자궁경부종양 환자에서 polymerase chain reaction 방법에 의한 인유두종바이러스 16형과 18형 검출에 관한 연구
Detection of human papillomavirus type 16 and 18 by PCR in patients with cervical neoplasia
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목적: 자궁경부종양 환자들에서 인유두종바이러스 16형과 18형의 감염률을 조사하고 그 임상적 의의를 알아보고자 하였다. 연구 방법: 21세에서 83세 사이의 여성 708명에게 고식적인 Pap 자궁경부 세포검사와 polymerase chain reaction 방법에 의한 인유두종바이러스 검사를 시행하였으며, 383예에서는 조직검사를 하였다. 결과: 708명의 세포검사에서 인유두종바이러스 검사는 편평세포암에서는 11예, 고등급 편평세포상피내병변에서는 41예, 저등급 편평세포상피내병변에서는 20예, 비정형 편평세포에서는 41예, 그리고 음성 세포진에서는 86예에서 양성으로 나왔다. 383예의 조직검사에서 인유두종바이러스 검사는 편평세포암에서는 24예, 자궁경부상피내종양 3에서는 42예, 자궁경부상피내종양 2에서는 12예, 자궁경부상피내종양 1에서는 12예, 비정형 변화 7예, 그리고 음성 조직진에서는 45예에서 양성으로 나왔다. 인유두종바이러스 검사가 음성인 239예에서 28.5%가 자궁경부상피내종양 1 이상의 조직학적 진단을 보였다. 자궁경부 세포검사가 음성이면서 인유두종바이러스 검사가 양성인 46예에서 50%가 자궁경부상피내종양 1 이상의 조직학적 진단을 보였다. 자궁경부 Pap 세포검사는 민감도 72.5%, 특이도 66.4%, 위음성률 27.5%를 보였으며, 인유두종바이러스 검사는 각각 57.5%, 76.7%, 42.5%를 보였다. 결론: 이 연구는 자궁경부 Pap 세포검사와 인유두종바이러스 검사는 상호 보완적이라는 사실을 확인시켜 준다. 자궁경부종양을 진료함에 있어 의사는 자궁경부 Pap 세포검사나 인유두종바이러스 검사를 과대평가해서는 안 된다. 이 두 가지 검사를 병합함은 자궁경부종양의 진단에서 정확성을 더욱 향상시킨다.
Abstract
Objective: The purpose of this study was to evaluate the detection rate of human papillomavirus (HPV) DNA Test (type 16 and 18) and to investigate the clinical significance of HPV DNA test in patients with cervical neoplasia. Methods: Of the 708 patients aged 21~83 years who had undergone both conventional Papanicolaou cervical cytologic test and HPV DNA test by polymerase chain reaction, 383 cases underwent histologic diagnoses. Results: Of the 708 cytologic diagnoses, there were 11 positive HPV DNA test diagnoses in squamous cell carcinoma (SCC), 41 in high-grade squamous intraepithelial lesion (HSIL), 20 in low-grade squamous intraepithelial lesion (LSIL), 41 in atypical squamous cells (ASC), and 86 in negative cytology. Of the 383 histologic diagnoses, there were 24 positive HPV DNA test diagnoses in SCC, 42 in cervical intraepithelial neoplasia (CIN) 3, 12 in CIN 2, 12 in CIN 1, 7 in atypical change, and 45 in negative histology. Of the 239 patients with negative HPV DNA test, 28.5% cases showed histologic diagnoses of CIN 1 or worse lesion. Of the 46 patients with negative cytology and positive HPV DNA test, 50.0% cases showed histologic dianoses of CIN 1 or worse lesion. Pap cytology revealed sensitivity of 72.5%, specificity of 66.4%, and false negative rate of 27.5%, whereas HPV DNA test showed 57.5%, 76.7%, and 42.5 %, respectively. Conclusion: This study confirmed that the primary standard Pap cytology and HPV DNA test were adjunctive. Also this study showed that physicians always should not overrate Pap cytology or HPV DNA test in managing the patient with cervical neoplasia. Combined test was a very effective diagnostic method for detecting cervical neoplasia.
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