سنجش اعتبار روش تشخیصی ویروس پاپیلومای انسانی در تریاژ بانوان با گزارش ASCUS در سیتولوژی سرویکس

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشیار، گروه زنان و زایمان، دانشکده‌ی پزشکی و مرکز تحقیقات پیش‌گیری سرطان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دستیار تخصصی، گروه زنان و زایمان، دانشکده‌ی پزشکی و مرکز تحقیقات پیش‌گیری سرطان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 متخصص پزشکی اجتماعی، مرکز تحقیقات پیش‌گیری سرطان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: در سال‌های اخیر، آزمون Human papillomavirus (HPV) در تریاژ بیماران با گزارش Atypical squamous cells of undetermined significance (ASCUS) در سیتولوژی گنجانده شده است. با این حال، کاربرد این آزمون در کشور ما با توجه به شیوع پایین سرطان دهانه‌ی رحم و هزینه‌ی بالا و دسترسی محدودتر به آن در مقایسه با کولپوسکوپی بیوپسی مبهم است.روش‌ها: 245 فرد تشخیص داده شده با گزارش ASCUS در سیتولوژی بر اساس معیارهای سیستم Bethesda 2001، کولپوسکوپی بیوپسی شدند و بر اساس نتایج آن، به دو گروه پرخطر (گزارش پاتولوژی Cervical Intraepithelial Neoplasia یا CIN > 2) و سالم طبقه‌بندی شدند. آزمون Cobas® HPV Test جهت شرکت کنندگان انجام شد. با در نظر گرفتن کولپوسکوپی بیوپسی به عنوان استاندارد طلایی، عملکرد تشخیصی آزمایش HPV تعیین شد.یافته‌ها: تعداد 24 بیمار گزارش CIN1، 10 بیمار 2 ≤ CIN و تعداد 4 بیمار 3 ≤ CIN داشتند. حساسیت و ویژگی آزمون HPV به ترتیب برابر 80 و 77 درصد به دست آمد. ارزش پیش‌گویی کننده‌ی مثبت و ارزش پیش‌گویی کننده‌ی منفی به ترتیب برابر 9/12 و 9/98 درصد بود.نتیجه‌گیری: با توجه به شیوع کم ضایعات پرخطر در ASCUS و ارزش اخباری منفی بالای آزمون، به کارگیری HPV می‌تواند در تریاژ اولیه‌ی بانوان با گزارش ASCUS در پاپ اسمیر کمک کند. به عبارتی، پاسخ منفی این آزمون، اطمینان کافی از عدم وجود ضایعات پیش سرطانی یا سرطانی به دست می‌دهد.

کلیدواژه‌ها

عنوان مقاله [English]

Accuracy of Human Papillomavirus (HPV) Test for Triage of Women with Atypical Squamous Cells of Undetermined Significance (ASCUS)

نویسندگان [English]

  • Fariba Behnamfar 1
  • Neda Moazam 2
  • Elham Moazam 3
1 Associate Professor, Department of Obstetrics and Gynecology, School of Medicine AND Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Resident, Department of Obstetrics and Gynecology, School of Medicine AND Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Community Medicine Specialist, Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: In recent years, human papillomavirus (HPV) test has been approved in triage of women with Atypical Squamous Cells of Undetermined Significance (ASCUS). However, due to the low prevalence of cervical cancer, high costs and limited access to test, the effectiveness of this test in our country is ambiguous.Methods: In a diagnostic accuracy study, 245 women who were diagnosed as ASCUS in cervical cytology based on Bethesda 2001 criteria, were then assessed with colposcopy. Cervical biopsy was taken when needed. They were classified according to the results to high risk [Cervical Intraepithelial Neoplasia (CIN) > 2] or normal. Cobas® HPV Test was conducted for participants. Considering the colposcopy-biopsy as the golden standard, the performance of the HPV test was determined for detecting precancerous lesions.Findings: 24 patients had CIN1, 10 patients CIN of 2, and 4 patients had CIN ≥ 3. The sensitivity and specificity of the HPV test was 80% and 77%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) was 12.9% and 98.9%, respectively.Conclusion: Considering the low prevalence of high-risk lesions in this series of women with ASCUS cytology, and the high NPV of the HPV test, it seems that its application can be helpful in the initial triage of patients with this pathology. In other words, the negative result of this test provides sufficient assurance that there are no precancerous or cancerous lesions.

کلیدواژه‌ها [English]

  • Papanicolaou test
  • Atypical squamous cells of the cervix
  • Human papillomavirus DNA tests

مراجع

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مجله دانشکده پزشکی اصفهان
دوره 38، شماره 585 - شماره پیاپی 585
مهر و آبان 1399
صفحه 551-556

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سابقه مقاله

  • تاریخ دریافت: 06 خرداد 1399
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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