Objective: To study the clinical management way for HPV(+)/papanicolaou (Pap)(-) during cervical cancer screening. Methods: To analyze retrospectively the data from the patients who had loop electrical excision procedure (LEEP) for biopsy confirmed cervical intraepithelial neoplasia (CIN) Ⅱ in Peking University People's Hospital from Jan. 2010 to Dec. 2014. Results: (1) For biopsy confirmed CIN Ⅱ, HPV positive rate was 98.5% (135/137), Pap test positive [≥atypical squamous cell of undetermined significance (ASCUS)] rate was 69.3% (95/137), there was significant difference between them (χ(2)=43.32, P<0.01). (2) For the 42 patients with HPV(+)/Pap(-), whose cytology slides were reviewed again. Among them, the interpretations of there were 16 cases confirmed as the same before, while 26 cases were changed to abnormal (≥ASCUS). Cytology be misdiagnosed was 19.0% (26/137) at the first review. Among the 26 cases, 13 (50.0%) cases were missed for the little amount of abnormal cells, 8 (30.8%) cases for mild atypical morphology changed; the other 5 (19.2%) cases missed for stain problems. (3) For the cervical LEEP samples, 37 cases of the pathology diagnosis were upgrade to CIN Ⅲ(+), among them, 2 cases of microinvasive cervical carcinoma, 1 case of invasive cancer, 34 cases of CIN Ⅲ; 37 cases were CINⅠ or no lesion found; 63 cases were still CIN Ⅱ. Four to six months later after LEEP, the cytology abnormal rate was 11.7% (16/137), and the HR-HPV positive rate was 34.3% (47/137). Conclusions: Compared with cytology alone, cytology combined with HPV testing increase the sensitivity of cervical high grade lesion. For the cases of HPV(+)/Pap(-) cases, the cytology slides should be reviewed. The quality control of cervical exfoliate sample collection and interpretation should be strengthened. LEEP procedure is not only a treatment method, but also it could provide samples to confirm the diagnosis.
目的： 初步探讨子宫颈高危型HPV（HR-HPV）阳性而细胞学阴性（HPV(+)/Pap(-)）患者的临床管理方法。 方法： 收集2010年1月—2014年12月在北京大学人民医院妇科门诊因子宫颈上皮内瘤变（CIN）Ⅱ行子宫颈环形电极切除（LEEP）术，且临床资料完整的患者，共137例。通过追溯137例患者阴道镜活检前的子宫颈细胞学检查和HR-HPV检测联合筛查结果以及LEEP术后的病理检查、术后4~6个月随访时的子宫颈细胞学检查和HR-HPV检测结果，复核HPV(+)/Pap(-)患者的子宫颈细胞学涂片的判读结果，初步分析其合理的临床管理方法。 结果： （1）活检前HR-HPV阳性率为98.5%（135/137），细胞学阳性率69.3%（95/137），HR-HPV阳性率显著高于细胞学阳性率（χ(2)=43.32，P<0.01）。（2）HPV(+)/Pap(-)患者共42例，占30.7%（42/137）。重新复核其细胞学涂片，16例（38.1%，16/42）维持原细胞学阴性结果，26例（61.9%，26/42）修订为细胞学阳性，首次细胞学判读的漏诊率为19.0%（26/137）。这26例患者的细胞学涂片判读结果出现误判的原因，13例（50.0%）由于异常细胞数量较少造成漏诊，8例（30.8%）由于异常细胞形态与正常细胞相似、异常细胞形态不典型而造成，另有5例（19.2%）由于染色问题影响判读结果。（3）LEEP术后病理检查显示，37例术后诊断升级，其中34例升级为CINⅢ，2例子宫颈微小浸润癌，1例为子宫颈浸润癌Ⅰb期；37例为CINⅠ或未见子宫颈上皮内病变；63例术后病理诊断依然为CINⅡ。LEEP术后4~6个月随访显示，细胞学阳性率为11.7%（16/137），HR-HPV阳性率为34.3%（47/137）。 结论： 与单独细胞学检查比较，细胞学联合HPV检测明显提高子宫颈病变筛查的敏感度。对于初筛结果为HPV(+)/Pap(-)的患者，应复核其细胞学涂片，并进一步加强细胞学取材和细胞学判读的质量控制，以减少CINⅡ的漏诊。LEEP术在达到治疗作用的同时能进一步明确诊断，确定后续是否需要进一步治疗或适时随访。.
Keywords: Cervical intraepithelial neoplasia; Cytodiagnosis; Papillomaviridae.