The relationship between the HR-HPV load and cervical lesions in Chaozhou area

目的 探讨高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)载量与宫颈病变级别之间的关系.方法 采用RT-PCR对农村35～60岁女性进行HR-HPV DNA定量检测并记录CT值,2 731例阳性者再进行核酸分子快速导流杂交分型技术(HybriMax)和液基薄层细胞学(thinprep liquid-based cytologic test,LCT)检查;对低级别鳞状上皮内病变(low grade squamous intraepithelial lesion,LSIL)及以上病变行阴道镜下组织病理学活检.根据LCT及病理活检结果按病变级别分成5组:无上皮内瘤变或恶性病变(non-squamous intraepithelial lesion or neoplasia,NILM)、未明确诊断意义的不典型鳞状上皮细胞(atypical squamous cells of undetermined significance,ASCUS)、LSIL、高级别鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL)和鳞状细胞癌(squamous cell cacinoma,SCC).在同级别宫颈病变中,按照HPV感染的类型分为4组:HPV52、HPV16、HPV58和多重HPV感染.采用方差分析的方法对各组平均CT值进行统计分析.结果 随宫颈病变级别的升高,CT均值降低,5组CT均值间差异均具有显著性(P＜0.05).在同级别宫颈病变中,NILM组HPV58和多重HPV差异有显著性(P＜0.05),ASCUS组HPV16和多重HPV差异有显著性,其余病变级别各HPV感染组间差异均无显著性(P＞0.05).结论 HR-HPV载量与宫颈病变级别呈正相关,高HR-HPV载量是影响宫颈病变级别的危险因素.     

子宫颈低级别鳞状上皮内病变与HR-HPV的关系

目的探讨高危型人乳头状瘤病毒(high risk human papillomavirus,HR-HPV)在子宫颈低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)中的分布特点及感染方式,并分析其在LSIL中的作用。方法应用实时荧光定量PCR和HPV原位杂交技术对328例诊断结果为168例LSIL、160例高级别鳞状上皮内病变(high-grade squamous intraepithelial lesions,HSIL)的子宫颈组织蜡块进行HPV分型检测。结果 HE染色结果显示,LSIL的病变细胞集中在子宫颈鳞状上皮表层,HSIL的病变细胞主要集中在上皮下层。168例LSIL患者中HR-HPV阳性率95.2%;LSIL、HSIL中HPV 16、18阳性率分别为26.2%、57.5%,其他型HR-HPV(不包括HPV 16、18)的阳性率分别为80.9%、55.0%,差异均有统计学意义(P0.001)。在原位杂交检测组中,HR-HPV的阳性率为70.2%,HR-HPV阳性LSIL中,棕黄色阳性细胞位于子宫颈鳞状上皮表层、中层,基底层未见阳性细胞。结论 HR-HPV感染与LSIL的发生、发展密切相关,尤其是其他型HR-HPV(不包括HPV 16、18);LSIL患者中HR-HPV的感染开始于子宫颈鳞状上皮表层。     

潮州地区高危型HR-HPV感染与子宫颈病变的关系

目的 探讨潮州地区高危型人乳头瘤病毒(HR-HPV)感染与子宫颈病变的关系.方法 采用实时荧光定量PCR技术对潮州农村35～60周岁的妇女进行HR-HPV检测,对HR-HPV阳性妇女进行核酸分子快速导流杂交分型技术(HybriMax)和液基薄层细胞学(LCT)检查,对低级别鳞状上皮内病变(low grade squamous intraepithelial lesions,LSIL)及以上患者行阴道镜下组织病理学活检确诊.结果 潮州地区妇女HR-HPV感染率为8.25%(4 080/49 458).发现15种HR-HPV,感染率最高的型别是HPV52,其次为HPV16、58、68、33和18型.HPV16、HPV59和混合型感染者子宫颈病变较严重,与其他型别感染者子宫颈病变程度差异有显著性(P<0.05).结论 潮州地区人群感染HR-HPV优势型别为HPV52,HR-HPV不同型别与子宫颈病变严重程度密切相关.     

人乳头瘤病毒L1壳蛋白在子宫颈活检组织中的表达及意义

目的探讨人乳头瘤病毒(human papilloma virus, HPV)L1壳蛋白在HPV阳性子宫颈活检组织中的表达与子宫颈鳞状上皮内病变(squamous intraepithelial lesion, SIL)程度的相关性及其应用价值。方法收集2017年1～9月上海市第一妇婴保健院因HPV阳性行子宫颈活检患者966例,以非同位素标记核酸分子杂交技术和免疫组化技术为基础行HPV L1壳蛋白检测。结果 966例中HPV L1壳蛋白的总阳性率为14.8%(143/966),其中慢性子宫颈炎、低级别鳞状上皮内病变(low grade squamous intraepithelial lesion, LSIL)、高级别鳞状上皮内病变(high grade squamous intraepithelial lesion, HSIL)和子宫颈浸润性鳞状细胞癌中HPV L1壳蛋白的阳性率分别为0.2%(1/513)、37.9%(121/319)、15.9%(21/132)和0(0/2)。LSIL中HPV L1壳蛋白率高于慢性子宫颈炎、HSIL和子宫颈浸润性鳞状细胞癌。结论 HPV L1壳蛋白在子宫颈活检组织中的表达与宫颈鳞状上皮病变程度呈负相关性。HPV L1在帮助了解子宫颈鳞状上皮病变程度,预测子宫颈鳞状上皮病变的发展趋势、转归、预后及选择临床处理方案中有一定参考价值。     

常见HR-HPV各型在子宫颈组织中致癌能力的评估

目的探讨高危型人乳头状瘤病毒(high-risk human papilloma viruses,HR-HPV)各型与子宫颈病变进展的关系。方法对135例诊断结果为45例非子宫颈上皮内瘤变(non-squamous intraepithelial lesions,NSIL)、42例低级别鳞状上皮内病变(low-grade squamous intraepithelial lesions,LSIL)、40例高级别鳞状上皮内病变(high-grade squamous intraepithelial lesions,HSIL)、8例子宫颈癌(squamous cervical cancer,SCC)的子宫颈活检组织蜡块进行HPV及E6/E7 mRNA的检测,分别应用PCR-反向杂交法、支链DNA技术(Quantivirus冷光仪)检测。结果 HPV 16在NSIL、LSIL、HSIL、SCC中感染率依次22.22%、21.43%、47.50%、62.50%,呈逐渐递增趋势(P=0.007);单一感染时,HPV 16的E6/E7 mRNA拷贝数依次是1 425.76、3 747.25、1 325.98、86 015.36,与子宫颈病变严重程度具有相关性(P=0.028);多重感染时,HPV 16伴其它HPV感染组在NSIL、LSIL、HSIL、SCC中的E6/E7 mRNA拷贝数呈递增趋势,差异有统计学意义(P=0.040),而其它HPV(不包括HPV 16)感染组表达的mRNA拷贝数与病变严重程度呈负相关性(P=0.044)。结论 HPV 16与子宫颈病变进展的关系最为紧密;在所有HR-HPV中HPV 16的致癌能力最强。     

细胞块在宫颈液基细胞学中的应用

目的探讨细胞块(cell block,CB)在宫颈液基细胞学(liquid-based preparation,LBP)中的应用价值。方法选择LBP阳性标本285例,其中高危HPV 16型45例、HPV 18型58例,HPV高危其他型(31、33、35、39、45、51、52、56、58、59、66、68型)182例,同时制作成CB并行阴道镜活检247例,最终均以组织学诊断为金标准。结果对于非典型鳞状上皮细胞(atypical squamous cells,ASC),应用LBP与LBP+CB检测同时阳性的组织学阳性符合率差异有显著性(72.3%±2.3%vs 83.2%±1.1%,P0.01),其中诊断为非典型鳞状上皮细胞-意义不明的(atypical squamous cells of undetermined significance,ASC-US)标本中,LBP与LBP+CB同时阳性的组织学阳性符合率分别为66.28%(57/86)、78.85%(41/52);诊断为非典型鳞状上皮细胞-不除外高级别鳞状上皮内病变(atypical squamous cells,cannot exclude hsil,ASC-H)标本中,LBP与LBP+CB同时阳性的组织学阳性符合率分别为82.98%(39/47)、89.74%(35/39)。对于低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL),LBP+CB同时阳性的组织学阳性符合率比LBP高,但差异无统计学意义(P0.05);而对≥高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)和非典型腺细胞(atypical glandular cells,AGC),LBP与LBP+CB同时阳性的组织学阳性符合率一致;在62例LBP诊断LSIL标本中,CB诊断分别为无上皮内病变或恶性病变(negative for squamous intraepithelial lesions or malignancy,NILM)2例、ASC-US 7例、ASC-H 10例、LSIL 33例、HSIL 10例;对于50例LBP诊断HSIL标本中,CB诊断分别为ASC-US 2例、ASC-H 11例、LSIL 5例、HSIL 30例、鳞状细胞癌(squamous cell carcinoma,SCC)2例。HSIL、NILM、LSIL组中p16表达差异有显著性(P0.05)。另外,p16在HSIL组中的阳性表达明显高于LSIL组。结论 CB在LBP中的应用,可以提高宫颈癌筛查的组织学阳性符合率,也可作为临床高度怀疑有病变或高危HPV而LBP未见阳性的一种补充,值得在临床细胞病理学中推广。     

血性/炎性涂片背景对宫颈液基细胞学诊断的影响

目的 探讨宫颈薄层液基细胞学涂片背景及其对细胞学诊断的影响.方法 回顾性分析北京市石景山医院病理科进行薄层液基细胞学检查的病例,并与活检病理诊断进行对比分析.结果绝大多数宫颈上皮病变背景干净,约8.72%的病例出现重度炎症背景,约3.15%的病例出现血性背景.鳞癌(squmaous carcinoma,SC)和腺癌(adenocarcinoma,AC)(100.00%)组、鳞状上皮内高度病变(high-grade squamous intraepithelial lesion,HSIL)(32.00%)组和非典型鳞状上皮、不除外高度病变(atypical squamous cells,cannot exclude high-grade squamous intraepithelial lesion,ASC-H)组(33.30%)血性/炎性背景发生率明显高于非典型鳞状上皮、意义不明确(atypical squamous cells of undetermined significance,ASCUS)组(6.30%)和鳞状上皮内低度病变(low-grade squamous intraepithelial lesion,LSIL)(4.76%).结论血性/炎性背景是导致宫颈上皮病变低诊断甚至漏诊的主要原因.冰醋酸溶液处理可有效清除血性背景,提高涂片质量.     

宫颈细胞学鳞状上皮内病变的诊断及风险管理

目的：探讨宫颈细胞学鳞状上皮内病变(squamous intraepithelial lesion,SIL)与组织学的关系,揭示细胞学SIL诊断的系统性风险及管理策略。方法：回顾性分析我院2013~2015年405例SIL,其中205例有组织学检查,比较两种结果的符合程度,对其差异产生的原因进行分析。结果：低度鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)的阳性预测值约71%,而HSIL的阳性预测值达98%以上。结论：细胞学高度鳞状上皮内病变(high-grade squamous intraepithelial lesion, HSIL)与组织学结果一致性良好,而LSIL与组织学结果符合度较差,需要加强对LSIL的管理。     

1117例女性人乳头瘤病毒感染状况及亚型分布的研究

【摘要】　目的　人乳头瘤病毒(human papillomavirus, HPV) 感染情况及亚型分布具有明显的地域差异性, 分析来自成都大学附属医院检测的1 117 例女性HPV 感染率及亚型分布, 为开发新一代HPV 疫苗和防治宫颈癌提供更多本土化的数据支持。方法　选取自2019 年10 月至2020 年12 月在成都大学附属医院进行宫颈癌筛查的1 117 例女性为研究对象, 取宫颈脱落细胞进行HPV 基因分型和细胞病理学检测, 统计分析HPV 感染情况和亚型分布。结果　1 117 例受检人员中, HPV 阳性270 例, 感染率为24. 17 %, 感染率最高的前3 种亚型依次是HPV52 (60 例)、HPV16 (42 例)、HPV58 (38 例), 单一感染阳性率为17.82 %, 构成比为73. 70 %。HPV 感染率最高的年龄组是51 ~60 岁组(32. 30 %), 随后依次为≤30 岁组(28. 67 %)、41 ~50 岁组(22. 42 %)、≥61 岁组(18. 52 %), 31 ~40 岁组HPV 感染率最低(18. 33 %)。宫颈上皮内病变阴性人群中HPV 感染率为19. 39 %, 而在不能明确意义的非典型鳞状细胞(atypical squamous cells of undetermined signification, ASCUS)、低级别鳞状上皮内病变( low-grade squamous intraepithelial lesion, LSIL)、高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion, HSIL) 和宫颈癌人群中HPV 感染率分别为32. 73 %、38. 10 %、54. 17 %和70. 27 %。结论　该院检出的HPV 感染率为24. 17 %, 感染亚型以HPV52、HPV16、HPV58 为主。年龄特异性HPV 感染率呈双峰分布, 即≤30 岁和≥51 岁人群感染率较高, 为高风险人群。且HPV 感染率与宫颈病理状态的严重程度呈正相关, 这对我国新一代HPV 疫苗开发与预防具有重要价值。本研究进一步更新和补充了地域性HPV 流行数据, 对宫颈癌的筛查和防治具有重 大意义。     

子宫颈鳞状上皮内病变中BAG-1、MCM2表达及其与p16、HR-HPV的关系

目的检测子宫颈鳞状上皮内病变(squamous intraepithelial lesion, SIL)组织中BAG-1、MCM2及p16蛋白的表达,探讨其与SIL进展程度、p16表达及高危型人乳头瘤病毒(high-risk human papillomavirus, HR-HPV)感染的相关性。方法采用免疫组化EnVision两步法检测36例正常子宫颈/慢性子宫颈炎、77例低度鳞状上皮内病变(low-grade squamous intraepithelial lesion, LSIL)、69例高度鳞状上皮内病变(high-grade squamous intraepithelial lesion, HSIL)组织中BAG-1、MCM2及p16蛋白的表达,并用PCR反向点杂交法对所有样本行HPV基因分型检测。结果 BAG-1、MCM2及p16蛋白的阳性率在正常子宫颈/慢性子宫颈炎组分别为5.6%(2/36)、2.8%(1/36)及0(0/36),在LSIL组分别为40.3%(31/77)、50.6%(39/77)及27.3%(21/77),在HSIL组分别为85.5%(59/69)、91.3%(63/69)及88.4%(61/69),HR-HPV感染率在三组中分别为25%(9/36)、63.6%(49/77)及92.8%(64/69),BAG-1、MCM2、p16阳性率及HR-HPV感染率均随SIL病变程度上升而增高(P均0.05)。不管在LSIL组还是HSIL组,BAG-1、MCM2表达与p16表达、HR-HPV感染均呈正相关(P均0.05)。结论 BAG-1及MCM2表达与SIL病变程度、p16表达及HR-HPV感染状态呈正相关,它们可能参与了子宫颈SIL的发生、发展过程。     

Prevalence of human papillomavirus genotypes in cytologic abnormalities from unvaccinated women living in north-western Spain

Cervical cancer and its precursors low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) are associated with infection by human papillomavirus (HPV), in particular HPV 16 and 18. The distribution of the HPV genotype varies with the severity of cervical disease, age and the geographic location of the patients. We report the results of a population study carried out in a region of north-western (NW) Spain aimed at determining the prevalence of single and multiple infections by 35 types of HPV using low-density microarrays for 113 cases with negative for intraepithelial lesions or malignancies; 588 with atypical squamous cells of undetermined significance (ASCUS)/LSIL; 183 with HSIL; and seven cases of squamous cell carcinomas. Of the 891 patients analysed, 50.2% had single infections and 49.8% had multiple HPV infections. In women aged below 30 years, there was a predominance of multiple infections (p = 0.027). ASCUS/LSIL was associated with multiple and HSIL with single infections (p = 0.025). We observed significant increases in the percentage of infections due to a high-risk (HR) type of HPV when the severity of the cytological lesion increased (p = 0.001). No relationship was found between greater aggressiveness in the cytological diagnosis and a higher number of HPV types involved in multiple infections. The five most frequent genotypes were HPV 16 (26.3%), 53 (18.2%), 51 (17.3%), 6 (14.8%) and 66 (13.1%). The prevalence of HPV 16, 33 and 58 increased significantly from ACUS/LSIL to HSIL and the prevalence of HPV 51, 53 and 66 decreased. HPV 16 was the only genotype that showed a significant increase in prevalence when the severity of the cytological disease increased in single infections (p = 0.0001). The implementation of bivalent prophylactic vaccination could potentially lead to prevention in 32% of the population included in the study - in at least a quarter of patients with ACUS/LSIL (26.7%), and in half of HSIL (50.2%).     

Detection and typing of human papillomavirus DNA by PCR using consensus primers in various cervical lesions of Korean women

The association between cervical cancers and human papillomavirus (HPV) is now well established. To estimate the extent of infection with common HPVs among Korean women, we have examined 224 cervical scrapes of various cervical lesions. Detection and typing of HPVs were done by polymerase chain reaction (PCR) using consensus primers followed by restriction enzyme digestion and PCR using type-specific primers. The prevalence of total HPV infection in patients with cervical intraepithelial neoplasia (CIN) and cervical cancer were significantly higher than those in healthy women and patients with atypical squamous cells of undetermined significance (ASCUS). HPV typing in 41 invasive carcinomas of the cervix revealed the prevalence of HPV 16 in 15 cases, followed by HPV 58, 18, 33, 31, 52 and 35. The distribution pattern of HPV types in CIN were not much different from carcinomas. HPV types except HPV 18 had a tendency to show higher prevalence in high-grade squamous intraepithelial lesion (HSIL) than low-grade squamous intraepithelial lesions (LSIL), however, HPV 18 was detected in LSIL but not in HSIL. HPV 18 tended to have the worse clinical stage, although it was not statistically significant. These findings suggest the importance of HPV typing other than HPV 16 and 18 and a different clinicopathologic significance of HPV 18.     

ASCUS患者发生宫颈高级别病变高危因素分析

探讨不能明确意义的非典型鳞状细胞患者发生CINⅡ 及其以上宫颈病变的影响因素。方法 通过完善设计的调查量表对我院门诊就诊行宫颈液基细胞学检查（TCT）为ASCUS的236例患者进行回顾性资料收集,同时行人乳头瘤状病毒（HPV）基因型检测,和阴道镜检查+宫颈活检,对相关危险因素进行单因素和多因素分析。结果 236例ASCUS病变中,病理证实CIN共68例（28.81%）,其中CINⅡ及以上检出36例,占总病例数的15.25%。236例ASCUS病例中,高危型HPV阳性率为55.51%,高危型HPV阳性及高危型HPV阴性组CINⅡ及以上病变检出率分别为25.19%、2.86%,差异有统计学意义（P＜0.05）。高危型HPV检测CINⅡ及其以上的敏感性达91.67%,阴性预测值达97.14%。单因素分析中年龄、初次性生活年龄、流产次数、HR-HPV与CINⅡ及其以上密切相关。Logistic多因素回归分析的结果表明初次性生活年龄、流产次数、HR-HPV是宫颈CINⅡ及其以上的高危因素。结论 高危型HPV检测是ASCUS患者分流的重要指标,尤其是年龄在30~50岁。初次性生活年龄≤20岁、流产次数＞2次、HR-HPV是ASCUS患者发生宫颈高度病变的独立的高危因素。     

Evaluation of the detection of human papillomavirus genotypes in cervical specimens by hybrid capture as screening for precancerous lesions in HIV-positive women

Given the frequency and persistence of human papillomavirus (HPV) infection and associated cytological alterations in HIV-1-positive women, the incidence of uterine cervix neoplasm is likely to increase along with patient survival. More appropriate screening programs, which, in addition to Pap smears (PS), also include tests to detect and type HPV, are needed for the early identification of precancerous cervical lesions. This prospective study involved 168 HIV-positive (group A) and 100 HIV-negative women (group B). Cervicovaginal samples were collected for a PS and HPV DNA search. The detected virus was typed as high–intermediate oncogenic risk HPV (HR-HPV) and low-risk HPV (LR-HPV) using hybrid capture (HC) (Murex-Digene) and in-house PCR tests. The HC-detected prevalence of HPV was 111/168 (66%:HR 75.6%) in group A and 15/100 (15%:HR 42.9%) in group B (P < 0.0001). Polymerase chain reaction (PCR) was positive in 91% and 48%, respectively. No significant difference was observed between drug addicts and heterosexual HIV-1-positive women (P = 0.09). HPV was detected in 94% of the 57 HIV-positive women with cytological alterations. HR-HPV was found in 41/49 women with low-grade and 7/8 with high-grade squamous intraepithelial lesions (LSIL and HSIL, respectively). In women with a negative PS, HPV was detected in 57/111 cases (HR 63%) of group A and in 13/98 of group B (6 cases of HR). Of the 54 group A women who underwent biopsy, histology revealed that 41 had LSIL (18 with negative PS, 19 with LSIL, and 4 with HSIL; HR-HPV in 73% and LR-HPV in 17%), nine had HSIL (5 LSIL and 4 HSIL on cytology; HR-HPV in 89% and LR-HPV in 11%), and four were negative (all cytology negative; 3 HR-HPV and 1 LR-HPV). HR-HPV was more frequent as immunodepression worsened. These results show that cytological evaluation alone underestimated histological alterations in 23/50 women (42.6%), whereas the combination of Pap smear and HPV detection reduced this underestimate to 5%. J. Med. Virol. 56:133–137, 1998. © 1998 Wiley-Liss, Inc.     

Resolving ASCUS without recourse to HPV testing: manual reprocessing of residual automated liquid-based cytology (ALBC) material using manual liquid-based cytology (MLBC)

We show that residual cell material from ThinPrep PapTest (Cytyc Corporation, Boxborough, MA) atypical squamous-cells of undetermined significance (ASCUS) cases may be manually reprocessed to triage women into actionable diagnostic categories (HSIL, LSIL, and Negative). Material remaining from each of 358 ThinPrep ASCUS cases was manually reprocessed as two slides, labeled "A" and "B." Interobserver agreement between case contributors (CCs) and three sequential reviewers (SRs) was analyzed with 186 cases (Study 1), and diagnostic reproducibility between SRs was examined with an additional 172 cases (Study 2). In Study 1, CCs classified 33% of cases as LSIL or greater, SRs classified 60% as LSIL or greater, and there was 58% diagnostic agreement between CCs and SRs. No "Negative" case assignment by one group afforded an "HSIL" assignment by the complementary group. In Study 2, there was 95% agreement between SRs A slide and B slide diagnoses with 54% of A slides and 55% of B slides classified as LISL or greater. Again, no "Negative" case assignment to one slide afforded an "HSIL" assignment to the complementary slide. Overall, 12.6% of the 358 cases showed HSIL, and all HSILs by one observer group were ASCUS or greater by the complementary observer group. Using manual reprocessing beyond the 21-day specimen outdate for HPV testing by the Hybrid Capture II High Risk HPV test (HR-HCII; Digene Corporation, Beltsville, MD), many ThinPrep ASCUS cases were reclassified as LSIL or HSIL. The 12.6% HSIL proportion of this study approximated the 11.5% CIN 2 or greater proportion of the ALTS ASCUS arm. Similar to ALTS, manual liquid-based cytology (MLBC) would have referred nearly 60% of women to colposcopy for a definitive diagnosis of HSIL or LSIL without resorting to HPV testing. These data demonstrate that many cases of automated liquid-based cytology (ALBC)-diagnosed ASCUS represent unrecognized SIL, which is present in the ALBC specimen vial at the time the ASCUS diagnosis is rendered.     

Squamous intraepithelial lesions in cervical smears of human immunodeficiency virus-seropositive adolescents

Various authors have reported a high rate of human papillomavirus (HPV) infection and HPV-related neoplasias in human immunodeficiency virus (HIV)-seropositive women. On the other hand, young women are most susceptible to cervical infection because of immaturity of the cervix, as it appears that HPV has more access to the basal cells of the differentiating epithelium. The purpose of the present work was to study cervical smears of 82 adolescent HIV-seropositive women (13–21 years of age) to search for cytological evidence of cervical intraepithelial neoplasias. Twenty-one cases showed characteristic features of HPV infection and squamous intraepithelial lesions (SIL; 25.6%). Sixteen cases aged from 17 to 21 years (mean age 19.5 years) had low-grade SIL (LSIL; 19.5%) and five cases aged from 18 to 21 years (mean age 20.2 years) had high-grade SIL (HSIL; 6.1%). There was no significant difference between the mean age of patients with LSIL and HSIL. Two cases had atypical squamous cells of undetermined significance (ASCUS). In the present work it was found that HIV-seropositive adolescents have a high risk for preneoplastic lesions of the cervix (25.6%) as well as a high incidence of more aggressive lesions (6.1% of HSIL) when compared to the general population of adolescents. As it can be assumed that, if the age of acquisition of the infection in both groups (in the general population and HIV-seropositive women) is the same, it is probable that HIV infection in adolescents not only increases the frequency of HPV infections but also facilitates the evolution to more aggressive preneoplastic lesions of the cervix due to HPV. Diagn. Cytopathol. 1998;18:91–92. © 1998 Wiley-Liss, Inc.     

Qualification of ASCUS. A comparison of equivocal LSIL and equivocal HSIL cervical cytology in the ASCUS LSIL Triage Study

Cytologic detection of high-grade squamous intraepithelial lesions (HSILs) is critical to cervical cancer prevention. Therefore, identifying "equivocal HSIL" (ASCUS [atypical squamous cells of undetermined significance]-H) may be useful. Accordingly, we compared findings associated with "equivocal low-grade SIL" (ASCUS-L), ASCUS-H, and HSIL using data from the ASCUS LSIL (low-grade squamous intraepithelial lesion) Triage Study. The frequency of oncogenic human papillomavirus (HPV) DNA detection and underlying lesions cervical intraepithelial neoplasia (CIN) 2 or worse or CIN 3 or worse in women with ASCUS-H was intermediate between that of ASCUS-L and HSIL. Oncogenic HPV DNA was associated with 85.6% of ASCUS-H ThinPreps and 69.8% of ASCUS-H smears. Histopathologic lesions CIN 2 or worse were associated with 40.5% of ASCUS-H ThinPreps and 27.2% of ASCUS-H smears (mostly CIN 3). Nevertheless, numerically more lesions CIN 2 or worse were preceded by ASCUS-L than by ASCUS-H because ASCUS-L was more common. ASCUS-H is an uncommon interpretation that derives clinical usefulness from its high positive predictive value for lesions CIN 2 or worse.     

Efficiency of immunohistochemical p16 expression and HPV typing in cervical squamous intraepithelial lesion grading and review of the p16 literature

Diagnosing and grading cervical cancer precursors is challenging. This study investigates the presence of HPV infection, the expression of p16, and any correlation between these two findings. H&E-stained slides of cervical loop excision materials diagnosed as LSIL and HSIL were reviewed. An immunohistochemical panel consisting of p16 as well as of all HPV types and HR-HPV types was applied. Staining of p16 was evaluated according to distribution extent and degree of intensity. All HSIL cases and 80% of LSIL cases were positive for p16. In HSIL cases, the staining distribution was as follows: 50% full thickness, 45% basal, and 5% rare. The staining intensity for the same cases was strong in 70%, variable in 20%, and weak in 10% accordingly. In LSIL cases, staining distribution was basal in 58.3% and rare in 41.7%. None of the LSIL cases showed full thickness of p16 positivity. The staining intensity of the same cases was strong in 25%, variable in 16.7%, and weak in 58.3%. Of all cases, 48.6% were positive for screening kit (all HPV types), and 31.4% of all cases were positive for HR-HPV. The distribution of this positivity was 35% for HSIL and 26.6% for LSIL cases. The total HPV-type positivity rate was 48.6%, the distribution being 50% for HSIL and 46.6% for LSIL cases. p16 is a highly sensitive marker for cervical epithelial dysplasia. Strong and full thickness staining of p16 in the cervix epithelium is highly supportive of HSIL, while weak and basal/rare staining favors LSIL. All HPV-positive cases were also p16-positive, but no statistically significant relationship between HPV infection positivity and the intensity and distribution of p16 was found. HPV is not helpful in the grading of SIL, as an unignorable rate of HR-HPV positivity (26.6%) was detected in LSIL group.     

芯片电泳快速检测高危型人类乳头状瘤病毒

目的建立人类乳头状瘤病毒（humanpa pillomavims,HPV）52和58基因型高危型的芯片电泳检测方法。方法选取114例宫颈细胞检测患者,提取宫颈脱落细胞DNA。PCR扩增HPV高危型52和58基因型特异性DNA序列,应用优化的芯片电泳分析方法对扩增产物进行分离检测。根据细胞学诊断结果将研究对象分为4组：正常组、不典型鳞状细胞组、低度鳞状上皮内病变组和高度鳞状上皮内病变组,比较各组的HPV52、58基因型感染情况。结果114份标本中,HPV52基因型检出率为8.8%（10/114）,HPV58基因型检出率为33.3%（38/114）。与正常对照组相比较,各病变组HPV52基因型检出率差异有统计学意义（P〈0.05）;而HPV58基因型检出率在病变组和正常对照组之间差异无统计学意义（P〉0.05）。结论芯片电泳法检测快速、成本低,可用于HPV52、58基因型感染的筛查。     

DNA倍体定量分析联合HR-HPV检测在宫颈病变中的应用价值

目的：探讨DNA倍体定量分析联合高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)检测技术在宫颈病变诊断中的应用价值。方法：对94例具有明确病理诊断结果的宫颈病变患者行DNA倍体定量和HR-HPV检测数据分析,分别计算单独和联合检测DNA异倍体、HR-HPV感染预测高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)及以上病变的灵敏度、特异度、阳性预测值、阴性预测值和诊断符合率,绘制相应的ROC曲线;分析DNA倍体定量的结果与HR-HPV检测的结果有无相关关系;比较DNA异倍体阳性的不同宫颈病变组织中>5c和>9c细胞的个数。结果：单独和联合检测DNA异倍体、HR-HPV感染预测HSIL及以上病变的灵敏度、特异度、阳性预测值、阴性预测值、诊断符合率分别为98.03%,94.11%,92.15%、41.86%,53.48%,72.09%、66.66%,70.58%,79.66%、94.73%,88.46%,88.57%、72.34%,75.53%,82.97%。从ROC曲线下面积可以直观地看出联合检测DNA异倍体和HR-HPV感染预测HSIL及以上病变的诊断价值最高。DNA异倍体阳性和阴性、HR-HPV阳性和阴性的不同宫颈病变发生率比较,差异均有统计学意义(P<0.01)。DNA倍体分析结果与HR-HPV检测结果呈正相关趋势(rn=0.281,P<0.01)。DNA异倍体阳性的不同宫颈病变组织每1000个被测细胞中出现>5c的细胞个数,在慢性宫颈炎、低度鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)、HSIL和宫颈癌中分别为0.31±0.14、0.40±0.16、2.08±0.68、2.37±0.81;慢性宫颈炎、LSIL患者分别与HSIL、宫颈癌患者比较,差异均有统计学意义(P<0.01)。慢性宫颈炎、LSIL患者中未见>9c细胞,HSIL、宫颈癌患者中>9c细胞个数分别为1.31±0.65、1.64±0.75,差异无统计学意义(P>0.05)。结论：DNA倍体定量分析联合HR-HPV检测在宫颈病变,特别是宫颈HSIL及以上病变的筛查中具有较高的诊断价值。>9c异倍体细胞的检出很大可能提示宫颈HSIL及以上病变的存在。