首页 > 期刊杂志 > 正文

Attributing Oncogenic Human Papillomavirus Genotypes to High-grade Cervical Neoplasia: Which Type Causes the Lesion?

致瘤性人乳头瘤病毒导致高级别宫颈瘤变:哪种类型导致病变?

van der Marel J,Berkhof J,Ordi J,Torné A,Del Pino M,van Baars R,Schiffman M,Wentzensen N,Jenkins D,Quint WG

Abstract

Human papillomavirus (HPV) is found in most women with high-grade cervical intraepithelial neoplasia (CIN) 2/3 in cervical cytology and biopsies. Multiple high-risk HPV (hrHPV) genotypes are present in 15% to 50% of cytology samples. We have shown by laser-capture microscopy (LCM)-polymerase chain reaction (PCR) that each lesion is associated with a single hrHPV type. Attribution of hrHPV types to CIN2/3 is important to understand the oncogenic role of different types and the limitations of cytologic typing. We studied hrHPV genotypes in 257 women with histologic CIN2/3 referred on the basis of abnormal cytology. HPV typing was done on cytology and CIN2/3 biopsies. If the whole-tissue section of the biopsy was positive for multiple hrHPV types, LCM-PCR was performed. We found 181 (70%) single and 71 (28%) multiple hrHPV infections in cytology, with 5 (2%) cases HPV-positive only on whole-tissue section PCR. Of cases with multiple cytologic hrHPV infections, 47/71 (66%) showed a single type in CIN2/3 lesions. In total, in 232 of 257 (90%) women with CIN2/3, a single hrHPV type caused CIN2/3. One was nonattributable on the LCM level. The remaining 24 women had 2 or more contiguous or separated lesions, each associated with a single hrHPV infection. The probability of HPV16 being present in CIN2/3, if detected in cytology, was 0.96 (95% confidence interval=0.90-0.98). LCM-PCR confirms that only 9% of histologic CIN2/3 is associated with multiple hrHPV types, much less than cytology would indicate, and each lesion was associated with a single hrHPV infection.

摘要

患有高级别宫颈上皮内瘤变(CIN)2/3级的大多数妇女宫颈细胞学和活检标本中发现了人乳头瘤病毒(HPV)。15%~50%的细胞学标本中发现了多种高危型HPV(hrHPV)基因型。我们通过激光捕获显微技术(LCM)-多聚酶链反应(PCR)已经发现每种病变均与某一种hrHPV类型有关。明确CIN2/3的hrHPV类型对于理解不同类型HPV的致瘤作用和细胞学分型的局限性具有重要意义。我们研究了257名妇女的hrHPV基因型,这些妇女在细胞学异常的基础上进行组织学检查发现CIN2/3。对细胞学标本和CIN2/3活检标本进行HPV分型。如果活检标本的全组织切片呈多种hrHPV类型阳性,则进行LCM-PCR检测。我们在细胞学标本中发现181(70%)单种和71(28%)多种hrHPV类型感染,5(2%)例仅在全组织切片PCR时发现HPV阳性。对于细胞学检测到多种hrHPV类型感染的病例,47/71(66%)在CIN2/3病变中显示单种HPV类型。整体上,232/257(90%)例患有CIN2/3的妇女中,单种hrHPV类型导致了CIN2/3。在LCM水平,一例无法检测到HPV。其余24名妇女有2处或更多连续的或分离的病变,每一病变均与单种hrHPV类型感染有关。如果用细胞学标本检测,HPV16在CIN2/3中出现的可能性为0.96(95%可信区间=0.90-0.98)。LCM-PCR证实,仅9%的组织学标本中的CIN2/3与多种hrHPV类型有关,远低于细胞学的检测结果,并且每一病变都与单一的hrHPV感染有关。

full text

我要评论

0条评论