Do women with high-risk HPV E6/E7 mRNA test positivity and NILM cytology need colposcopy?

IF 3.1 2区医学 Q3 IMMUNOLOGY

Infectious Agents and Cancer Pub Date : 2023-09-29 DOI:10.1186/s13027-023-00531-w

Ying Liu, Xiu Jin, Yingying Gong, Yingying Ma, Beibei Du, Linqing Yang, Yunfei Wang, Weipei Zhu

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Abstract

Purpose: This study aimed to assess the value of an HPV E6/E7 mRNA assay and HPV 16 18/45 genotype assay combined with age stratification for triaging women negative for intraepithelial lesions or malignancy (NILM) cytology.

Methods: From January 2017 to December 2021, a total of 162,309 eligible women underwent cervical cancer screening at the Affiliated Hospital of Jining Medical University, China. Excluding those with negative HPV E6/E7 mRNA, abnormal and unsatisfactory cytology, and those who failed to undergo colposcopy, 6,845 women were ultimately included in our study. We analysed the triage guidance for different subtypes of HPV in the presence of NILM cytology.

Results: Among 162,309 women, 19,834 (12.2%) were positive for HPV E6/E7 mRNA. Of the 6,845 women included in the study, 1,941 (28.4%), 561 (8.2%), 55 (0.8%) and 4,288 (62.6%) tested positive for HPV 16, HPV 18/45, HPV16/18/45 or other HR-HPV genotypes, respectively. The proportions of LSIL+ (including LSIL, HSIL and ICC) and HSIL+ (including HSIL and ICC) pathological results in the HPV 16/18/45 + group were 57% and 34.1%, respectively, higher than 36.3% and 11% in the other HR-HPV + group (χ² = 653.214, P < 0.001). The percentages of LSIL + and HSIL + in the HPV16 + group (61.3% and 42.8%, respectively) and HPV16+/18/45 + group (76.3% and 41.9%, respectively) were much higher than those in the HPV18 + group (40.6% and 13.1%, respectively) (P < 0.001). However, there was no significant difference in the percentage of histopathological results between the HPV16 + group and HPV16+/18/45 + groups (P > 0.05). The above results were consistent after stratification according to age.

Conclusion: The rate of histopathological abnormalities was still high for the other HR-HPV subtypes with NILM cytology, although the rate of histopathological abnormalities was much higher for the HPV 16/18/45 positive subtypes. Therefore, colposcopy should be performed in women with HPV E6/E7 mRNA positivity and NILM cytology, regardless of age and HPV genotype.

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高危HPV E6/E7 mRNA检测阳性和NILM细胞学检查的女性是否需要阴道镜检查？

目的：本研究旨在评估HPV E6/E7 mRNA检测和HPV 16 18/45基因型检测结合年龄分层对上皮内病变或恶性肿瘤（NILM）细胞学阴性女性进行分型的价值。方法：2017年1月至2021年12月，共有162309名符合条件的女性在济宁医科大学附属医院接受了癌症筛查。排除那些HPV E6/E7 mRNA阴性、细胞学异常和不令人满意的患者，以及那些未能接受阴道镜检查的患者，6845名女性最终被纳入我们的研究。我们分析了存在NILM细胞学的不同亚型HPV的分诊指南。结果：在162309名女性中，有19834人（12.2%）的HPV E6/E7mRNA阳性。在纳入研究的6845名女性中，1941人（28.4%）、561人（8.2%）、55人（0.8%）和4288人（62.6%）的HPV 16、HPV 18/45、HPV16/18/45或其他HR-HPV基因型检测呈阳性。LSIL+（包括LSIL、HSIL和ICC）和HSIL+（包含HSIL和ICC-）病理结果在HPV 16/18/45中的比例 + 组分别为57%和34.1%，高于其他HR-HPV组的36.3%和11% + 组（χ2 = 653.214，第页 0.05）。根据年龄分层后，上述结果是一致的。结论：NILM细胞学检查的其他HR-HPV亚型的组织病理学异常发生率仍然很高，尽管HPV16/18/45阳性亚型的病理学异常率要高得多。因此，无论年龄和HPV基因型如何，都应在HPV E6/E7mRNA阳性和NILM细胞学检查的女性中进行阴道镜检查。

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来源期刊

Infectious Agents and Cancer ONCOLOGY-IMMUNOLOGY

CiteScore

5.80

自引率

2.70%

发文量

期刊介绍： Infectious Agents and Cancer is an open access, peer-reviewed online journal that encompasses all aspects of basic, clinical, epidemiological and translational research providing an insight into the association between chronic infections and cancer. The journal welcomes submissions in the pathogen-related cancer areas and other related topics, in particular: • HPV and anogenital cancers, as well as head and neck cancers; • EBV and Burkitt lymphoma; • HCV/HBV and hepatocellular carcinoma as well as lymphoproliferative diseases; • HHV8 and Kaposi sarcoma; • HTLV and leukemia; • Cancers in Low- and Middle-income countries. The link between infection and cancer has become well established over the past 50 years, and infection-associated cancer contribute up to 16% of cancers in developed countries and 33% in less developed countries. Preventive vaccines have been developed for only two cancer-causing viruses, highlighting both the opportunity to prevent infection-associated cancers by vaccination and the gaps that remain before vaccines can be developed for other cancer-causing agents. These gaps are due to incomplete understanding of the basic biology, natural history, epidemiology of many of the pathogens that cause cancer, the mechanisms they exploit to cause cancer, and how to interrupt progression to cancer in human populations. Early diagnosis or identification of lesions at high risk of progression represent the current most critical research area of the field supported by recent advances in genomics and proteomics technologies.