[Contribution of viral typing in cytological anomalies of the cervix].
Management practices for low-grade cervical lesions identified on screening swabs have been modified by research on the HPV. The appropriate approach for low-grade lesions is particularly difficult to determine due to the potential risk of malignant transformation coupled with the cost implications of treating lesions which will heal spontaneously in the majority of patients. The diagnosis of these low-grade lesions can be improved by thin layer swabs which have a greater sensitivity than conventional swabs. The current consensus is that swab results should be expressed according to the Bethesda classification. Routine tests for HPV (Hybrid Capture II) should be reserved for patients with an ASC-US swab. Colposcopy is indicated if the swab is positive for a low-grade lesion followed by cytology if the colposcopy is normal. If there is no evidence of HPV, search for oncogenes can lighten the treatment regimen due to the high specificity of the test. If a low-grade histological lesion (CIN1) is proven, cytocolposcopic surveillance should be proposed, surgical resection being undertaken in colposcopy cannot be performed. Here again search for HPV oncogenes at one year is an interesting alternative if the examination is negative. These practices are applicable in adolescents and HIV- positive patients who are particularly exposed to HPV.
Levêque
J
J
Département d'Obstétrique Gynécologie et Médecine de la Reproduction, Hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes Cedex 2.
Classe
J-M
JM
Marret
H
H
Audrain
O
O
D000293:Adolescent; D003127:Colposcopy; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D006801:Humans; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000821:virology; D002577:Uterine Cervical Diseases / Q000175:diagnosis / Q000473:pathology / Q000821:virology*