宫颈癌及其癌前病变诊断技术研究进展

在各种癌症中,宫颈癌对妇女的威胁仅次于乳腺癌.宫颈癌是一种可预防、可治愈的疾病,关键是进行筛查[1].筛查的方法和技术对宫颈癌的早期诊断极其重要,特别是近十几年来,随着自动化技术的应用,细胞学的诊断技术取得了惊人的进展.对细胞学的发展历史作一个简单的回顾,有助于选用适合本地区的宫颈癌筛查方法,满足不同人群的检查需要.     

宫颈癌的早期筛查及预防对策

目的 探讨宫颈病变早期筛查的重要性和宫颈癌的预防.方法 对2008年3～9月910例来我院进行宫颈癌早期筛查的患者进行分析,所有患者均采用宫颈液基薄层细胞学检查,并随访2年.结果 910例患者中,生殖道感染的患者528例,人乳突瘤病毒(HPV)感染81例,发生癌前病变75例,已发生原位癌的患者26例.根据检查结果,对发生癌前病变和原位癌的101例患者进行治疗,跟踪随访2年,患者中有1例发生了宫颈癌复发,复发率为0.99％.结论 宫颈癌的早期筛查,对发生宫颈癌前病变和发生早期宫颈癌的患者检出率高,可做到早期发现,早期治疗,对预防宫颈癌和减少宫颈癌死亡率有极大的价值,因此,应该普及宫颈病变筛查.     

430例体检女职工宫颈癌及癌前病变筛查结果分析

目的:了解我单位女职工宫颈癌及癌前病变的筛查情况,探讨薄层液基细胞检测(TCT)技术在妇科体检中的应用价值,并为宫颈癌的防治提供依据.方法:选择漯河医专第三附属医院2014年3月7 日-2014年4月29日进行宫颈癌筛查的女职工430例,对宫颈癌筛查结果进行回顾性分析,了解女职工宫颈癌及癌前病变的流行情况.结果:430例标本中,阳性标本6例,占1.40％,其中ASC-US 5例,占1.16％;HSIL 1例,占0.23％;阳性标本经病理学检测结果显示为炎症3例,CINⅠ1例,CIN Ⅱ2例;阴性标本424例,其中轻度炎症236例;中度炎症132例;重度炎症38例,正常18例.结论:薄层液基细胞学检查可作为宫颈癌筛查的首选方法,可以早期发现宫颈细胞学异常,结合宫颈活检可进一步明确高危病例;妇科疾病中,宫颈炎的患病率较高,应成为今后防治工作的重点.     

912例宫颈液基细胞学检查结果分析

目的 评价液基细胞学检查技术可作为宫颈癌筛查的首选方法.方法 采用液基细胞学检查(TCT)制片对912例宫颈病变患者同时行阴道镜进行宫颈癌筛查,细胞诊断采用TBS分级系统进行分析和处理,对所有不明确意义的非典型鳞状细胞(ASCUS)以上患者行阴道镜检查及多点活检.结果 912例患者中94例为ASCUS,13例为低度鳞状上皮内病变(LSIL),2例为非典型腺细胞(AGC),行阴道镜检者49例,病理检查结论:慢性宫颈炎43例,CINⅠ 4例,CINⅢ 1例,早期浸润癌1例.结论 宫颈TCT技术可作为宫颈癌筛查的首选方法,如TCT发现异常,则行阴道镜及组织学活检三阶梯式诊断程序,提高诊断准确率,育龄妇女应定期行液基细胞学检查,以筛查宫颈癌及癌前病变.     

门诊系统健康教育在宫颈癌筛查中的影响研究

[目的]探讨门诊系统健康教育在宫颈癌筛查中的作用.[方法]将2008年1月-2008年12月就诊1 000例妇科病人随机分为对照组与实验组各500例.对照组给予常规指导,对实验组进行系统健康教育,比较两组间宫颈癌防治知识知晓率与宫颈癌筛查参与率的变化.[结果]实验组宫颈癌防治知识知晓率大大高于对照组(P<0.05);实验组宫颈癌筛查参与率74.2%,明显高于对照组(26.2%,P<0.05).[结论]门诊健康教育能有效提高病人宫颈癌防治意识,提高宫颈癌筛查率,对早发现、早治疗宫颈癌具有重要意义.     

健康教育在宫颈癌筛查中提升疾病认知的效果

目的:探讨健康教育在宫颈癌筛查中提升疾病认知的效果。方法:将我院2015年1~12月接受宫颈癌筛查的妇女460例作为对照组,将2016年1~12月接受宫颈癌筛查的妇女510例作为研究组,对照组仅按流程完成宫颈癌筛查,研究组在对照组基础上实施健康教育,包含宫颈癌基础认知、宫颈癌与人乳头瘤病毒(HPV)关联及宫颈癌筛查认知3个方面,比较两组人群筛查后对宫颈癌知识的知晓率。结果:研究组妇女对宫颈癌基础认知、宫颈癌与HPV关联及宫颈癌筛查认知方面知晓率显著高于对照组(P0.05)。结论:健康教育可提升宫颈癌筛查妇女对宫颈癌知识的知晓率,对于扎实推进宫颈癌筛查、预防宫颈癌有重要的社会价值。     

高危型HPV+TCT筛查对宫颈癌的价值

目的 探讨高危型HPV联合TCT筛查对宫颈癌的价值.方法 550例行宫颈癌筛查的已婚女性均行TCT检查及高危型HPV检查,对TCT或高危HPV检查任一阳性者行病理检查,分析检查结果.结果 TCT+高危型HPV并联阳性的灵敏度明显高于高危型HPV单一检测,P＜0.05,二者串联的特异度明显高于单一检测,P＜0.05.结论 高危型HPV+TCT可用于宫颈癌筛查,敏感度及特异度均较高.     

1208例门诊患者宫颈癌筛查认知情况调查及影响因素分析

目的:了解本院妇科门诊患者对宫颈癌筛查的认知状况及参与情况,分析其影响因素,探讨宫颈癌机会性筛查在门诊应用的意义。方法:选择2015年度在本院妇科门诊初诊的本地户籍患者,接受宫颈癌机会性筛查同时完成调查问卷1 208份。结果:门诊妇女对宫颈癌筛查总体知晓率为38.1%。城区妇女对宫颈癌筛查认知度高于县乡妇女,不同文化程度的妇女对宫颈癌筛查认知度不同,差异均有统计学意义。从未参加过宫颈癌筛查及不规律参加宫颈癌筛查者分别占50.3%、43.2%。结论:大多数妇女对宫颈癌筛查认知度低,应制定适合不同层次人群的健康宣教措施,提高宫颈癌筛查认知度和参与率,以早期发现宫颈癌及癌前病变,同时在医院开展宫颈癌机会性筛查可作为基层普查外的有益补充。     

对门诊女性患者宫颈癌筛查知信行的调查

目的了解门诊女性患者对宫颈癌筛查知识的认知以及相关的态度和行为,为提高宫颈癌筛查参与率的护理干预方案提供理论依据。方法采取随机抽样法,使用宫颈癌筛查知识的认知以及相关的态度和行为的调查问卷,对门诊就诊的1116例女性患者进行调查。结果本研究显示,不同年龄、文化程度、经济收入妇女对宫颈癌筛查相关知识认知度不同,差异均有统计学意义（X2=42．377,138．7,32．519,P〈0．01）,学历较高者、经济情况较好者对宫颈癌筛查知识知晓率较高。76．3％赞成“早期发现宫颈癌可提高生存率”这一观点,47．5％赞成“筛查可以早期发现宫颈癌”,45．3％的妇女愿意接受宫颈癌筛查。43．8％的妇女曾经做过宫颈癌筛查,定期每年做1次的有4．9％。不同年龄、受教育程度、经济收入妇女宫颈癌筛查率的比较差异均有统计学意义（X2=16．155,9．052,28．801,P〈0．01）。结论女性患者对宫颈癌筛查知识了解不足,文化程度低、经济条件差的患者对宫颈癌筛查的认知度低,实际参加宫颈癌筛查率低。护理人员应帮助患者树立积极态度,提高对宫颈癌筛查的认知,根据患者不同情况采取不同形式和渠道进行宫颈癌筛查健康教育,从而改善宫颈癌筛查率低的现状。     

新疆地区城镇妇女对HPV感染与宫颈癌相关性的认知和行为干预研究

目的：探讨城镇妇女对HPV感染与宫颈癌相关性的认知情况和行为干预的影响。方法：对在我院妇产科门诊就诊接受宫颈癌筛查的患者同时进行HPV感染与宫颈癌相关性宣传教育,应用自行设计的问卷评估干预效果。结果：干预后患者对HPV感染与宫颈癌相关性知识综合掌握情况和愿意接受宫颈癌筛查的患者明显提高。结论：对就诊患者进行宫颈癌筛查的宣传,重视对HPV感染与宫颈癌相关性的健康教育,可提高城镇妇女对疾病的认识,使患者消除顾虑,建立健康的行为和生活方式,对城镇妇女宫颈癌的防治有着重要意义。     

宫颈人乳头瘤状病毒感染危险因素的研究进展

宫颈癌是全球女性发病率和病死率居于第4位的癌症,是目前唯一可以预防的癌症。持续性的高危型HPV感染是宫颈癌发生的必要不充分条件。发现并深入了解HPV感染的危险因素,对高危人群进行密切随访或严格筛查,从而降低宫颈癌的发生和发展。现有研究发现,年龄、吸烟、多个性伴侣等是HPV感染的危险因素,另外也有研究发现不同避孕方式、代谢综合征、系统性红斑狼疮、饮食、教育方式等与HPV感染有明显的相关性。因此,重视和加强对女性高危人群的筛查和宣传教育,可促进宫颈癌防治工作的发展。     

Towards improving cervical cancer screening in Nigeria: a review of the basics of cervical neoplasm and cytology

Cervical cancer screening is the key to reducing the incidence and mortality of cervical cancer in developing countries. In the absence of a national screening program, healthcare givers in Nigeria are encouraged to routinely inform and screen eligible women. This review aims at equipping health workers for this task by re-educating them on the basics of the disease and its screening by cytology. Relevant texts and online databases including Pubmed, African Journal Online, and Google Scholar, were searched for relevant literature on the subject area. Persistent infection by a high-risk human papilloma virus, especially types 16 and 18, is necessary for the development of cervical cancer. The exfoliation of cells from the metaplastic squamous cells of transformation zone of the cervix is the basis of cervical cytology. Organized Pap screening reduces the incidence and mortality of cervical cancer, but screening protocols vary. Nevertheless, annual screening is not recommended except for high-risk women such as HIV-positive women. Abnormal Pap smear results are currently reported using either the Bethesda System or the British Society for Clinical Cytology classification, and colposcopy with or without biopsy are necessary when indicated. In conclusion, the use of cervical cytology to detect pre-cancerous lesions followed by an appropriate treatment when necessary is the key to reducing invasive cervical cancer. The task of provider-initiated counseling and testing for cervical cancer by health practitioners requires update on the current etio-pathology of cervical cancer, and its screening as reviewed.     

2000多例女性免费两癌筛查结果分析

目的总结分析2000多例女性免费两癌筛查的结果。方法现对在本单位进行两癌筛查,即子宫颈癌和乳腺癌的女性展开研究,其中实施宫颈癌筛查的女性2424例,进行乳腺癌筛查的女性2422例,研究时间为2019年1月至2019年11月。分析两癌筛查的结果。结果在宫颈癌的筛查中,检查结果异常的主要是生殖道感染和生殖系统良性疾病的女性,通过TCT检查发现其中近3.22%的女性显示异常,最终经阴道镜和组织病理检查显示其中有12例女性存在宫颈病变,占比率为0.5%;而在乳腺癌的筛查中,经乳腺超声、X线检查和组织病理检查显示仅有2例患者为浸润性导管癌,TNM分期显示为ⅡA期。结论在两癌的筛查过程中,高危类型的女性癌症确诊的几率较高,并且在常见生殖系统疾病和乳腺疾病中的发病率也明显高于其他两个类型的女性,并且对于疾病知识的知晓率也明显较低。因此需加强对两癌健康知识的普及和宣传力度,提高群众的认知度和知晓率,从而采取有效的措施进行预防和干预,降低癌症的发生率。     

Screening for cervical cancer and initial treatment of patients with abnormal results from papanicolaou testing

New techniques for cervical cancer screening and a better understanding of the natural history of human papillomavirus (HPV) and cervical neoplasia have inspired a quest for more rational screening strategies for cervical cancer. Often, screening intervals for women older than 30 years can be expanded safely to every 3 years, and experts now agree that screening may cease after hysterectomy and in elderly women (provided certain criteria have been met). Liquid-based cytology produces more satisfactory specimens than conventional testing and offers the valuable option of treating atypical squamous cells of undetermined significance by "reflex" testing for high-risk types of HPV on the original specimen. Testing for HPV as an adjunct to cervical cytology for primary screening is now considered reasonable for many women older than 30 years.     

Update on cervical cancer screening. Current diagnostic and evidence-based management protocols

Pap smear screening for cervical cancer has been a preventive health success. Although improved technology is increasing the accuracy of this technique, more women who have never been tested will need to undergo screening in order to further decrease the incidence of cervical cancer in the United States. The establishment of infection with high-risk genital HPV types as a causative factor in cervical cancer is a major breakthrough in understanding of this disease. Testing for the presence of high-risk HPV DNA should increase the ability to identify women who are truly at risk for cancer and true cancer precursors and to more efficiently plan further diagnostic evaluation. The 2001 revisions in TBS reflect our improved understanding of the epidemiology and natural history of cervical epithelial abnormalities and cervical cancer. These revisions are designed to facilitate communication between the clinician and the laboratory and to improve the clinician's ability to accurately interpret the cytology report and plan initial management of any abnormalities.     

Molecular basis for advances in cervical screening.

Human papillomaviruses (HPVs) cause cervical lesions, which can, in some instances, progress to high-grade neoplasia and cancer. Around half a million cases of cervical cancer occur each year, with most occurring in developing countries where cervical cancer is a major cause of cancer-related death. The reduction in cervical cancer incidence in developed countries is largely attributed to the introduction of cervical screening.Cervical screening currently depends on the identification by cytology of abnormalities in cells taken from the surface of the cervix. The standard Pap test was developed >50 years ago, and despite modifications, still forms the basis of the test currently in use in most routine screening laboratories. Advances in our understanding of the molecular mechanisms that lead to the development of cervical cancer have been slow to impact on screening, despite the relatively high false-negative rates that can be associated with the conventional Pap smear.Improvements in screening strategies fall into a number of categories. Methods that improve cell presentation and attempt to eliminate artefacts/obscuring debris can be combined with image analysis systems in order to enhance diagnostic accuracy. Such approaches still rely on cytological evaluation and do not incorporate advances in our knowledge of how HPV causes cancer. By contrast, markers of virus infection or cell cycle entry, particularly those that offer some degree of prognostic significance, may be able to highlight abnormal cells more reliably than cytology, and could be combined with cytology to improve the detection rate. Our understanding of the molecular biology of HPV infection and the organization of the HPV life-cycle during cancer progression provides a rational basis for marker selection. The general assumption that persistent active infection by high-risk HPV types is the true precursor of cervical cancer provides the rationale for HPV DNA testing in conjunction with enhanced cytology, while the development of RNA-based approaches should allow active infections to be distinguished from those that are latent. The detection in superficial cells of marker combinations at the level of RNA or protein has the potential to predict disease status more precisely than the detection of markers in isolation. There is also a need for better prognostic markers if the predictive value of screening is to be improved.The potential to control infection by vaccination should reduce the incidence of HPV-associated neoplasia in the population, and this may cause a change in the way that screening is carried out. Nevertheless, the lack of a therapeutic vaccine, and the difficulties associated with eliminating infection by multiple high-risk HPV types, means that some form of screening will still be required as a preventive measure for the control of cervical cancer for the foreseeable future.     

Detection of human papillomavirus DNA by PCR/microfluorometry for screening of cervical cancer

BACKGROUND: Cervical cancer screening is conducted by a cytological Papanicolaou (Pap) test. For screening, it is becoming increasingly important to introduce a more objective result, based on human papillomavirus (HPV) DNA test. We describe here a practical method allowing the mass detection of HPV-DNA by PCR followed by fluorogenic DNA intercalation. METHODS: Samples used were cervical scrapes or biopsy specimens obtained from women who had undergone cytological testing for cervical cancer. Crude DNAs were extracted by a simplified proteinase K-boil method. Common and type-specific primers were newly designed for major types of high-risk HPVs. A fluorogenic DNA intercalator, SYBR Green I was directly added to the specific PCR products. The resultant fluorescence was measured by a conventional fluorometric microplate reader. RESULTS: The proposed PCR/microfluorometry (MFL) allowed a simple, rapid and economical detection of HPV-DNA without any use of labeling primers or probes. HPV-DNAs were found in 48.2% (123/255) of the cervical scrapes. The detection rate of HPV in cervical cancer biopsy specimen was 92.4% (61/66). CONCLUSIONS: PCR/MFL detection of HPV-DNA, followed by combined type-specific PCR, is expected to be an extremely useful tool in cervical cancer screening.     

液基细胞学检查在诊断宫颈病变中的临床价值

[目的]探讨宫颈液基细胞学检查(TCT)对宫颈病变的诊断价值及意义.[方法]回顾性分析中国医科大学附属盛京医院门诊57 784例TCT筛查结果.细胞学诊断采用TBS(2001)分级报告系统,阳性诊断包括意义不明确的不典型鳞状细胞(ASC-US)及以上病变,其中阳性者554例行阴道镜下宫颈活组织检查,其中317例同时又进...     

阴道微生态与HPV感染及宫颈病变的关系探讨

目的 探讨阴道微生态与人乳头瘤病毒(HPV)感染及宫颈病变的关系.方法 选择于我院接受宫颈病变筛查的240例女性为研究对象,分析受检者的阴道pH、乳酸杆菌减少、细菌性阴道炎(BV)、滴虫性阴道炎(TV)、念珠菌性阴道炎(VVC)等阴道微生态变化异常率,HPV感染率及感染类型,宫颈病变异常及病变类型.分析阴道微生态指标与...