hpv+TCT培训教材.ppt

Sensitivity, Specificity, and PPV against CIN2+ Biopsy… not Pap1 HPV-DNA现状 1. Szarewski, et al, Comparison of Predictors for High-Grade Cervical Intraepithelial Neoplasia in Women with Abnormal Smears – Cancer Epidemiological Biomarkers, November 2008 特异性不高 对于宫颈癌的敏感性也不足 Data compilation of three published Kaiser studies (ObGyn 2010;116:76–84, JLGTD 2010; 14:287A, GynOnc2011;121:309-313) by Dr. Marshall Austin MD PhD, Professor of Pathology and Director of Cytopathology Magee-Womens Hospital of University of Pittsburgh Medical Center. HC2 FALSE NEGATIVES IN CANCER - KAISER STUDIES 2003-2009 PAP Result CxCa HC2+ HC2- Carcinoma 4 n/a 4 HSIL 79 78 1 ASC-H 29 25 4 AGC 30 27 3 AIS 2 n/a 2 LSIL 8 2 6 ASCUS 26 21 5 Endometrial 1 n/a 1 Negative Pap 53 44 9 TOTAL 232 197 35 超过7年的追踪中，15％的癌症被HC2漏掉。 * HPV-DNA现状 宫颈癌筛查新方案---E6E7mRNA 宫颈癌的发病机理： 高危HPV持续的慢性感染 病毒基因整合 肿瘤抑癌基因的失活、端粒酶活性高表达 免疫监视的逃逸 无论感染哪一种高危型别的HPV， E6/E7mRNA在宫颈癌中均普遍表达。 E6 E7 mRNA Transient Infection (80%) Upregulation of E6 and E7 mRNA expression Cervical Cancer (3-5%) HPV Infection HPV DNA Persistent Infection (20%) HPV特异性频谱 1. Szarewski, et al, Comparison of Predictors for High-Grade Cervical Intraepithelial Neoplasia in Women with Abnormal Smears – Cancer Epidemiological Biomarkers, November 2008 3. Voss, et al, Assessment of Fluorescence in Situ Hybridization and Hybridization and Hybrid Capture 2 Analyses of Cervical Cytology Specimens Diagnosed as Low Grade Squamous Intraepithelial Lesion for the Detection of High Grade Cervical Intraepithelial Neoplasia – AQCH, June 2010 4. Weiss, et al, Intracellular HPV E6, E7 mRNA Quantification (HPV OncoTect) Predicts CIN 2+ in Cervical Biopsies Better than PAP Screening for Women Regardless of Age - Accepted Archives of Pathology and Laboratory Medicine 2011. 各种HPV检测导致CIN2+（基于组织活检结果）的特异性的临床研究: 0% 28% 92% 33% Qiagen1 Roche1 p161 HPV ONCO TECT4 3q263 48% 69% Gen-Probe1 44% Hologic2 100% 42% 2. Einstein, et al, Clinical validation of the Cervista HPV HR and 16/18 genotypi