人工智能电子阴道镜辅助诊断系统对宫颈癌筛查的现实挑战和未来机遇

摘 要：我国基层较差的阴道镜诊断水平一直是宫颈癌筛查中存在的难点和痛点。目前,随着人工智能在医学诊断学领域的发展,人工智能电子阴道镜辅助诊断系统的出现将解决我国基层阴道镜医生资源不足和能力提升问题,有助于提高宫颈癌筛查质量。该研究介绍了人工智能的概念和发展状况、人工智能电子阴道镜辅助诊断系统的研究意义以及研究进展,探讨其对宫颈癌筛查的现实挑战和未来机遇。     

山西省农村妇女生殖道感染和宫颈癌筛查情况调查

[目的]通过对山西省农村妇女生殖道感染（RTI）和宫颈癌初级筛查暨基层妇保院服务能力进行调查分析,探索适合山西省基层低收入人群的将生殖道感染防治和宫颈癌筛查相整合的妇女病普查普治模式。[方法]采用整群抽样的方法抽取山西省3县2503例20～59岁农村已婚妇女作为研究对象,进行了生殖道感染实验室检测和宫颈癌醋酸（VIA）筛查和碘染色（VILI）初级筛查,并对其中VIA阳性或VILI阳性的妇女进行阴道镜检查,异常者取活检进行病理诊断。同时,对21所基层妇幼保健院生殖道感染防治和宫颈癌筛查服务能力进行了调查分析。[结果]2503例调查对象中84.58%从未做过妇女病普查,经检查发现生殖道感染患病率达67.96%,宫颈癌及癌前病变患病率1.56%。而基层妇幼院服务能力普遍低下,宫颈细胞学筛查覆盖面小,仅有少数单位可开展阴道镜和病理诊断技术。[结论]基层妇幼机构生殖道感染检测和宫颈癌筛查技术亟待提高。应积极培训人员,在基层单位推广WHO推荐的RTI防治和宫颈癌初级筛查相结合的妇女病普查模式。     

山西省农村妇女宫颈癌筛查结果分析

[目的]评价2014年山西省农村妇女宫颈癌检查结果,探讨宫颈癌流行趋势与特点,为进一步推进宫颈癌筛查工作提供科学依据.[方法]回顾性分析2014年宫颈癌筛查项目35～64岁农村已婚妇女的筛查数据资料.[结果]2014年共计完成408 618例农村妇女的免费宫颈癌筛查,检出宫颈癌前病变721人,检出率为176.44/10万;检出宫颈癌215人,检出率为52.62/10万.[结论]进行育龄妇女人群的健康教育,加强高危人群管理,重点培训参加宫颈癌筛查的基层医师,是提高宫颈癌早诊早治的关键.     

宫颈癌细胞凋亡和增殖与预后的探讨

目的 :探讨宫颈癌细胞凋亡、增殖与宫颈癌临床病理参数和预后的关系。方法 :利用TUNEL法和HE染色检测 5 0例宫颈癌组织 (鳞癌、腺癌各 2 5例 )的细胞凋亡指数 (AI)和核分裂指数 (MI)。结果 :腺癌的AI、MI明显高于鳞癌 (P <0 0 5 ) ,但AI MI指数比值两者差异有显著性。随着宫颈癌恶性级别增高、肿瘤体积的增大 ,AI、MI水平增高。AI与MI之间及AI MI的比值与宫颈癌 5年生存率之间有强的正相关性。结论 :宫颈癌细胞凋亡和增殖水平的增高与宫颈癌的恶化进展有关 ,同时检测AI、MI更有助于宫颈癌预后评价     

人工智能辅助系统在宫颈病变细胞学诊断中的应用效果研究

目的：分析人工智能(AI)辅助系统在宫颈病变细胞学诊断中的应用效果。方法：收集宫颈液基薄层细胞学(TCT)标本2 719例，同时进行AI辅助阅片和人工阅片，比较两者的一致性。以活体组织检查结果为金标准，比较AI辅助阅片和人工阅片的准确性，诊断高级别病变及癌的敏感性、特异性及ROC曲线下面积。结果：AI辅助阅片和人工阅片的细胞学分级诊断结果基本一致。AI辅助阅片在诊断低级别病变及炎症的准确率高于人工阅片(P<0.01)。在诊断高级别病变及癌方面，AI辅助阅片敏感性为82.1%，高于人工阅片的敏感性48.3%；AI辅助阅片特异度为94.3%，略低于人工阅片的特异度95.0%；AI辅助阅片的ROC曲线下面积为0.882，大于人工阅片的ROC曲线下面积0.717(P<0.01)。结论：AI辅助阅片在宫颈癌诊断方面准确度较高，不仅能提高宫颈癌筛查的覆盖率，而且能提高筛查质量，能够在广大人群中得到广泛推广。     

湖北省基层妇幼保健院子宫颈癌防控一体化门诊规范化建设专家共识

子宫颈癌是一种可以通过病因学预防、发病学预防及临床预防达到有效控制直至消除的恶性肿瘤。中国在子宫颈癌综合性防控体系建设方面存在发展不平衡、能力建设不足及机构分散等问题。湖北省政府于2022年启动了为期三年的全省1 267万35～64岁的妇女进行免费宫颈癌筛查的政府民生工程。充分利用本轮宫颈癌筛查人群全覆盖的规模和队伍优势,构建基层妇幼保健院宫颈癌防控一体化门诊,实施规范化建设与管理,是一个历史性的机遇,具有重要意义。湖北省妇幼保健协会宫颈疾病防治专业委员会专家组结合国内外最新进展和湖北省的实际情况,制定了本共识。共识中阐释了一体化门诊建设的一般要求、HPV疫苗接种门诊建设规范与工作流程、子宫颈癌筛查门诊建设规范与工作流程、阴道镜门诊建设规范及工作流程、癌前病变治疗门诊建设规范及工作流程、癌前病变治疗后的随访、科普及公众教育等,适合于指导湖北省内辖区基层（县、区级）妇幼保健院宫颈癌防控一体化门诊的规范化建设与管理。     

城市计划生育服务站进行宫颈癌筛查可行性分析

[目的]分析城市基层计划生育服务站进行宫颈癌筛查的可行性。[方法]在街道级计划生育服务站每年一度的计划生育妇检中,应用液基细胞学（TCT）检查和HPV检测方法进行宫颈癌筛查,对筛查结果为阳性者（≥不能明确意义的不典型鳞状上皮细胞）转诊阴道镜检查,并行宫颈组织病理诊断,同时进行行政费用的调查。[结果]参加妇科检查的社区居民育龄妇女6630人,672人进行了初筛,顺应性10.14%,发现≥不能明确意义的不典型鳞状上皮细胞58例,占8.63%;人乳头瘤病毒（HPV）检测了67人,阳性28人;59例转诊阴道镜和病理检查,≥宫颈上皮内瘤变（CIN）Ⅱ级8例,CIN检出率1.19%;行政费用率0.29%,与深圳市妇幼保健院妇科门诊机会性筛查相比,差异无统计学意义（χ2=0.395,P〉0.05）。[结论]完善的计生网络及良好的运作为宫颈癌防治工作提供了组织保障,街道计生中心具备技术能力开展宫颈癌的初级筛查。建议政府在每年一度的妇检中加入宫颈癌筛查项目,并依托医院医疗技术进行宫颈癌的早期防治。     

宫颈癌筛查现状与展望

宫颈癌是严重危害妇女健康的公共卫生问题之一,宫颈癌与癌前病变筛查仍然是目前预防宫颈癌的重要手段。宫颈癌的筛查技术近年来已有了很大进展,有组织的筛查能有效预防宫颈癌,筛查阳性者回访率、人群覆盖率、高危人群管理是影响宫颈癌防治效果的重要因素,国外宫颈癌防治经验值得我们借鉴。     

宫颈癌早期筛查与预防的研究进展

宫颈癌是最常见的严重威胁女性健康的妇科恶性肿瘤，宫颈癌的发生及发展与高危型人乳头瘤病毒(HPV)持续性感染密切相关；采取宫颈癌的一级、二级预防措施，进行宫颈癌预防的公众教育、宫颈癌疫苗接种及规范的宫颈癌筛查可以有效降低宫颈癌的发病率和死亡率，甚至在将来可能通过宫颈癌疫苗接种的早期普及做到消除宫颈癌。宫颈细胞学检查、VIA/VILI、HPV-DNA检测、HPV E6/E7 m RNA检测、阴道镜检查等均为早期筛查宫颈癌病变的重要方法，为临床明确病情提供可靠的参考依据。本文将对上述目前临床常用的宫颈癌筛查方法及宫颈癌疫苗的临床应用和研究进展做一综述。     

河南省新密市2010~2013年农村女性宫颈癌筛查结果分析

摘 要：［目的］ 根据2010～2013年河南省新密市农村地区宫颈癌筛查数据,分析当地女性宫颈癌筛查的参与率,宫颈炎、宫颈癌前病变及宫颈癌的检出率,为当地制定宫颈癌筛查策略提供依据。［方法］ 2010～2013年对新密市35～64岁农村妇女进行宫颈癌筛查,绝经前女性使用醋酸/碘染色肉眼观察法（VIA/VILI）初筛,绝经后女性使用巴氏涂片法初筛。VIA/VILI异常及巴氏涂片结果≥ASC-US者召回行阴道镜检查,并对镜下检查异常处取活检。病理结果为金标准,CIN2及以上妇女转诊进行手术治疗。［结果］ 2010~2013年共筛查115 789名农村女性,总体顺应性为59.50%;VIA/VILI筛查84 762人,阳性率为20.0%;巴氏涂片筛查31 027人,阳性率为4.81%。13 914人进行阴道镜检查,取活检4438例(31.90%)。病理诊断宫颈炎症3830例(3.31%),CIN1 126例(0.11%),CIN2 125例(0.11%),CIN3/原位癌204例(0.18%),宫颈癌67例(0.06%),另发现5例内膜癌(0.004%)、2例外阴癌(0.002%)。［结论］ 2010~2013年新密市CIN2+的整体检出水平较高。农村女性参加筛查的整体顺应性不高,VIA/VILI筛查的假阳性率高,应加强对基层医生技术水平的培训。     

National Data Analysis and Systematic Review for Human Resources for Cervical Cancer Screening in Japan

Background: Although cervical cancer screening has been performed as a national program since 1983 in Japan, the participation rate has remained below 20%. Equity of access is a basic requirement for cancer screening. However, taking smears from the cervix has been limited to gynecologists or obstetricians in Japan and it might be a barrier for accessibility. We examined the current access and its available human resources for cervical cancer screening in Japan. Methods: We analyzed the number of gynecologists and obstetricians among 47 prefectures based on a national survey. A systematic review was performed to clarify disparity and use of human resources in cervical cancer screening, diagnosis, and treatment for cervical cancers in Japan. Candidate literature was searched using Ovid-MEDLINE and Ichushi-Web until the end of January 2020. Then, a systematic review regarding accessibility to cervical cancer screening was performed. The results of the selected articles were summarized in the tables. Results: Although the total number of all physicians in Japan increased from 1996 to 2016, the proportion of gynecologists and obstetricians has remained at approximately 5% over the last 2 decades. 43.6% of municipalities have no gynecologists and obstetricians in 2016. Through a systematic review, 4 English articles and 1 Japanese article were selected. From these 5 articles, the association between human resources and participation rates in cervical cancer screening was examined in 2 articles. Conclusions: The human resources for taking smears for cervical cancer screening has remained insufficient with a huge disparity among municipalities in Japan. To improve accessibility for cervical cancer screening another option which may be considered could be involving general physicians as potential smear takers.     

New insights into cervical cancer screening

Worldwide, cervical cancer is a leading cause of cancer related morbidity and mortality. For over 50 years, cervical cytology has been the gold standard for cervical cancer screening. Because of its profound effect on cervical cancer mortality in nations that have adopted screening programs, the Pap smear is widely accepted as the model screening test. Since its introduction, many studies have analyzed the Pap smear and found that it is not without its shortcomings including low sensitivity for detection of cervical intraepithelial neoplasia 2/3. Additionally, the discovery of infection with the human papillomavirus (HPV) as a necessary step in the development of cervical cancer has led to the development of HPV testing as an adjunct to cytology screening. More recently, researchers have compared HPV testing and cytology in the primary screening of cervical cancer. In this review, we will discuss cytologic testing limitations, the role of HPV DNA testing as an alternative screening tool, the impact of the HPV vaccine on screening, and future directions in cervical cancer screening.     

Cervical cancer screening: on the way to a shift from cytology to full molecular screening

Cytology-based nation-wide cervical screening has led to a substantial reduction of the incidence of cervical cancer in western countries. However, the sensitivity of cytology for the detection of high-grade precursor lesions or cervical cancer is limited; therefore, repeated testing is necessary to achieve program effectiveness. Additionally, adenocarcinomas and its precursors are often missed by cytology. Consequently, there is a need for a better screening test. The insight that infection with high-risk human papillomavirus (hrHPV) is the causal agent of cervical cancer and its precursors has led to the development of molecular tests for the detection of hrHPV. Strong evidence now supports the use of hrHPV testing in the prevention of cervical cancer. In this review, we will discuss the arguments in favor of, and concerns on aspects of implementation of hrHPV testing in primary cervical cancer screening, such as the age to start hrHPV-based screening, ways to increase screening attendance, requirements for candidate hrHPV tests to be used, and triage algorithms for screen-positive women.     

人工智能在乳腺癌诊断中应用的研究进展

乳腺癌是世界范围内女性最常见的恶性肿瘤之一,严重威胁女性的身心健康,早期诊断和早期治疗是其良好预后的关键。人工智能(artificial intelligence,AI)是当今科技发展的代表性前沿技术,已在医学影像、病理、辅助决策、医学教育等方面取得了长足的进展,许多AI产品已经从实验阶段过渡到了临床应用阶段。在乳腺癌诊断领域,基于AI的乳腺癌影像技术不仅有望大大减轻临床医生的工作负担,同时也能够不断提高乳腺癌筛查和诊断的准确性及敏感性。本文就当前乳腺癌诊断领域中AI技术的发展及应用现状进行分析和综述,并对乳腺癌影像AI未来的发展方向进行展望,以期为相关AI技术的研究提供参考。     

Artificial intelligence in oncology

Artificial intelligence (AI) has contributed substantially to the resolution of a variety of biomedical problems, including cancer, over the past decade. Deep learning, a subfield of AI that is highly flexible and supports automatic feature extraction, is increasingly being applied in various areas of both basic and clinical cancer research. In this review, we describe numerous recent examples of the application of AI in oncology, including cases in which deep learning has efficiently solved problems that were previously thought to be unsolvable, and we address obstacles that must be overcome before such application can become more widespread. We also highlight resources and datasets that can help harness the power of AI for cancer research. The development of innovative approaches to and applications of AI will yield important insights in oncology in the coming decade.     

Cervical Cancer Screening in Resource-Constrained Countries:Current Status and Future Directions

Cervical cancer continues to be a major public health problem affecting large numbers of women in many developing countries. Limitations of various screening modalities and the lack of ready availability of a cost-effective point-of-care screening tool have hindered the efficient implementation of population-based screening programs in these settings. It has not proved possible for many countries to adopt cytology as a screening modality due to inadequate infrastructure and trained manpower. However, recent developments, notably design and testing of a low-cost HPV test kit and initiatives by countries like India in developing and putting into operation a framework for large-scale screening of women, have raised hopes that cervical cancer control may be possible even in resource-constrained locations. With the advent of HPV vaccination, primary prevention of cervical cancer also seems a distinct possibility. However, wide availability and acceptability of vaccination is still an unresolved issue for developing countries. The possible future effects of vaccination on test characteristics of various screening strategies also need to be evaluated. This review gathers information on the current status of cervical cancer screening with a special focus on low resource settings. It revisits the strengths and limitations of the available screening modalities for cervical cancer viz. cytology, visual methods and HPV testing, in the context of their applicability in developing countries. In addition, the role of newer HPV-detection methods, for instance DNA, RNA and protein-based techniques, in triage of screen-positive women is discussed. The contemporary issue of impact of HPV vaccination on cervical cancer screening is also addressed briefly. The main highlight of the review is the reference to ‘operational framework guidelines’ for population-based cervical cancer screening, which have recently been formulated and are in the process of being implemented in India. The guidelines may serve as a model for other similar low-resource settings where implementation of cancer screening is desired.     

Review of Strategies in Promoting Attendance for Cervical Screening

Background: The importance of cervical screening has been addressed in numerous studies. However, reviewsconducted to explore of strategies to promoting attendance for cervical screening have been limited. This studyaimed to explore strategies to promote attendance for cervical screening. Materials and Methods: A literaturesearch from databases (1994-2011) was undertaken to include papers that identified strategies related to thecervical screening. Results: Twenty-four papers were included in this review. The review of existing strategiesidentified valuable information on cervical screening and areas that could be improved in meeting womens’ needs.Conclusions: The review highlighted important aspects of cervical screening that could be further addressedby promoting strategies to attendance. Assessing women’s health beliefs, inpatient cervical cancer screening,nurse-led screening, and cognition-emotion focused programs are among the strategies to promote attendancefor pap smear testing.     

人工智能在鼻咽癌诊断与预后领域的研究进展

人工智能（artificial intelligence,AI）的应用可以帮助解决鼻咽癌（nasopharyngeal carcinoma,NPC）诊断中的诸多问题,包括影像学诊断、病理学诊断、内镜筛查等,并可以通过AI对鼻咽癌患者达到预测预后的目的。就目前而言,虽然AI在鼻咽癌领域的应用越来越多,但是AI在实际应用方面仍面临较多挑战。相信随着AI在鼻咽癌领域的应用增加与不断改进的算法,未来AI能作为常用的工具应用于临床。     

Current principles for radiotherapy in cervical cancer

Cancer of the uterine cervix is most common in countries that do not have access to cervical cancer screening and prevention programs. Treatment of cervical cancer varies significantly between countries (adjusted to stage) and is dependent on medical resources. Radiotherapy for the treatment of gynecological malignancy has been used with different techniques for treating the local tumor and regional lymph nodes. This review discusses recommendations of radiotherapy for cervical cancer according to stage.