目的评估细胞学P16、液基细胞学(LBP)、高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)不同分层组合发生宫颈上皮内瘤变≥2级(cervical intraepithelial neoplasia grade 2 or worse,CIN2+)的风险。方法选取2018年1月至201...目的评估细胞学P16、液基细胞学(LBP)、高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)不同分层组合发生宫颈上皮内瘤变≥2级(cervical intraepithelial neoplasia grade 2 or worse,CIN2+)的风险。方法选取2018年1月至2019年7月北京大学第一医院宫颈病变门诊数据库中900例患者的临床数据,分析细胞学P16、LBP、高危HPV检测以及阳性转诊阴道镜的病理结果,评估不同组合对CIN2+病变的分层差异。结果存在细胞学P16、LBP、HR-HPV三种异常者发生CIN2+的风险均较高且大于60.0%,分别是93.1%(LBP高级别、其他HR-HPV、P16阳性)、85.5%(LBP高级别、16/18阳性、P16阳性)和68.4%(LBP低级别、HPV 16/18阳性、P16阳性)。P16阴性发生CIN2+风险低于15.0%,风险排序基本符合P16的变化规律。结论当阴道镜检查前发现三者均为阳性,发生CIN2+风险高,阴道镜检查时需高度重视,充分活检,避免漏诊,重视细胞学P16结果,P16阴性者发生CIN2+风险低,阴道镜检查时避免盲目活检,以免宫颈损伤。展开更多
Background: The main objective of this study is to analyse the change in the type of lesions developed by HPV-infected patients after the introduction of the vaccine in three different periods;2002-2006 (years previou...Background: The main objective of this study is to analyse the change in the type of lesions developed by HPV-infected patients after the introduction of the vaccine in three different periods;2002-2006 (years previous to the implementation of the vaccine in Spain), 2009-2011 (shortly after the vaccination) and 2020-2021 (years where the vaccine was well established) at a single hospital. Methods: This is an observational, descriptive, retrospective study based on the review of the results of the biopsies of patients with HPV lesions at a single large tertiary hospital, Hospital Clínico San Carlos, in Madrid, Spain. We have collected the data from three different time periods: 2002-2006, 2009-2011, 2020-2021 to try to understand the potential changes in these lesions after vaccine introduction. Results: In this time we have reviewed the data from 946 women. In these three periods, a decreasing trend in the rate of squamous cell carcinoma was noted, the rate of adenocarcinoma remains stable, and the rate of cervical intraepithelial neoplasia grades 2 - 3 (CIN 2-3) lesions shows an increasing trend. We have also found a change in the mean ages of the patients with these lesions, as this increased in the three lesions caused by HPV after the implementation of the vaccine. Our study indicates that the identification of other high risk serotypes, apart from 16 and 18, as well as those with indeterminate risk, has undergone a progressive increase, increasing from 24.24% and 14.11% respectively in 2002-2006 to 40.42% and 28.34% in 2020-2021. Conclusion: Our study confirms the effectiveness of the vaccines developed so far, against the HPV serotypes they contain. This is demonstrated by the evidence, in our population, of a decrease in the incidence of squamous cell carcinoma in uterine cervix. In parallel, an increase in the mean age of diagnosis has been verified, for both squamous cell carcinoma and its CIN 2-3 precursor lesions, as well as a change in the infective trend of HPV serotypes that are not included in the current vaccines.展开更多
文摘Background: The main objective of this study is to analyse the change in the type of lesions developed by HPV-infected patients after the introduction of the vaccine in three different periods;2002-2006 (years previous to the implementation of the vaccine in Spain), 2009-2011 (shortly after the vaccination) and 2020-2021 (years where the vaccine was well established) at a single hospital. Methods: This is an observational, descriptive, retrospective study based on the review of the results of the biopsies of patients with HPV lesions at a single large tertiary hospital, Hospital Clínico San Carlos, in Madrid, Spain. We have collected the data from three different time periods: 2002-2006, 2009-2011, 2020-2021 to try to understand the potential changes in these lesions after vaccine introduction. Results: In this time we have reviewed the data from 946 women. In these three periods, a decreasing trend in the rate of squamous cell carcinoma was noted, the rate of adenocarcinoma remains stable, and the rate of cervical intraepithelial neoplasia grades 2 - 3 (CIN 2-3) lesions shows an increasing trend. We have also found a change in the mean ages of the patients with these lesions, as this increased in the three lesions caused by HPV after the implementation of the vaccine. Our study indicates that the identification of other high risk serotypes, apart from 16 and 18, as well as those with indeterminate risk, has undergone a progressive increase, increasing from 24.24% and 14.11% respectively in 2002-2006 to 40.42% and 28.34% in 2020-2021. Conclusion: Our study confirms the effectiveness of the vaccines developed so far, against the HPV serotypes they contain. This is demonstrated by the evidence, in our population, of a decrease in the incidence of squamous cell carcinoma in uterine cervix. In parallel, an increase in the mean age of diagnosis has been verified, for both squamous cell carcinoma and its CIN 2-3 precursor lesions, as well as a change in the infective trend of HPV serotypes that are not included in the current vaccines.
