HPV DNA检测在宫颈细胞学不典型腺细胞中的作用

目的 探讨高危型人乳头瘤病毒检测(HPV DNA test)和组织病理学诊断在宫颈细胞学的结果为不典型腺上皮细胞(AGC)中的关系及临床意义.方法 选择2007年1月至2009年12月北京朝阳医院阴道镜门诊就诊的97例宫颈细胞学AGC患者,分析其宫颈活检、分段诊刮、宫颈LEEP术的组织病理结果及HR HPV DNA检测的结果.结果 (1)65例(67.01%)病理异常:2例腺癌;63例(96.92%)宫颈鳞状上皮内瘤变(CIN)中40例LSIL、17例HSIL、6例鳞癌.(2)97例行HRHPV检测,其中阳性39例.在高度病变17例及宫颈癌8例中,HR-HPV检测阳性24例,其敏感性96%,特异性92.86%,阳性预测值96%,阴性预测值92.86%.(3)97例中6例行子宫全切,手术后病理检查无异常发现.1例CIN1者失访,90/91例完成随访,随访率98.9%.第1次随访6例HRHPV检测阳性及3例细胞学异常者,于第2次随访时细胞学及HR HPV检测均阴性.结论 细胞学AGC的患者给予HR HPV检测以及立即的阴道镜检查,对正确诊断、及时治疗和因其较高的阴性预测值而对临床减少过度治疗、随访管理有重要的作用.

Abstract：

Objective To evaluate the potential link between high-risk human papilloma virus (HPV) DNA testing and histological diagnosis in women referred for atypical glandular cells ( AGC) at Pap smear. Methods All cervical cytological examinations with the diagnosis of AGC between January 2007 and Dec 2009 were identified by means of a computerized database in 97 patients. The histopathological results of cervix were analyzed by colposcopic biopsy, dilatation and curettage ( D&C), cervical loop electrosurgical excision procedure(LEEP) and high-risk human papilloma virus DNA testing. Results ( 1 ) All patient were monitored by colposcopy, histopathology and HPV DNA test. Sixty-four patients had pathologic lesions. (2)In predicting the presence of high-grade of cervical intraepithelial neoplasia, the sensitivity of human papilloma virus was 96%, specificity 92. 86%, positive predictive value 96% and negative predictive value 92. 86%. (3)98. 9% of the AGC patients received colposcopic, cytological examinations and HPV test at follow-ups: 3 cases of PAP smear and 6 cases of HPV testing were abnormal at the first follow-up, and 100% negative for cytological examination and HPV test at the second follow-up visit. Conclusion HPV DNA test and colposcopic examination are effective in the initial evaluation and subsequent follow-ups of cytological atypical glandular cells.

Significance for the detection of human papillomavirus DNA in cervical atypical glandular cells

Objective To evaluate the potential link between high-risk human papilloma virus (HPV) DNA testing and histological diagnosis in women referred for atypical glandular cells ( AGC) at Pap smear. Methods All cervical cytological examinations with the diagnosis of AGC between January 2007 and Dec 2009 were identified by means of a computerized database in 97 patients. The histopathological results of cervix were analyzed by colposcopic biopsy, dilatation and curettage ( D&C), cervical loop electrosurgical excision procedure(LEEP) and high-risk human papilloma virus DNA testing. Results ( 1 ) All patient were monitored by colposcopy, histopathology and HPV DNA test. Sixty-four patients had pathologic lesions. (2)In predicting the presence of high-grade of cervical intraepithelial neoplasia, the sensitivity of human papilloma virus was 96%, specificity 92. 86%, positive predictive value 96% and negative predictive value 92. 86%. (3)98. 9% of the AGC patients received colposcopic, cytological examinations and HPV test at follow-ups: 3 cases of PAP smear and 6 cases of HPV testing were abnormal at the first follow-up, and 100% negative for cytological examination and HPV test at the second follow-up visit. Conclusion HPV DNA test and colposcopic examination are effective in the initial evaluation and subsequent follow-ups of cytological atypical glandular cells.