大量HPV基因分型在女性不典型腺体细胞中的宫颈高级别瘤变的临床意义

The significance of extensive HPV genotyping for cervical high-grade neoplasia among women with atypical glandular cells

AMERICAN JOURNAL OF CLINICAL PATHOLOGY

影响因子:1.9

分区:医学4区 / 病理学3区

发表日期:2025 Jan 28

作者: Xiao Tang, Megan L Zilla, Wei Jiang, Yanmei He, David Starr, Lei Li, Lingling Tong, Cheng Wang, Wei Wang, Kaixuan Yang, Rutie Yin, Chengquan Zhao

DOI: 10.1093/ajcp/aqae103

摘要

本研究旨在探讨伴有AGC（不典型腺体细胞）检测的患者中，广泛HPV基因分型与宫颈高级别瘤变（CIN3+）风险的相关性。通过筛选带有AGC诊断的巴氏涂片（Pap）样本，结合广泛的高危HPV（hrHPV）基因分型和组织学随访结果。本研究分析了469,694份巴氏涂片中的0.4%的AGC病例，其中1267例进行了高危HPV基因检测，40.3%的病例为hrHPV阳性。在随访的组织学检查中，hrHPV阳性病例的CIN3+发生率为52.2%，而hrHPV阴性病例仅为4.9%。与这些病例相关的五种主要高危HPV基因型为HPV16、HPV18、HPV58、HPV52和HPV33。在此群体中，至少感染上述任一HPV基因型的CIN3+病例占比达92.8%。检测宫颈CIN3+的敏感性为85.6%，若包括额外的12种HPV基因型，敏感性略增至89.0%。在带有AGC的Pap筛查中，感染HPV16/18/58/52/33的患者，其发生宫颈CIN3+的风险显著增加。结合全面的HPV基因分型，有助于风险分层和制定更个性化的管理策略。© 本作品由牛津大学出版社代表美国临床病理学会于2024年出版。若需商业再利用，请联系reprints@oup.com获取稿件和翻译授权，其他权限请通过我们网站上的RightsLink服务获取，详情请联系journals.permissions@oup.com。

Abstract

To examine the associated risk of cervical intraepithelial neoplasm grade 3+ (CIN3+) lesions in patients with AGC and extensive human papillomavirus (HPV) genotyping.Cases with atypical glandular cell (AGC) interpretation on a Papanicolaou (Pap) test were identified along with associated extensive HPV genotyping and histologic follow-up results.Within this cohort of 469,694 Pap tests, 0.4% were diagnosed as AGCs. In total, 1267 cases had concurrent high-risk HPV (hrHPV) genotyping, and 40.3% were hrHPV positive. The percentage of AGC cases with cervical CIN3+ on histologic follow-up was 52.2% when hrHPV was positive, whereas it was 4.9% with a negative hrHPV result. The top 5 hrHPV genotypes associated with cervical CIN3+ in this cohort were HPV16, HPV18, HPV58, HPV52, and HPV33. Indeed, 92.8% of the hrHPV-associated CIN3+ lesions identified in this cohort were positive for at least one of these HPV genotypes. The sensitivity of detecting cervical CIN3+ lesions was 85.6% with the top 5 hrHPV genotypes (HPV16/18/58/52/33) and only increased to 89.0% when the additional 12 genotypes were included.In patients with an AGC Pap, the risk of having a cervical CIN3+ lesion is greatly increased by positivity for hrHPV types 16, 18, 58, 52, and/or 33. Incorporating comprehensive HPV genotyping into AGC cytology allows for refined risk stratification and more tailored management strategies.© The Author(s) 2024. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.