细胞学检测为非典型鳞状细胞且人乳头瘤病毒阴性妇女的宫颈癌患病风险评估

Risk assessment on cervical cancer in women with cytology atypical squamous cells of undetermined significance but negative human papillomavirus

目的评估宫颈癌筛查中非典型鳞状细胞（ASC—US）但人乳头瘤病毒（HPv）阴性的妇女罹患中度及以上宫颈上皮内瘤样病变（CIN2＋）的风险。方法汇总1999-2008年在我国开展的17项以人群为基础的宫颈癌筛查横断面研究，共30371名17～59岁妇女参加筛查，所有妇女均进行了液基细胞学检查（LBC）、HPV检测（hybridcapture2，HC2）和醋酸染色肉眼观察法（VIA），任一结果阳性者转诊阴道镜。最终28810名具有完整细胞学、HPV、病理检测结果的妇女纳入分析，分别以细胞学正常且HPV阴性组（LBC-／HPV-）、细胞学正常组（LBC-）为参照，评估细胞学为ASC—US且HPV阴性组（ASC—US／HPV-）的CIN2＋患病风险。结果LBC-／HPV-、LBC-和ASC．US／HPV-组分别有22003、24139和1834名妇女，C1N2＋的患病率分别为0．05％、0．36％和0．16％。分别以LBC-／HPV-组、LBC-组为参照，ASC．US／HPV-组罹患CIN2＋的风险分别为3．00（95％Ch0．85～10．65）和0．46（95％CI：0．15～1．45），其校正OR值分别为4．00（95％CI：1．08～14．87）、0．47（95％CI：0．15—1．49）。结论ASC．US／HPV-妇女CIN2＋的患病风险介于LBC-和LBC-／HPV-妇女之间。依据“同等风险、同等管理”的原则，可采用对LBC-者的3年筛查间隔，而对于卫生资源相对匮乏地区可采用对LBC-／HPV-者的5年筛查间隔。

Objective To assess the risk of cervical cancer and high grade cervical intraepithelial in women with negative human papillomavirus （HPV） and cytology atypical squamous cells of undetermined significance （ASC-US） and to provide evidence for clinical management. Methods We pooled 17 population-based cross-sectional studies which were conducted across China from 1999 to 2008. Totally, 30 371 women aged 17-59 were included in these studies. All women received liquid-based cytology test （LBC）, HPV testing （hybrid capture 2 test, HC2） and visual inspection with acetic acid test （VIA）. Women with any positive result from above tests were referred to colposcopic examination. Totally, 28 810 women with complete results from HPV, cytology and pathology were included in the final analysis. Women with negative HPV （LBC-/HPV-） or negative cytology （LBC-） results served as the control, respectively. Risk on high grade cervical intraepithelial neoplasia （C1N2 ＋ ） was calculated for women with HPV negative and ASC-US results （ASC-US/HPV-）. Results There were 22 003 women with LBC-/HPV-, 24 139 women with LBC-, and 1 834 with ASC-US/HPV-indentified in our study. C1N2 ＋ prevalence rates to the above women appeared as 0.05%, 0.36% and 0.16%, respectively. Compared with women with LBC-/HPV- and women with LBC-, the odds ratios （ORs） for CIN2 ＋ in women with ASC-US/HPV- were 3.00 （95%CI： 0.85-10.65） and 0.46 （95%CI： 0.15-1.45）, with adjusted ORs as 4.00 （95%CI： 1.08-14.87） and 0.47（95%CI： 0.15-1.49）, respectively. Conclusions The risk of CIN2 ＋ in women with ASC-US/HPV- was in between the risks of women with LBC-/HPV- or with LBC-. Based on the ＂equal risk, equal management＂ principle, women with ASC-US/HPV- were suggested to be followed under the ＇3-year interval＇ program, which was the same as for those cytology negative women. However, in areas with limited health resources, the follow-up interval can be extended to 5 years, similar to the management on women with LBC-/HPV-.