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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 2009-04-14 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 2009-05-02 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？
| 以下是引用城北在2009-4-7 13:01:00的发言：
作为病理医生我们不建议病人作HPV检测筛查，推荐HPV筛查检测的专家大多是妇产科医师，我们这里也是。妇产科医师坚持要为病人作HPV检测，需要相应的科室开展这项常规工作。在国内凯普的导流杂交和亚能的膜杂交技术都是国产的分型检测HPV的技术。能检测20多种HPV并且分型（在这一点上优于HC2），有文章指出，这两种方法敏感性要比HC2差一些。 我不建议做HPV筛查，即如上所言，查出来阳性甚或hrHPV阳性，我们没有什么好的办法，还是要去做细胞学、HPV检测的随诊。精神压力和经济支出增加不少。 不过对于细胞学检测为ASC-US的病例，作HPV检测的意义还是比较大的，有助于明确其意义。 另外，（前面我也说过）听说现在可以检测HPV感染状态（致癌、非致癌），如果是某种（不管哪一型）HPV致癌性感染，那么发展为癌的风险更大。就是以前所说的CIN2、3也有相当部分有自限性，不进展为癌，但是如果检测出HPV致癌性感染，就会发展为癌。如果是这样，知道治疗的意义就大了。请教各位，这个传说的真实性和原理。 |
In the USA HC2 is FDA-approved HPV detection method for liquid-based Pap. HC2 detects 13 types of high risk HPV. There are more than 100 types of HPV and about 40 types can cause infect human. If types of HPV can cause cancer they are called high risk HPV. Recently some other types besides the 13 types detected by HC-2. However they account for rare cases. From Dr. Yu's table you can know most cases of CIN2/3 will not develope into cancer. Almost all cases of CIN2/3 are caused by high risk HPV infection. In fact most of CIN2/3 are caused by HPV16 and HPV18.
Also women infected with HPV 16, 18 are more easy to develope high grade dyspalsia and cancer compared the cases with other high risk HPV infection. This is why some people suggest to detect HPV 16 and 18 only.
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本帖最后由 于 2009-05-01 23:25:00 编辑
I hope these kinds of trials will not be performed in China. The companies and researchers like the population in China, contrysides. We welcome some good trials and should against some trials with final purpose.
我希望这种类型的实验不要在中国进行。这些公司和研究机构看中的是中国农村广大的人口。我们欢迎一些好的科研实验和反对一些操控最终目标的科研实验。
讨论这个问题很有必要，我相信许多病理医生在脑子里遇到过这个问题的。
HPV普查觉得没必要，因为相对普遍的感染和低发病率，另一方面是病家经济和精神的双重负担、医方资源的支出。
病理组织学、细胞学是判断病情的最直接的方法和相对金标准，因此认为细胞学检查用于普查是合适的。
而对于那些细胞学检查结果不确切又有某些高危因素的病例，适当地开展HPV高危型的检测是可行的。
医学研究HPV具体的类型与宫颈癌的相关性是必要的，是临床医学的循证所必需。目前的那些方法可能并不成熟或不完备，但一定程度上而言其探索的过程是必经的。
在我的日常工作中，只有少数的病例我会建议病人做HPV检测。
- “人生没有彩排，每一天都是现场直播”
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.
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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 ?
