at least between 1 mm distally and 21 mm proximally from the most caudal point of the ectocervix.     

Laser Conization Assisted by Crypt Visualization for Cervical Intraepithelial Neoplasia

Objective: To describe intraoperative visualization of crypts and its effects on specimen clearance, safety, and clinical results of excisional treatment of cervical intraepithelial neoplasia (CIN).Methods: We treated 147 patients with high-grade CIN (II–III) and colposcopically-assessed endocervical extension, using a CO₂ laser instrument in a day-hospital setting. Endocervical walls were stained preoperatively with a 2% methylene blue aqueous solution. Cervical conization was done by laser under colposcopic vision. Stromal incision and cone shape were directed laterally to the endocervical crypts by intraoperative visualization in transparency of the stain.Results: We were able to make stromal incisions at minimal and uniform radial distances from the cervical canal, thus allowing individualized cone shape and optimal bleeding control. Median (range) base diameter and height of specimens were 18 (13–24) and 20 (15–26) mm, respectively. The final histologic diagnosis was CIN II in 35 patients, CIN III in 111, and microinvasive carcinoma in one. Endocervical disease extension was confirmed in 103 patients (70%); the median (range) length of CIN in the 99 evaluable cases was 15.6 (0.5–25.7) mm, and crypt involvement was found in 39 (26.5%). All lateral margins were free of dysplasia. Four specimens (2.7%) had positive apical margins. No significant complications occurred, and fertility did not seem to be impaired. With a median (range) follow-up period of 68 (60–92) months, only 1.4% of patients experienced recurrence; two patients, both with involved crypts, had recurrent dysplasia at 23 and 45 months, respectively.Conclusion: Laser microsurgical conization assisted by crypt visualization facilitates safe and complete removal of CIN extending into the endocervix.     

Detection and typing of human papillomavirus DNA in uterine cervices with coexistent grade I and grade III intraepithelial neoplasia: biologic progression or independent lesions?

OBJECTIVE: To examine the HPV type infection of cervical cone specimens with coexistent CIN1 and CIN3 lesions, in order to define if coexistence of low- and high-grade lesions in the same cervix represent different stages of evolution in a continuing process that is caused by a single viral type or independent lesions induced by different HPV types. STUDY DESIGN: The examined material included 43 cases with coexistent CIN1 and CIN3 in the cone biopsy specimen. Detection and typing of HPV was made by RFLP-PCR. RESULTS: All CIN1 lesions were HPV positive, while three CIN3 lesions were HPV-negative. The proportion of agreement of the HPV type in the two lesions, excluding negative cases (n = 40), was 60% (95% confidence interval: 43.3-75.1). HPV 16 was the most common type in both CIN3 (56.8%) and CIN1 (46.5%). CONCLUSIONS: The so-called morphologic progression of CIN is not always synonymous with biologic progression, since many coexistent CIN lesions are caused by different HPV types, and so represent different cell clones. Clonality of coexistent CIN lesions may be implicated in the evolution of CIN as other recent studies have shown.     

A histological and immunohistological study of cervical intraepithelial neoplasia in relation to recurrence after local treatment

Summary. A retrospective histological study was performed on 23 patients who had presented with recurrent cervical intraepithelial neoplasia (CIN) 18 months or more after apparently adequate local destructive treatment and a comparable control group of 23 patients who had no recurrence at 18 months. All recurrences were in women with CIN 3. Detailed examination of pretreatment biopsies showed that there were significant differences in both the extent of crypt involvement ( P <0.01) and maximum depth of CIN (P<0.01) between the recurrent groups and the comparison group of women without recurrence. There was also a significant difference in mitotic count between the two groups ( P <0.01). Immunocytoehemical staining for Langerhans' cells or human papilloma virus common antigen showed no significant difference between the two groups. A mitotic count of 35 per ten high-power fields or a depth of crypt involvement > 1.7 mm in the pretreatment biopsy was invariably associated with recurrence and identified 13/22 (59%) cases of recurrent disease. The histological reporting of these features may be of value in predicting a group of women at high risk of recurrence of CIN after local treatment.     

A histological and immunohistological study of cervical intraepithelial neoplasia in relation to recurrence after local treatment

A retrospective histological study was performed on 23 patients who had presented with recurrent cervical intraepithelial neoplasia (CIN) 18 months or more after apparently adequate local destructive treatment and a comparable control group of 23 patients who had no recurrence at 18 months. All recurrences were in women with CIN 3. Detailed examination of pretreatment biopsies showed that there were significant differences in both the extent of crypt involvement (P less than 0.01) and maximum depth of CIN (P less than 0.01) between the recurrent groups and the comparison group of women without recurrence. There was also a significant difference in mitotic count between the two groups (P less than 0.01). Immunocytochemical staining for Langerhans' cells or human papilloma virus common antigen showed no significant difference between the two groups. A mitotic count of 35 per ten high-power fields or a depth of crypt involvement greater than 1.7 mm in the pretreatment biopsy was invariably associated with recurrence and identified 13/22 (59%) cases of recurrent disease. The histological reporting of these features may be of value in predicting a group of women at high risk of recurrence of CIN after local treatment.     

Angiogenesis in cervical intraepithelial neoplasia and early-staged uterine cervical squamous cell carcinoma: clinical significance

The objective of this study is to evaluate angiogenesis in cervical intraepithelial neoplasia (CIN), microinvasive squamous cell carcinoma (MIC), and early-staged squamous cell carcinoma (SCC), stage IB-IIA of the cervix. Microvessel density (MVD) was evaluated and correlated with other pathologic prognostic factors and disease outcomes. Four hundred seventy-four cervical specimens were studied. Among these, 100 were designated normal cervix, 30 CIN1, 32 CIN2, 178 CIN3, 74 MIC, and 60 early-staged SCC. MVD per high-power field (x400) of early-staged SCC, MIC, and CIN3 were significantly higher in comparison to CIN2, CIN1, and control subjects (P<0.05). There was no statistically significant difference in MVD between control group, CIN1, and CIN2. In early-staged SCC, no correlation between MVD and pelvic lymph node status, parametrial involvement, depth of stromal invasion, and lymphovascular space invasion was found. Patients with bad outcomes (recurrence or death) showed no statistically different MVD from the ones who had unremarkable clinical courses.     

Negative predictive value of human papillomavirus test following conization of the cervix uteri.

OBJECTIVE: The goal of this study was to determine/evaluate the negative predictive value of human papillomavirus (HPV) testing following conization of cervix uteri. METHODS: A prospective analysis was undertaken on 79 cone biopsies of women with high-grade lesions (cervical intraepithelial neoplasia (CIN) III). HPV testing was performed on cervical smears before and after conization. We correlated the margin status (defined as positive cone margin or endocervical curettage status) and positive conization HPV status with the residual disease in a hysterectomy specimen. A Digene II kit was used to perform HPV testing. HPV detection was done by Hybrid Capture assay. RESULTS: Of the 79 patients, 47(59.5%) had positive margins after conization. HPV testing was positive in 37 cases (78.7%) and negative in 10 cases (21.3%). Residual disease was found in 31 of 47 (66%) postconization hysterectomy specimens. No residual lesions were found in HPV-negative cases. Of the 32 cases with negative margins following conization, HPV testing was negative in 25 cases (78%) and was positive in 7 cases (22%). Among these 25 cases with negative HPV tests, no residual lesion was detected, and in 7 HPV-positive cases, only one residual lesion was found. CONCLUSION: HPV testing is potentially an effective tool in predicting residual dysplasia after conization and could potentially assist in the decision between hysterectomy and conservative follow-up in women with CIN III.     

Triage of atypical squamous cells of undetermined significance with hybrid capture II: colposcopy and histologic human papillomavirus correlation

OBJECTIVE: To estimate the effectiveness of Hybrid Capture II to predict high-grade cervical intraepithelial neoplasia (CIN) from a cytological cervical sample. Evidence of high-risk human papillomavirus (HPV) was also determined from biopsy samples using the polymerase chain reaction (PCR) for women referred with atypical squamous cells of undetermined significance (ASCUS) Papanicolaou smears. METHODS: We screened 8170 women with Papanicolaou smears, of whom 278 (3.4%) returned ASCUS. All ASCUS cases underwent colposcopy and Hybrid Capture II testing. High-grade CIN biopsy specimens were tested for high-risk HPV by PCR. RESULTS: Nearly 30% of ASCUS cases had CIN biopsy results (11.9% showing CIN II or CIN III and 17.6% showing CIN I). Hybrid Capture II positive rates were 93.3% for cases with CIN III, 72.2% for CIN II, and 51.0% for CIN I (P <.001). ASCUS-Premalignant Process Favored cases showed a 28.1% high-grade biopsy rate and a 100% Hybrid Capture II positive rate. For ASCUS-Undefined and ASCUS-Reactive Process Favored cases, Hybrid Capture II returned positive in 90.9% of CIN III and 61.5% of CIN II cases (P <.001). Sixty-nine of 178 (38.8%) patients with no evidence of CIN tested positive for Hybrid Capture II. Human papillomavirus deoxyribonucleic acid (DNA) high-risk subtypes were detected by PCR in the tissue of all high-grade CIN cases with negative Hybrid Capture II results. CONCLUSION: Hybrid Capture II returned negative in 25% of cases with biopsy-proven high-grade CIN with associated high-risk HPV DNA by PCR (non-Premalignant ASCUS subset), and positive in 39.3% of cases with normal results; this limits its clinical utility.