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Abstract：
Objective This project aims to use our robust women\'s health patient data to analyze the correlation between cytology and high-risk human papillomavirus (Hr-HPV) testing, study the performance of Hr-HPV testing for detecting cytology lesions, and examine epidemiologic measures of human papillomavirus (HPV) infections in the women\'s veteran population. Methods We collected patient data from 2014 to 2020 from our computerized patient record system. We performed HPV assays using the cobas® 4800 system (Roche Diagnostics, Basel, Switzerland). The cobas HPV assay detects HPV 16, HPV 18, and 12 other HPV types (31, 33, 35, 39, 45, 51, 56, 58, 59, 66, and 68). We organized cytology results and Hr-HPV assays with Microsoft Access and Microsoft Excel (Microsoft Corporation, Washington, USA) for analysis. Results A total of 9437 cervical specimens were co-tested. High-grade cytology lesions - high-grade intraepithelial lesion (HSIL) or higher and atypical squamous cells, cannot exclude HSIL (ASC-H) - were overwhelmingly positive for Hr-HPV (94.1% and 87.2%, respectively). Low-grade cytology lesions - low-grade squamous intraepithelial lesion ((LSIL) and atypical squamous cells of undetermined significance (ASC-US) - were positive for Hr-HPV in lower percentages (72.6% and 54.9%, respectively). Hr-HPV testing had a sensitivity of 91.3%, a specificity of 93.1%, a positive predictive value of 16.4%, and a negative predictive value of 99.8% for detecting high-grade cytology lesions. Hr-HPV testing had a lower performance for detecting low-grade cytology lesions. Ten cases had high-grade cytology and negative Hr-HPV test. Out of 10 such patients, nine showed no dysplasia (six) or low-grade dysplasia (three) on subsequent biopsy. Overall, 14.4% of tests were positive for Hr-HPV. The highest positive Hr-HPV test rates were in the third and eighth decades of life, 25.1% and 22.0%, respectively. However, the eighth decade consisted of a small sample of only 50 women. In women over 30 years of age with Hr-HPV infections, HPV types 16 and 18 were present in 11.7% and 6.4% of tests, respectively. Other HPV types were present in 82.3% of tests. Conclusions Hr-HPV testing has a high performance in detecting high-grade cytology lesions and a lower performance for detecting low-grade cytology lesions. However, studies show that LSIL rarely progresses to cervical intraepithelial neoplasia grade 3 or higher (CIN3+), suggesting minimal to no impact on cervical cancer screening. We believe our findings are in accordance with recent studies and affirm the guidelines that recommend primary Hr-HPV testing as the preferred screening method. The percentage of positive Hr-HPV tests and rates for age and HPV types 16 and 18 in our women\'s veteran population suggest similar HPV prevalence to that of the general US population.
摘要：
目的本项目旨在利用我们健壮的女性健康患者数据,分析细胞学检查与高危型人乳头瘤病毒(Hr-HPV)检测的相关性,研究Hr-HPV检测检测细胞学病变的性能，并检查女性退伍军人人群中人乳头瘤病毒（HPV）感染的流行病学指标。方法我们从我们的计算机化病历系统收集了2014年至2020年的患者数据。我们使用cobas®4800系统(RocheDiagnostics,巴塞尔,瑞士)。cobasHPV测定检测HPV16、HPV18和12种其他HPV类型(31、33、35、39、45、51、56、58、59、66和68)。我们使用MicrosoftAccess和MicrosoftExcel（MicrosoftCorporation，华盛顿,美国)进行分析。结果共检测9437份宫颈标本。高级别细胞学病变-高级别上皮内病变（HSIL）或更高级别和非典型鳞状细胞，不能排除HSIL（ASC-H）-Hr-HPV绝大多数为阳性（94.1%和87.2%，分别)。低度细胞学病变-低度鳞状上皮内病变（（LSIL）和意义不明的非典型鳞状细胞（ASC-US）-Hr-HPV阳性百分比较低（72.6％和54.9％，分别)。Hr-HPV检测的敏感性为91.3%，特异性为93.1%，阳性预测值为16.4%，检测高级别细胞学病变的阴性预测值为99.8%。Hr-HPV检测在检测低度细胞学病变方面的性能较低。10例细胞学检查为高级别，Hr-HPV检测阴性。在10个这样的病人中，在随后的活检中,9例患者未出现异型增生(6例)或低度异型增生(3例).总的来说,14.4%的检测为Hr-HPV阳性。Hr-HPV检测阳性率最高的是在生命的第三和八十年，25.1%和22.0%，分别。然而,第八个十年仅有50名女性。在30岁以上患有Hr-HPV感染的女性中，HPV16型和18型在11.7%和6.4%的检测中存在，分别。其他HPV类型存在于82.3%的测试中。结论Hr-HPV检测在检测高级别细胞学病变中具有较高的性能，而在检测低级别细胞学病变中具有较低的性能。然而,研究表明，LSIL很少进展到宫颈上皮内瘤变3级或更高（CIN3+），提示对宫颈癌筛查影响最小或没有影响。我们相信我们的研究结果与最近的研究一致，并肯定了推荐原发性Hr-HPV检测作为首选筛查方法的指南。在我们的女性退伍军人人群中，Hr-HPV检测阳性的百分比以及年龄和HPV类型16和18的比率表明HPV患病率与美国普通人群相似。
