高危HPV检测在ASC-H结果分流中的作用分析

Analysis of high-risk HPV testing in triage of women with ASC-H

目的:分析高危人乳头状瘤病毒(hr HPV)检测在不除外高级别鳞状上皮内病变的非典型细胞(ASC-H)分流中的作用,为ASC-H病例不同分流策略的选择提供依据。方法:对2013年1月至2016年12月济南金域病理室宫颈细胞学判读为ASC-H病例的组织学随访结果和hr HPV检测结果进行总结分析。结果:在245例有组织学随访结果的ASC-H患者中,同时有HPV检测结果为68例9(为HCII法检测,29例为HPV分型法检测)。≥50组活检结果为CIN2及以上病变(≥CIN2)病变的检出率和hr HPV的阳性率均明显低于20岁～29岁组和30岁～49岁组。hr HPV分流后≥CIN2病变的检出率(58. 8%)与直接阴道镜检查的检出率(55. 9%)相当,但可减少26. 5%阴道镜检查。HPV16/18/45分流后≥CIN2病变的检出率则明显降低,仅为31. 0%。两例HCII法检测hr HPV阴性,而活检结果分别为CIN2和CIN3的病例,石蜡组织HPV分型检测均为HPV16阳性。另外,Ki-67和P16免疫组化染色也支持形态学诊断。结论:hr HPV检测能明显提高ASC-H患者≥CIN2病变的检出率,进而能减少阴道镜检查和活检的例数,是临床值得考虑的分流方法。

Objective:To investigate the accuracy of high-risk human papillomavirus(hrHPV) in triage of women with atypical squamous cells not excluding high-grade squamous intraepithelial lesion(ASC-H),in order to provide evidence for the selection of different triage strategies for ASC-H cases. Methods: The histopathologic follow-up and hr HPV testing results of women detected with ASC-H from January 2013 to December 2016 at pathology laboratory of Jinan King Med Diagnostics were retrieved and analyzed. Results: Of 245 ASC-H cases who had histopathologic follow-up results,68 had HPV testing results(39 for HCII testing and 29 for HPV genotyping detection). The detection rate of CIN2 or worse( ≥CIN2) and the hr HPV-positive rate in females ≥50 years old were much higher than these in 20-29-year and 30-49-year age groups respectively. With triage by hr HPV,the detection rate of ≥CIN2(58. 8%) was similar to that with immediate reference for colposcopy(55. 9%) in ASC-H patients.However,colposcopy test was decreased by 26. 5%. With triage by HPV16/18/45,the detection rate of ≥CIN2 was only 31. 0%,which was much lower than these of direct colposcopy reference and the triage strategy with hr HPV. In the two cases with negative HCII results before CIN2 and CIN3 diagnosis,HPV16 was detected in paraffinembedded tissues with genotyping detection. Immunohistochemical staining with Ki-67 and P16 also confirmed the histopathologic diagnoses. Conclusions: HrHPV triage can increase the detection rate of ≥CIN2,and reduce the number of cases for colposcopy in patients with ASC-H,so it is a highly useful triage method for women with ASCH results.