大约20-40%的高级别宫颈上皮内瘤变(CIN)自发消退,但是单个病变的自然预后是不可预测的。染色体3q区域的增益,在3q26上含有人端粒酶RNA基因,在CIN病变和宫颈癌中发现,并与疾病分级相关。这项研究的目的是评估3q26增益作为单个遗传标记是否可以预测高等级CIN的自然预后。通过对文献和试点研究进行回顾。进行了文献综述。此外,我们在19例经组织学证实的高级别CIN病变患者中进行了一项初步研究,随访时间平均为115天,之后进行环切除术。对初始诊断活检进行荧光原位杂交分析以确定3q26的增益。文献综述中包括了8项研究,共有407名患者。其中,只有22例患者出现高级别病变.所有研究都发现3q26增益与疾病预后之间存在关联。阳性预测值(PPV)范围为50%至93%,阴性预测值(NPV)为75%至100%。在没有3q26增益的155名患者中,只有5名(3.2%)显示疾病持续或进展。在我们关于高级别CIN的3q26增益的初步研究中,疾病持续3q26增益的PPV为67%,净现值100%。所有4例无3q26增益的患者均显示疾病消退。总之,在诊断性活检中不存在3q26增益的情况下,可以应用于识别具有较高疾病消退概率的高级别CIN病变.
Approximately 20-40% of high-grade Cervical Intraepithelial Neoplasia (CIN) regresses spontaneously, but the natural prognosis of an individual lesion is unpredictable. Gain of the chromosomal 3q region, which contains the human telomerase RNA gene on
3q26, is found in CIN lesions and cervical carcinoma and shows correlation with disease grade. The aim of this study is to assess whether 3q26 gain as a single genetic marker can predict the natural prognosis of high-grade CIN, by performing a review of the literature and pilot study. A literature review was conducted. Additionally, we performed a pilot study in 19 patients with histologically confirmed high-grade CIN lesions who were followed for a mean of 115 days, after which loop excision was performed. Fluorescent in situ hybridization analysis was performed on the initial diagnostic biopsies to determine gain of 3q26. Eight studies were included in the literature overview, with a total of 407 patients. Of these, only 22 patients had high-grade lesions. All studies found an association between
3q26 gain and disease prognosis. Positive predictive values (PPV) ranged from 50 to 93%, negative predictive values (NPV) ranged from 75 to 100%. Only five out of 155 patients (3.2%) without
3q26 gain showed disease persistence or progression. In our pilot study on
3q26 gain in high-grade CIN, the PPV of
3q26 gain for disease persistence was 67%, the NPV 100%. All four patients without
3q26 gain showed disease regression. In conclusion, the absence of 3q26 gain in diagnostic biopsies may be applied to identify high-grade CIN lesions with a high probability of disease regression.