Результаты ВПЧ-генотипирования эпителия шейки матки и анальной области у пациенток с цервикальными интраэпителиальными неоплазиями
Результаты ВПЧ-генотипирования эпителия шейки матки и анальной области у пациенток с цервикальными интраэпителиальными неоплазиями
Суламанидзе Л.А., Назарова Н.М., Прилепская В.Н. и др. Результаты ВПЧ-генотипирования аногенитальной области у пациенток с цервикальными интраэпителиальными неоплазиями. Гинекология. 2016; 18 (1): 45–48.
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Sulamanidze L.A., Nazarova N.M., Prilepskaya V.N. Results of the study of HPV-typing of anogenital area in patients with cervical intraepithelial neoplasia.
Gynecology. 2016; 18 (1): 45–48.
Результаты ВПЧ-генотипирования эпителия шейки матки и анальной области у пациенток с цервикальными интраэпителиальными неоплазиями
Суламанидзе Л.А., Назарова Н.М., Прилепская В.Н. и др. Результаты ВПЧ-генотипирования аногенитальной области у пациенток с цервикальными интраэпителиальными неоплазиями. Гинекология. 2016; 18 (1): 45–48.
________________________________________________
Sulamanidze L.A., Nazarova N.M., Prilepskaya V.N. Results of the study of HPV-typing of anogenital area in patients with cervical intraepithelial neoplasia.
Gynecology. 2016; 18 (1): 45–48.
Цель работы – изучить частоту встречаемости различных типов вируса папилломы человека (ВПЧ) в цервикальном канале и анальной области у пациенток с ВПЧ-ассоциированными цервикальными интраэпителиальными неоплазиями (CIN) разной степени тяжести и сравнить с результатами аноскопии с высоким разрешением и анальной цитологии. Материал и методы: клинические методы исследования; расширенная кольпоскопия; аноскопия с высоким разрешением; цитологический метод; типирование ВПЧ. Результаты. Обследованы 204 женщины, средний возраст 30±1,2 года. По результатам обследования сформировано 2 группы: 1-я – 92 (45%) женщины с гистологически верифицированным диагнозом CIN I–III, 2-я – 112 (55%) без CIN. У пациенток 1-й группы в цервикальном канале достоверно чаще встречались ВПЧ 16, 68-го типа, при этом в анальной области – 15, 56-го типа (р<0,05). У женщин 2-й группы в цервикальном канале наиболее часто встречались 16 (21,4%), 52 (19,6%), 31, 44 (12,5%), 33-й тип (10,7%). В анальной области наиболее часто встречались 44 (25%), 31 (19,4%), 53, 6 (13,8%), 16, 52, 11, 18-й тип (11,1%). У пациенток 1-й группы в 1,5 раза чаще выявлялись выраженные и слабовыраженные изменения анального эпителия по сравнению со 2-й группой. Аномальная анальная цитология была выявлена у 12% пациенток. Высокоонкогенные типы ВПЧ вызывают более тяжелые изменения анального эпителия по аналогии с шейкой матки. Заключение. У пациенток с CIN выявлены различия типов ВПЧ в цервикальном канале и анальной области. Доминирующим типом ВПЧ у пациенток с CIN в цервикальном канале и анусе является ВПЧ 16-го типа. ВПЧ-ассоциированные заболевания шейки матки, в частности CIN, создают риск инфицирования и развития ВПЧ-ассоциированных заболеваний анальной области, в том числе и анальной интраэпителиальной неоплазии. Ключевые слова: цервикальная интраэпителиальная неоплазия, вирус папилломы человека, рак шейки матки, анальная интраэпителиальная неоплазия, аноскопия с высоким разрешением.
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Objective: to study the prevalence of different types of human papilloma virus (HPV) in cervix and anal canal in patients with HPV-associated cervical intraepithelial neoplasia (CIN) of varying severity. Material and methods: the clinical examination, colposcopy; high resolution anoscopy; cytology; typing of HPV. Results. The study involved 204 women, mean age 30±1.2 years. By results of inspection are formed 2 groups: 1 – 92 (45%) with CIN I–III, 2 – 112 (55%) without CIN. In group 1 in the cervical canal were detected HPV 16, 68 (р<0.05), in anal region 15, 56 (р<0.05). In group 2 in the cervical canal were detected HPV 16 (21.4%), 52 (19.6%), 31, 44 (12.5%), 33 (10.7%), in anal region 44 (25%), 31 (19.4%), 53, 6 (13.8%), 16, 52, 11, 18 (11.1%). In patients in group 1, 1.5 times more likely was found changes of anal epithelium compared with the group 2. Abnormal anal cytology was found in 12% of patients. High risk HPV cause more severe changes in the anal epithelium similar to the cervix. Conclusion. In patients with HPV-associated diseases of anogenital region revealed differences in the types of HPV in the cervical canal and anal region. The dominant type of HPV in women with CIN in the cervix and anus is the HPV type 16. HPV-associated cervical disease, including CIN, pose a risk of infection and HPV-associated diseases of the anal region, including anal intraepithelial neoplasia. Key words: cervical intraepithelial neoplasia, human papilloma virus, cervical cancer, anal intraepithelial neoplasia, high resolution anoscopy.
1. Centers for Disease Control and Prevention. Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States, February 2013.
2. Comparetto C, Borruto F. Human Papillomavirus Infection: Overview. Handbook on human papillomavirus: prevalence, detection and management (Harris B.Smith). New York: Nova Science Publishers, Inc. 2013; 1: 1–137.
3. Schiffman M, Wentzensen N. From Human papillomavirus to cervical cancer. Obstet Gynecol 2010; 116 (1): 177–85.
4. Bosh FX, Manos MM, Munoz N et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. J Natl Cancer Inst 1995; 87: 796–802.
5. Walboomers JM, Jacobs MV, Manos MM et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 87: 796–802.
6. De Sanjose S, Quint WG, Alemany L et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol 2010; 11: 1048.
7. Bosh FX, Lorincz A, Munoz N et al. The causal realation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55: 244–65.
8. Shiffman M, Kjaer SK. Chapter 2: natural history of anogenital human papillomavirus infection and neoplasia. Vaccine 2008; 26 (Suppl. 10): K1–16.
9. http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics
10. Scholefield JH, Castle MT, Watson NF. Malignant transformation of high-grade anal intraepithelial neoplasia. Br J Surg 2005; 92: 1133–6.
11. http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-what-is-key-statistics
12. Johnson LG, Madeleine MM, Newcomer LM et al. Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000. Cancer 2004; 101 (2): 281–8.
13. Прилепская В.Н., Назарова Н.М., Суламанидзе Л.А. и др. Взаимосвязь ВПЧ-ассоциированных неоплазий генитальной и анальной областей, их диагностики и лечения. Акушерство и гинекология. 2014; 1: 23–8. / Prilepskaia V.N., Nazarova N.M., Sulamanidze L.A. i dr. Vzaimosviaz' VPCh-assotsiirovannykh neoplazii genital'noi i anal'noi oblastei, ikh diagnostiki i lecheniia. Akusherstvo i ginekologiia. 2014; 1: 23–8. [in Russian]
14. ElNaggar AC, Santoso JT. MD Risk Factors for Anal Intraepithelial Neoplasia in Women With Genital Dysplasia. Obstet Gynecol 2013; 122 (2): 1.
15. Суламанидзе Л.А., Назарова Н.М., Бурменская О.В. и др. Распространенность анальной ВПЧ-инфекции у женщин с цервикальными неоплазиями. XXI Всероссийский конгресс с международным участием «Амбулаторно-поликлиническая помощь: от менархе до менопаузы». 3–6 марта, 2015. Сборник тезисов. С. 153–4. / Sulamanidze L.A., Nazarova N.M., Burmenskaia O.V. i dr. Rasprostranennost' anal'noi VPCh-infektsii u zhenshchin s tservikal'nymi neoplaziiami. XXI Vserossiiskii kongress s mezhdunarodnym uchastiem «Ambulatorno-poliklinicheskaia pomoshch': ot menarkhe do menopauzy». 3–6 marta, 2015. Sbornik tezisov. S. 153–4. [in Russian]
16. Berry JM, Jay N, Palefsky JM. The anal canal and perianus: HPV-related disease. Modern coploscopy textbook and atlas (E.J.Mayeaux Jr, MD, J.Thomas Cox, MD). ASCCP 2013; 17: 488.
17. Quaas J, Reich O, Frey Tirri B, Küppers V. Explanation and Use of the Colposcopy Terminology of the IFCPC (International Federation for Cervical Pathology and Colposcopy Rio 2011). 2013.
18. Darragh TM, Birdsong GG, Luff RD, Davey DD. Anal-rectal cytology. In: Solomon D, Nayar R, eds. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria and Explanatory Notes (2nd ed.). New York: Springer, 2004: 169–75.
19. Darragh TM. Anal cytology. In: Wilbur DC, Henry MR, eds. College of American Pathologists Practical Guide to Gynecologic Cytopathology: Morphology, Management and Molecular Methods. Northfield, IL: CAP Press, 2008; p. 177–81.
20. Edgren G, Sparén P. Risk of anogenital cancer after diagnosis of cervical intraepithelial neoplasia: a prospective populationbased study. Lancet Oncol 2007; 8: 311–6.
21. Palefsky JM, Holly EA, Ralston ML et al. Prevalence and risk factors for anal human papillomavirus infection in human immunodeficiency virus (HIV)-positive and high-risk HIV-negative women. J Infect Dis 2001; 183: 383–91.
22. Tandon R, Baranoski AS, Huang F et al. Abnormal anal cytology in HIV-infected women. Am J Obstet Gynecol 2010; 203 (21): e21–6.
23. Durante AJ, Williams AB, Da Costa M et al. Incidence of anal cytological abnormalities in a cohort of human immunodeficiency virusinfected women. Cancer Epidemiol Biomarkers Prev 2003; 12: 638–42.
24. Hessol NA, Holly EA, Efird JT et al. Anal intraepithelial neoplasia in a multisite study of HIV-infected and high-risk HIV-uninfected women. AIDS 2009; 23: 59–70.
25. Kojic EM, Cu-Uvin S, Conley L et al. Human papillomavirus infection and cytologic abnormalities of the anus and cervix among HIVinfected women in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (The SUN Study). Sex Transm Dis 2011; 38: 253–9.
26. Baranoski AS, Tandon R, Weinberg J et al. Risk factors for abnormal anal cytology over time in HIV-infected women. Am J Obstet Gynecol 2012; 207 (107): e1–8.
27. Goncalves MA, Randi G, Arslan A et al. HPV type infection in different anogenital sites among HIV-positive Brazilian women. Infect Agent Cancer 2008; 3: 5.
28. Jay N, Berry JM, Miaskowski C et al. Colposcopic characteristics and Lugol'sstaining differentiate anal high-grade and low-grade squamous intraepithelial lesions during high resolution anoscopy. Papillomavirus Res 2015.
29. Saleem AM, Paulus JK, Shapter AP et al. Risk of anal cancer in a cohort with human papillomavirusrelated gynecologic neoplasm. Obstet Gynecol 2011; 117: 643–9.
30. Benard VB, Johnson CJ, Thompson TD et al. Examining the association between socioeconomic status and potential human papillomavirus-associated cancers. Cancer 2008; 113 (Suppl. 10): 2910–8.
31. Fisher G, Harlow SD, Schottenfeld D. Cumulative risk of second primary cancers in women with index primary cancers of uterine cervix and incidence of lower anogenital tract cancers, Michigan, 1985–1992. Gynecol Oncol 1997; 64: 213–23.
32. Frisch M, Goodman MT. Human papillomavirus-associated anal carcinbomas in Hawaii and the mainland US. Cancer 2000; 88: 1464–9.
33. Joseph DA, Miller JW, Wu X et al. Understanding the burden of human papillomavirus associated anal cancers in the US. Cancer 2008; 113 (Suppl. 10): 2892–900.
34. Nelson RA, Levine AM, Bernstein L et al. Changing patterns of anal carcinoma in the United States. J Clin Oncol 2013; 31: 1569–75.
________________________________________________
1. Centers for Disease Control and Prevention. Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States, February 2013.
2. Comparetto C, Borruto F. Human Papillomavirus Infection: Overview. Handbook on human papillomavirus: prevalence, detection and management (Harris B.Smith). New York: Nova Science Publishers, Inc. 2013; 1: 1–137.
3. Schiffman M, Wentzensen N. From Human papillomavirus to cervical cancer. Obstet Gynecol 2010; 116 (1): 177–85.
4. Bosh FX, Manos MM, Munoz N et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. J Natl Cancer Inst 1995; 87: 796–802.
5. Walboomers JM, Jacobs MV, Manos MM et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 87: 796–802.
6. De Sanjose S, Quint WG, Alemany L et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol 2010; 11: 1048.
7. Bosh FX, Lorincz A, Munoz N et al. The causal realation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55: 244–65.
8. Shiffman M, Kjaer SK. Chapter 2: natural history of anogenital human papillomavirus infection and neoplasia. Vaccine 2008; 26 (Suppl. 10): K1–16.
9. http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics
10. Scholefield JH, Castle MT, Watson NF. Malignant transformation of high-grade anal intraepithelial neoplasia. Br J Surg 2005; 92: 1133–6.
11. http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-what-is-key-statistics
12. Johnson LG, Madeleine MM, Newcomer LM et al. Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000. Cancer 2004; 101 (2): 281–8.
13. Prilepskaia V.N., Nazarova N.M., Sulamanidze L.A. i dr. Vzaimosviaz' VPCh-assotsiirovannykh neoplazii genital'noi i anal'noi oblastei, ikh diagnostiki i lecheniia. Akusherstvo i ginekologiia. 2014; 1: 23–8. [in Russian]
14. ElNaggar AC, Santoso JT. MD Risk Factors for Anal Intraepithelial Neoplasia in Women With Genital Dysplasia. Obstet Gynecol 2013; 122 (2): 1.
15. Sulamanidze L.A., Nazarova N.M., Burmenskaia O.V. i dr. Rasprostranennost' anal'noi VPCh-infektsii u zhenshchin s tservikal'nymi neoplaziiami. XXI Vserossiiskii kongress s mezhdunarodnym uchastiem «Ambulatorno-poliklinicheskaia pomoshch': ot menarkhe do menopauzy». 3–6 marta, 2015. Sbornik tezisov. S. 153–4. [in Russian]
16. Berry JM, Jay N, Palefsky JM. The anal canal and perianus: HPV-related disease. Modern coploscopy textbook and atlas (E.J.Mayeaux Jr, MD, J.Thomas Cox, MD). ASCCP 2013; 17: 488.
17. Quaas J, Reich O, Frey Tirri B, Küppers V. Explanation and Use of the Colposcopy Terminology of the IFCPC (International Federation for Cervical Pathology and Colposcopy Rio 2011). 2013.
18. Darragh TM, Birdsong GG, Luff RD, Davey DD. Anal-rectal cytology. In: Solomon D, Nayar R, eds. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria and Explanatory Notes (2nd ed.). New York: Springer, 2004: 169–75.
19. Darragh TM. Anal cytology. In: Wilbur DC, Henry MR, eds. College of American Pathologists Practical Guide to Gynecologic Cytopathology: Morphology, Management and Molecular Methods. Northfield, IL: CAP Press, 2008; p. 177–81.
20. Edgren G, Sparén P. Risk of anogenital cancer after diagnosis of cervical intraepithelial neoplasia: a prospective populationbased study. Lancet Oncol 2007; 8: 311–6.
21. Palefsky JM, Holly EA, Ralston ML et al. Prevalence and risk factors for anal human papillomavirus infection in human immunodeficiency virus (HIV)-positive and high-risk HIV-negative women. J Infect Dis 2001; 183: 383–91.
22. Tandon R, Baranoski AS, Huang F et al. Abnormal anal cytology in HIV-infected women. Am J Obstet Gynecol 2010; 203 (21): e21–6.
23. Durante AJ, Williams AB, Da Costa M et al. Incidence of anal cytological abnormalities in a cohort of human immunodeficiency virusinfected women. Cancer Epidemiol Biomarkers Prev 2003; 12: 638–42.
24. Hessol NA, Holly EA, Efird JT et al. Anal intraepithelial neoplasia in a multisite study of HIV-infected and high-risk HIV-uninfected women. AIDS 2009; 23: 59–70.
25. Kojic EM, Cu-Uvin S, Conley L et al. Human papillomavirus infection and cytologic abnormalities of the anus and cervix among HIVinfected women in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (The SUN Study). Sex Transm Dis 2011; 38: 253–9.
26. Baranoski AS, Tandon R, Weinberg J et al. Risk factors for abnormal anal cytology over time in HIV-infected women. Am J Obstet Gynecol 2012; 207 (107): e1–8.
27. Goncalves MA, Randi G, Arslan A et al. HPV type infection in different anogenital sites among HIV-positive Brazilian women. Infect Agent Cancer 2008; 3: 5.
28. Jay N, Berry JM, Miaskowski C et al. Colposcopic characteristics and Lugol'sstaining differentiate anal high-grade and low-grade squamous intraepithelial lesions during high resolution anoscopy. Papillomavirus Res 2015.
29. Saleem AM, Paulus JK, Shapter AP et al. Risk of anal cancer in a cohort with human papillomavirusrelated gynecologic neoplasm. Obstet Gynecol 2011; 117: 643–9.
30. Benard VB, Johnson CJ, Thompson TD et al. Examining the association between socioeconomic status and potential human papillomavirus-associated cancers. Cancer 2008; 113 (Suppl. 10): 2910–8.
31. Fisher G, Harlow SD, Schottenfeld D. Cumulative risk of second primary cancers in women with index primary cancers of uterine cervix and incidence of lower anogenital tract cancers, Michigan, 1985–1992. Gynecol Oncol 1997; 64: 213–23.
32. Frisch M, Goodman MT. Human papillomavirus-associated anal carcinbomas in Hawaii and the mainland US. Cancer 2000; 88: 1464–9.
33. Joseph DA, Miller JW, Wu X et al. Understanding the burden of human papillomavirus associated anal cancers in the US. Cancer 2008; 113 (Suppl. 10): 2892–900.
34. Nelson RA, Levine AM, Bernstein L et al. Changing patterns of anal carcinoma in the United States. J Clin Oncol 2013; 31: 1569–75.
1. ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России. 117997, Россия, Москва, ул. Академика Опарина, д. 4;
2. ФГБНУ Российский онкологический научный центр им. Н.Н.Блохина. 115478, Россия, Москва, Каширское ш., д. 23
*lika.sulamanidze@gmail.com
1. V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. 1179974, Russian Federation, Moscow, ul. Akademika Oparina, d. 4;
2. N.N.Blokhin Russian Cancer Research Center. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23
*lika.sulamanidze@gmail.com