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Abstract：
BACKGROUND: Cervical cancer screening results that are negative for cytology but positive for high-risk human papillomavirus (HR-HPV) are not uncommon. One-year follow-up is suggested for patients with no history of HPV positivity under the most recent American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines (2019). The aim of this study was to evaluate the immediate risk of cervical intraepithelial neoplasia (CIN) among cytology-negative patients positive for HR-HPV. The diagnostic accuracy of colposcopy in these patients was investigated.
METHODS: A retrospective study was conducted in patients who were cytology negative but HR-HPV positive and referred for colposcopy from January 2022 to August 2023. Patients were compared in terms of the immediate rate of CIN lesions among the HPV16-positive group, the HPV18-positive group and the non-16/18 HR-HPV-positive group. The distribution of CIN2 + lesions according to age was evaluated. The factors associated with the accuracy of colposcopy were evaluated using univariate and multivariate logistic regression.
RESULTS: Among the 372 patients, 195 had chronic cervicitis, 131 had CIN1, 37 had CIN2/3, and nine had carcinoma. The immediate rates of CIN2 + lesions and CIN3 + lesions in patients who were not HR-HPV16/18-positive were comparable to those in patients who were HPV16/18-positive (P = 0.699). In addition, among patients diagnosed with CIN2 + lesions, 8 (17.39%) patients were women aged < 30 years. When pathological results were used as a reference, the consistency rate of colposcopy was 61.0% (227/372). Multivariate analyses revealed that age and the type of cervical transformation zone were independent factors affecting the accuracy of colposcopy (P < 0.001).
CONCLUSIONS: In countries with limited resources, immediate colposcopy referral should be recommended for patients who are cytology negative but HR-HPV-positive (including non-16/18 HR-HPV-positive), and cervical cancer screening via cotesting should be suggested for women aged < 30 years. Colposcopy has moderate diagnostic value and can be affected by age and the type of cervical transformation zone.
METHODS: A retrospective study was conducted in patients who were cytology negative but HR-HPV positive and referred for colposcopy from January 2022 to August 2023. Patients were compared in terms of the immediate rate of CIN lesions among the HPV16-positive group, the HPV18-positive group and the non-16/18 HR-HPV-positive group. The distribution of CIN2 + lesions according to age was evaluated. The factors associated with the accuracy of colposcopy were evaluated using univariate and multivariate logistic regression.
RESULTS: Among the 372 patients, 195 had chronic cervicitis, 131 had CIN1, 37 had CIN2/3, and nine had carcinoma. The immediate rates of CIN2 + lesions and CIN3 + lesions in patients who were not HR-HPV16/18-positive were comparable to those in patients who were HPV16/18-positive (P = 0.699). In addition, among patients diagnosed with CIN2 + lesions, 8 (17.39%) patients were women aged < 30 years. When pathological results were used as a reference, the consistency rate of colposcopy was 61.0% (227/372). Multivariate analyses revealed that age and the type of cervical transformation zone were independent factors affecting the accuracy of colposcopy (P < 0.001).
CONCLUSIONS: In countries with limited resources, immediate colposcopy referral should be recommended for patients who are cytology negative but HR-HPV-positive (including non-16/18 HR-HPV-positive), and cervical cancer screening via cotesting should be suggested for women aged < 30 years. Colposcopy has moderate diagnostic value and can be affected by age and the type of cervical transformation zone.
摘要：
背景：细胞学检查阴性但高危型人乳头瘤病毒（HR-HPV）阳性的宫颈癌筛查结果并不少见。根据最新的美国阴道镜和宫颈病理学学会（ASCCP）指南（2019），建议无HPV阳性病史的患者进行一年的随访。这项研究的目的是评估HR-HPV阳性的细胞学阴性患者中宫颈上皮内瘤变（CIN）的直接风险。研究了这些患者阴道镜检查的诊断准确性。
方法：从2022年1月至2023年8月，对细胞学阴性但HR-HPV阳性并转诊为阴道镜的患者进行了回顾性研究。在HPV16阳性组中，比较了患者的CIN病变即刻发生率，HPV18阳性组和非16/18HR-HPV阳性组。根据年龄评估CIN2病变的分布。使用单变量和多变量逻辑回归评估与阴道镜检查准确性相关的因素。
结果：在372名患者中，195人患有慢性宫颈炎,131例hadCIN1，37例hadCIN2/3，9例患有癌症。非HR-HPV16/18阳性的患者的CIN2病变和CIN3病变的即时发生率与HPV16/18阳性的患者相当（P=0.699）。此外,在诊断为CIN2+病变的患者中，8例(17.39%)患者为年龄<30岁的女性。当病理结果作为参考时，阴道镜检查的一致性率为61.0%(227/372)。多因素分析显示，年龄和宫颈转化区类型是影响阴道镜检查准确性的独立因素（P<0.001）。
结论：在资源有限的国家，对于细胞学阴性但HR-HPV阳性（包括非16/18HR-HPV阳性）的患者，应建议立即进行阴道镜转诊，对于年龄<30岁的女性，应建议通过共同测试进行宫颈癌筛查。阴道镜检查具有中等诊断价值，并且可以受年龄和宫颈转化区类型的影响。
方法：从2022年1月至2023年8月，对细胞学阴性但HR-HPV阳性并转诊为阴道镜的患者进行了回顾性研究。在HPV16阳性组中，比较了患者的CIN病变即刻发生率，HPV18阳性组和非16/18HR-HPV阳性组。根据年龄评估CIN2病变的分布。使用单变量和多变量逻辑回归评估与阴道镜检查准确性相关的因素。
结果：在372名患者中，195人患有慢性宫颈炎,131例hadCIN1，37例hadCIN2/3，9例患有癌症。非HR-HPV16/18阳性的患者的CIN2病变和CIN3病变的即时发生率与HPV16/18阳性的患者相当（P=0.699）。此外,在诊断为CIN2+病变的患者中，8例(17.39%)患者为年龄<30岁的女性。当病理结果作为参考时，阴道镜检查的一致性率为61.0%(227/372)。多因素分析显示，年龄和宫颈转化区类型是影响阴道镜检查准确性的独立因素（P<0.001）。
结论：在资源有限的国家，对于细胞学阴性但HR-HPV阳性（包括非16/18HR-HPV阳性）的患者，应建议立即进行阴道镜转诊，对于年龄<30岁的女性，应建议通过共同测试进行宫颈癌筛查。阴道镜检查具有中等诊断价值，并且可以受年龄和宫颈转化区类型的影响。
