不典型鳞状细胞和低度鳞状上皮内病变中高危型人乳头瘤状病毒检测的作用

目的:探讨高危型人乳头瘤状病毒(human papillomavirus , HPV)检测对宫颈液基细胞学诊断为不能明确意义的不典型鳞状细胞(atypical squamous cells undetermined significance, ASC-US)和低度鳞状上皮内病变(low squamous intraepithelial lesion , LSIL)的分流管理作用.方法:对940例宫颈液基细胞学检查结果为ASC-US或LSIL的患者采用二代杂交捕获(hybird capture Ⅱ, HC-Ⅱ)方法检测高危型HPV DNA,并在阴道镜指导下进行宫颈活检.结果:940例中,ASC-US 497例,LSIL 443例.行宫颈活检病理诊断,慢性宫颈炎417例,宫颈湿疣315例,宫颈上皮内瘤变(cervical intraepithelial lesions, CIN)1级124例,CIN2 级65例,CIN3级或宫颈浸润癌19例.在宫颈细胞学异常的ASC-US和LSIL组中,高危型HPV阳性率分别是59.6%和84.9%.在ASC-US和LSIL组HPV阴性时CIN2级及其以上病变(CIN2级,CIN3级或宫颈浸润癌)检出率为0.5%和6.0%,HPV阳性时检出率是8.8%和14.1%,HPV阳性时CIN2级及其以上病变检出率高于HPV阴性患者,差异具有统计学意义.在ASC-US组中,高危型HPV检测对CIN2级及其以上病变的阴性预测值达99.5%;当高危型HPV DNA检测结果在1～9.99时,CIN2级及其以上病变仅占1.6%;在10以上时,CIN2级及其以上病变占10.7%.结论:宫颈细胞学为ASC-US的患者如果高危型HPV阳性,检出CIN2级及其以上病变的概率增加,并且高危型HPV检测的阴性预测值高,在ASC-US患者中,随着HPV载量增高,检出CIN2级及其以上病变的概率随之增高.高危型HPV检测和病毒载量有助于ASC-US的分流管理,而对LSIL无分流管理作用.

Use of high-risk human papillomavirus DNA testing to deal with atypical squamous cells undetermined significance and low squamous intraepithelial lesion

OBJECTIVE: To explore the role of high-risk human papillomavirus (HPV) DNA testing in improvement of recognition of cervical intraepithelial lesions (CIN) 2, 3 or cervical cancer confirmed by biopsy in women with abnormal cervical cytology including atypical squamous cells undetermined significance (ASC-US) and low squamous intraepithelial lesion (LSIL). METHODS: Total 940 patients with abnormal cervical liquid-based cytology including ASC-US and LSIL were included in this study. Hybrid capture II assay was applied in the high-risk HPV detection. The cervical pathologic diagnoses were obtained under colposcopy guided biopsy. RESULTS: Of the 940 cases, 497 were ASC-US, and 443 LSIL. With pathological diagnosis of cervical biopsy, 417 cases were chronic inflammation, 315 condyloma, 124 CIN 1, 65 CIN 2, 19 CIN 3 or cervical cancer. The positive rate of high-risk HPV DNA in groups of ASC-US and LSIL were 59.6% and 84.9%, respectively. In each group of abnormal cytology, detection rates of CIN 2, 3 or cervical cancer in patients with positive HPV DNA were 8.8% and 14.1%, respectively, which were higher than those with negative HPV DNA (0.2% and 6.0%, P < 0.05). In group of ASC-US, high-risk HPV DNA test had a negative predictive value of 99.5%; detection rates of CIN 2, 3 or cervical cancer in patients with HPV DNA virus load 1-9.99 and > or = 10 was 1.6% and 10.7%, respectively. CONCLUSION: High-risk HPV DNA test were helpful to improve the detection rates of CIN 2, 3 or cervical cancer in patients with ASC-US.