The Role of Human Papillomavirus DNA Testing in Detecting High-Grade Squamous Intraepithelial Neoplasia in Women with Mild Cervical Cytologic Abnormalities

人類乳突瘤病毒檢測方法在篩檢輕度子宮頸抹片病變的婦女罹患高度子宮頸皮內贅瘤中所扮演的角色

陳震宇(Chen-Yu Chen) ； 陳鴻生(Hung-Sheng Chen) ； 楊育正(Yuh-Cheng Yang) ； 蘇聰賢(Tsung-Hsien Su) ； 王道遠(Tao-Yeuan Wang) ； 黃玉文(Yu-Wen Huang)

《Taiwanese Journal of Obstetrics & Gynecology》 42卷2期 (2003/06) Pp. 91-100

https://doi.org/10.29787/TJOG.200306.0002

摘要

目的：利用前瞻性的研究方式評估人類乳突瘤病毒檢測方法在篩檢輕度子宮頸抹片病變的婦女罹患高度分化鱗狀皮內細胞病變方面的臨床價值。材料和方法：共有513位婦女其子宮頸抹片檢查為非典型鱗狀上皮細胞病變或低度分化鱗狀皮內細胞病變，之後同時接受重複抹片檢查，人類乳突瘤病毒檢測，及陰道鏡組織切片。分析三者間陰道鏡的使用率，對高度分化鱗狀皮內細胞病變診斷的敏感度，及價格方面的差異。
結果：在高度分化鱗狀皮內細胞病變診斷的敏感度方面，人類乳突瘤病毒檢測為90.2 %（37/41，非典型鱗狀上皮細胞病變）及95.4 %（62/65，低度鱗狀皮內細胞病變）；相對而言，重複抹片檢查的敏感度只有71.8 %（28/39，非典型鱗狀上皮細胞病變）及76.2 %（48/63，低度鱗狀皮內細胞病變）。使用人類乳突瘤病毒檢測方式追蹤128位原先抹片檢查為非典型鱗狀上皮細胞病變而切片診斷為正常或低度鱗狀皮內細胞病變的婦女，其在之後演變成高度鱗狀皮內細胞病變上，有統計上的意義。然而，在80位原先抹片為低度鱗狀皮內細胞病變的婦女，則無統計上的意義。結論：人類乳突瘤病毒檢測方法在篩檢輕度子宮頸抹片病變的婦女罹患高度鱗狀皮內細胞病變方面有相當的敏感度。使用人類乳突瘤病毒檢測方式追蹤原先抹片檢查為非典型鱗狀上皮細胞病變的婦女，可以明顯降低陰道鏡的使用率，並減少檢查者和病人的焦慮。然而，在追蹤原先抹片檢查為低度鱗狀皮內細胞病變的婦女，則可以直接使用陰道鏡檢查。另外，在經濟因素的考量方面，由於在台灣地區陰道鏡的檢查收費較低，因此在篩檢輕度子宮頸抹片病變的婦女，陰道鏡的檢查可以當做第一線的診斷工具。

關鍵字

人類乳突瘤病毒 ； 非典型鱗狀上皮細胞病變 ； 低度鱗狀皮內細胞病變 ； 高度鱗狀皮內細胞病變

並列摘要

Objective: This prospective study was designed to evaluate whether human papillomavirus (HPV) DNA testing is a cost-effective tool in the management of women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL) detected by Papanicolaou (Pap) smear.
Material(s) and Method(s): Our study included a total of 513 women with ASCUS or LSIL detected by Pap smear. All then had a repeat Pap smear, HPV DNA testing, and colposcopically directed biopsies. The methods were compared with regard to sensitivity for detecting high-grade cervical intraepithelial neoplasia (CIN) and cost.
Result(s): The sensitivity of HPV DNA for high-grade CIN or invasive cancer was 90.2% (37/41) for ASCUS and 95.4% (62/65) for LSIL, whereas the corresponding values for repeat Pap smears were only 71.8% (28/39) and 76.2% (48/63). In 128 women with ASCUS whose biopsy results were normal or had low-grade CIN, a positive HPV DNA test was helpful in predicting those who subsequently developed high-grade CIN. While repeat Pap smear testing was the least expensive method (NTD 11051/case of high-grade CIN detected), it was also the least sensitive. Colposcopic biopsy was less expensive than HPV DNA testing (NTD 14,034 vs. 18,709).
Conclusion(s): While HPV DNA testing is sensitive in predicting concurrent and subsequent high-grade lesions, its role is limited by its cost. Colposcopic biopsy is the most cost-effective first step in evaluating women with ASCUS and LSIL. In women with high-grade CIN, therapy should be given on that basis. However, in women with ASCUS, if the biopsy results are normal or low-grade CIN, HPV DNA testing at that point is useful to predict which women will require closer follow up. In women with LSIL but with low-grade CIN on biopsy, there is no need to test for HPV since almost all will be positive, and they are suggested to perform colposcopy directly.

並列關鍵字

human papillomavirus ； atypical squamous cells of undetermined significance ； low-grade squamous intraepithelial lesions ； high-grade squamous intraepithelial lesions