The use of biomarkers and HPV genotyping to improve diagnostic accuracy in women with a transformation zone type 3
Menée à partir d'échantillons cervicaux, cette étude analyse l'efficacité d'une stratégie comportant une excision de la grande boucle de la zone de transformation, l'utilisation de différents biomarqueurs (coloration p16/Ki-67, coloration hématoxyline-éosine) et le génotypage du papillomavirus humain, pour améliorer la précision du diagnostic chez les femmes dont le col de l'utérus présente une zone de transformation de type 3
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.
British Journal of Cancer , résumé, 2021