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- 你认为HPV 检测有必要吗?
Please share your oppinion:
请分享你的观点
Recently I noticed this topic in another cytology website in China. Let us have a discussion here.
最近我在另一个中国的细胞学网站中注意到这个主题。让我们一起在这里讨论。
1. Are all cervical carcinoma related to HPV infection?
所有的宫颈癌都是由HPV导致的吗？
2. When the women or who should have high risk HPV (hrHPV) testing?
那些女性需要或者什么时候做高危HPV检测呢？
3. What methods to detect hrHPV do you used in your hospitals?
你们医院用的是那种方法检测高危HPV？
4. What should the women do if she has positive hrHPV result?
如果她的高危HPV的结果是阳性的，她们该怎么办？
5. hrHPV testing should be performed for women with AGC?
细胞学结果为AGC的女性应该进行高危的HPV检测吗？
6. Any question, experience or oppinion you have, please share or discuss.
所有以上问题，就你个人的观点或经验来分享和讨论吧。
We as pathologists should know some basic information about HPV even though HPV testing might not be oerformed in your hospital, or the patients might not be able to pay for the test.
即使HPV检测在你们医院没有开展或病人没有经济能力支付这项检测。我们做为病理学医生应该知道一些关于HPV的基本知识。
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本帖最后由 于 2009-04-06 09:33:00 编辑
×参考诊断
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本帖最后由 于 2009-04-30 01:41:00 编辑
The above paper was out just in April 1. Dr. Austin (did the main work) and I analysed their data in details and noted that the authors manipulated the data and obtained the conclusion that one HPV screening is better than one cytology screening. We think it is abiase. The paper is agaist Pap cytology.
上述文章是刚刚发表于4月1日。Austin 博士（做了主要工作）和我在分析他们数据的细节时注意到作者操纵了数据并获得的结论是：HPV筛查优于细胞学筛查。我们认为这是可悲的 。该文章是against子宫颈细胞学检查。
In fact, the study acknowledged that the positive predictive value (PPV) for detecting CIN 2-3 was 19.3% in the cytologic-testing group, higher than 11.3% in the HPV-testing group, and study results indicate that essentially the same numbers of cervical cancers were detected after positive screening test results in the cytology arm (88) as in the HPV arm (87). Cervical cancer detection rates were 0.344% in the cytologic-testing group and 0.321% in the HPV-testing group. However the authors can obtain different conclusion based on the results.
事实上，这项研究在检测CIN2-3获得的阳性预测值（ PPV ）中细胞学为19.3%， 高于11.3 ％的HPV检测组。研究结果表明，基本上是相同的宫颈癌检测的筛查数据，检测的阳性结果在细胞学为（ 88 ）在HPV为（ 87 ）。宫颈癌检出率在细胞学检测组和HPV检测组分别为0.344 ％和0.321 ％。然而，基础上的结果作者可以得到不同的结论。
Now most large studies are company related or finally related. We write a commentary titled as " Test group biases and ethical issues mar New England Journal of Medicine articles promoting HPV screening for cervical cancer in rural
现在大多数大型研究都与公司利益相关或最后公司利益相关。对这一文章我们写一篇“新英格兰医学杂志发表的文章中在印度农村地区进行HPV筛查宫颈癌的试验组的偏见和伦理问题”评论，今日并递给细胞杂志（线上杂志）。希望它可以快速发表。
"Mar" is a fancy word which means ruin, spoil, spoil, blight.
I just learn this word.
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本帖最后由 于 2009-04-29 21:40:00 编辑
N Engl J Med. 2009 Apr 2;360(14):1385-94.
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International Agency for Research on Cancer, Lyon, France. sankar@iarc.fr
国际癌症研究机构 法国里昂。
BACKGROUND: In October 1999, we began to measure the effect of a single round of screening by testing for human papillomavirus (HPV), cytologic testing, or visual inspection of the cervix with acetic acid (VIA) on the incidence of cervical cancer and the associated rates of death in the Osmanabad district in India.
背景：1999年10月，在印度的Osmanabad区，我们开始衡量效果地进行单轮HPV筛查检测、细胞学检测、或直视下醋酸检查宫颈癌的发生率和与宫颈癌相关的死亡率。
METHODS: In this cluster-randomized trial, 52 clusters of villages, with a total of 131,746 healthy women between the ages of 30 and 59 years, were randomly assigned to four groups of 13 clusters each. The groups were randomly assigned to undergo screening by HPV testing (34,126 women), cytologic testing (32,058), or VIA (34,074) or to receive standard care (31,488, control group). Women who had positive results on screening underwent colposcopy and directed biopsies, and those with cervical precancerous lesions or cancer received appropriate treatment.
方法：本组随机分组实验，52个村庄进行分组，共有31746名年龄介于30到达9岁的健康女性，被随机分配到4个组，每组有13个村庄。分组随机指定接受HPV检测（34126名妇女）、细胞学检测（32058名妇女）、或直视下醋酸检查（VIA）（34074名妇女）或接受标准护理（31488名妇女，对照组）。对筛查结果为阳性进行阴道镜下活检。以及对那些有宫颈癌前病变和癌进行适当的治疗。
RESULTS: In the HPV-testing group, cervical cancer was diagnosed in 127 subjects (of whom 39 had stage II or higher), as compared with 118 subjects (of whom 82 had advanced disease) in the control group (hazard ratio for the detection of advanced cancer in the HPV-testing group, 0.47; 95% confidence interval [CI], 0.32 to 0.69). There were 34 deaths from cancer in the HPV-testing group, as compared with 64 in the control group (hazard ratio, 0.52; 95% CI, 0.33 to 0.83). No significant reductions in the numbers of advanced cancers or deaths were observed in the cytologic-testing group or in the VIA group, as compared with the control group. Mild adverse events were reported in 0.1% of screened women.
结果：在HPV检测组，被诊断为宫颈癌症127例（其中39例为STAGEII及以上）；而相对于对照组[在HPV组检测晚期癌症的风险比：0.47；95%的可信区间（CI）：0.32-0.69]为118例（其中82例有晚期的病变）。在HPV检测组中有34例死于癌症，而对照组有64例（风险比：0.52；95%的可信区间：0.38-0.83）。细胞学检测组或VIA组在晚期癌症或死亡病例的数据同对照组比较没有显著的减少。在筛查的妇女中被报道轻度不良反应为0.1%。
CONCLUSIONS: In a low-resource setting, a single round of HPV testing was associated with a significant reduction in the numbers of advanced cervical cancers and deaths from cervical cancer. 2009 Massachusetts Medical Society
结论：在低资源环境中，一个单轮的HPV检测在减少晚期宫颈癌和死亡的宫颈癌的人数有显著的相关性。 2009年马萨诸塞州医学会。
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本帖最后由 于 2009-05-02 11:23:00 编辑
Excellent discussion here initiated by Dr. Zhao, I just would like to add more fuel to the fire. In November 2007, I attended the International HPV meeting held in Beijing. I had extensive conversation with Dr. Mark Stoler (a leading expert cytologist on Pap test) and his friends of world experts on Gynecologic Oncology, their opinions are at least using HPV HC2 test as the primary screening test to replace Pap test, Pap test may be the secondary test or even replaced totally by other test. They said that I would not see any Paps in the near future with this proposed guidline and the HPV vacine. What's your thoughts on this?
这是赵博士发起的出色讨论,我只想“火上浇油”。2007年11月，我参加了在北京举行的国际HPV会议。我同Mark Stoler 博士（一个在巴氏试验领域领先的细胞学专家）和他的朋友们（世界妇科肿瘤专家）进行了广泛的交流。他们的意见是至少使用HPV HC2检测作为主要筛查试验以取代巴氏试验。巴氏试验可能是次要的试验，甚至完全被其他试验取代。基于他们的提议指南和HPV疫苗，在不久的将来，我们将看不到巴氏涂片。您对此有何想法？
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Some Chinese national organizations should design some large trials. High risk HPV DNA in larger number of LBC specimens is detected by HC2 and some detection products made by China. Then comparison of sensitivity and specificity. I totally agree that we should have our own products.
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本帖最后由 于 2009-04-14 12:01:00 编辑
如果细胞学为明确病变（HSIL或LSIL），或活检也能明确诊断，则不需要检测HPV。
You are right.
More than 80% LSIL and more than 90% (aaverage 95%) HSIL cases are high risk HPV positive detected by HC2. This is why HPV testing should not be done for these women. I know some medical school hospitals in China detect HPV for all women with abnormal Pap including LSIL and HSIL. This really wastes patients' money. I feel pain for these women especially for those who pay their own money for the testing. As pathologists we need to let clinical physicians know that. We have the responsibility.
By the way, how much for one convention Pap, LBC, and HC2 HPV testing?
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本帖最后由 于 2009-04-12 12:14:00 编辑
Thank 法师 for your considerate statement. I appreciate the way you share your oppinion. Wish more pathologists could do the same as our 法师 did. it is good part of internet that every one can share your own oppinion. By communication and discussion we can learn from each other and know somethings in details.
What are your oppinion? Do you agree with 法师 ?
| 以下是引用cqzhao在2009-4-7 5:08:00的发言：
DR. 法师, Do you think HPV testing can be useful for women with atypical squamous cell Pap? I am interested to know your comment.
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cqzhao老师：
很高兴回答您的提问，对于巴氏涂片发现非典型细胞有无必要进行HPV测定，我的看法是不提倡，因为通常对某一疾病进行病原学检测主要目的有以下几方面：1、有针对性的治疗；2、作为传染源加以控制，防止感染他人，比如HIV检测；3、在应用疫苗前进行检测，比如HBV。在我所生活的地区，对于HPV，上述条件均暂时不具备，相反存在着许多检测HPV的单位或声称治疗HPV的医院，甚至有广告说可以进行基因治疗，在细胞学检测报告中无选择的建议进行HPV检测无疑是让患者花更多的钱去进行一项并不确定的检查和治疗，相反一次HPV的检测费用足够进行多次细胞学检查
。这让我想起了前几年某基因诊断公司推广的致癌基因的检测，说检测出有致癌基因的人患癌症的机会比常人高很多倍，当时我们在想，是不是知道了自己有致癌基因患癌症的机率还会成倍升高？上面的是我的真心话，当然在工作中也会灵活处理，比如细胞学阳性，其它检测阴性，患者产生怀疑时，进行HPV测定就有必要了。
Agree with Dr. Yu. People think almost all cervical squamous cell ca and endocervical ca are related to HPV infection. A few scc and relative percentage of adenocarcinoma are HPV negative even using PCR test. Two possibilities: 1) rare cases may not caused by HPV, 2) some studies indicated the HPV genes lost in some invasive cancer cases.
As Dr. Yu mentioned that relative % of vagina and anal scc are not related with HPV infection.
