The use of biomarkers and HPV genotyping to improve diagnostic accuracy in women with a transformation zone type 3.

Autor: Manley K; University Hospitals Bristol NHS Foundation Trust, Bristol, UK. Kristyn.Manley@uhbw.nhs.uk.; University of Bristol, Bristol, UK. Kristyn.Manley@uhbw.nhs.uk., Patel A; University Hospitals Bristol NHS Foundation Trust, Bristol, UK., Pawade J; Department of Pathology, North Bristol Trust, Bristol, UK., Glew S; University of Bristol, Bristol, UK., Hunt K; Department of Pathology, North Bristol Trust, Bristol, UK., Villeneuve N; Department of Pathology, North Bristol Trust, Bristol, UK., Mukonoweshuro P; Department of Pathology, Royal United Hospitals Bath, Bristol, UK., Thompson S; Department of Pathology, North Bristol Trust, Bristol, UK., Hoskins H; Department of Pathology, North Bristol Trust, Bristol, UK., López-Bernal A; University of Bristol, Bristol, UK., Wills A; University of Bristol, Bristol, UK.
Jazyk: angličtina
Zdroj: British journal of cancer [Br J Cancer] 2022 Jan; Vol. 126 (1), pp. 91-99. Date of Electronic Publication: 2021 Oct 29.
DOI: 10.1038/s41416-021-01539-y
Abstrakt: Background: Twenty percent of women referred to colposcopy have a type 3 transformation zone-where colposcopic assessment for high-grade dysplasia (CIN2+) is not possible. This study examines the effectiveness of HPV biomarkers and genotyping in combination with techniques that sample an endocervical TZ.
Methods: A prospective diagnostic accuracy study. Women booked for large-loop excision (LLETZ) with squamous dyskaryosis, high-risk HPV and a TZ3 were recruited. Immediately prior to LLETZ samples were collected for p16/Ki-67 dual-stained cytology, HPV genotyping and H&E, p16- and Ki-67-stained endocervical curettings.
Results: In women with low-grade screening (n = 64), 35.9% had CIN2+; dual-stained cytology had the greatest effect on the PPV of routine screening (76.1% vs 35.9%) and perfectly predicted the absence of CIN2+. In women with a high-grade screening result (n = 37); 75.6% had CIN2+ and dual-stained curettings improved the PPV (96.5 vs 75.6%).
Conclusions: With high-grade screening and a TZ3, LLETZ appears safest as three quarters have CIN2+ . Women with low-grade screening and a TZ3 have a twofold increased risk of CIN2+ when compared to women where the TZ is visible. The use of dual-stained cytology may help identify those women who can be safely offered surveillance and those who require treatment.
(© 2021. Crown.)
Databáze: MEDLINE
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