TruScreen系统在宫颈癌筛查中的应用效果

目的：探讨宫颈癌筛查系统TruScreen（TS）在宫颈癌筛查中的应用效果。方法回顾性分析368例检查者,分为TS检测组和TCT检测组,每组184例,TS检测组行TS检测,TCT检测组行液基薄层细胞学（TCT）检测,以组织病理学为诊断标准,比较TS与TCT检查在宫颈癌筛查中的应用效果。结果 TS检测组与TCT检测组检测敏感度分别为93.2%、100%,特异度分别为76.0%、75.0%,阳性符合率分别为64.7%、55.7%。结论 TS检测与TCT检测在宫颈癌筛查中具有相似的检测效果,值得临床推广和运用。     

Impact of HPV testing in opportunistic cervical screening: Support for primary HPV screening in the United States

Human papillomavirus (HPV) testing for cervical screening increases diagnosis of precancer and reduces the incidence of cervical cancer more than cytology alone. However, real-world evidence from diverse practice settings is lacking for the United States (U.S.) to support clinician adoption of primary HPV screening. Using a population-based registry, which captures all cervical cytology (with or without HPV testing) and all cervical biopsies, we conducted a real-world evidence study of screening in women aged 30 to 64 years across the entire state of New Mexico. Negative cytology was used to distinguish cotests from reflex HPV tests. A total of 264 198 cervical screening tests (with exclusions based on clinical history) were recorded as the first screening test between 2014 and 2017. Diagnoses of cervical intraepithelial neoplasia grades 2 or 3 or greater (CIN2+, CIN3+) from 2014 to 2019 were the main outcomes. Of cytology-negative screens, 165 595 (67.1%) were cotests and 4.8% of these led to biopsy within 2 years vs 3.2% in the cytology-only group. Among cytology-negative, HPV tested women, 347 of 398 (87.2%) CIN2+ cases were diagnosed in HPV-positive women, as were 147 of 164 (89.6%) CIN3+ cases. Only 29/921 (3.2%) CIN3+ and 67/1964 (3.4%) CIN2+ cases were diagnosed in HPV-negative, cytology-positive women with biopsies. Under U.S. opportunistic screening, across a diversity of health care delivery practices, and in a population suffering multiple disparities, we show adding HPV testing to cytology substantially increased the yield of CIN2+ and CIN3+. CIN3+ was rarely diagnosed in HPV-negative women with abnormal cytology, supporting U.S. primary HPV-only screening.     

深圳市子宫颈癌早诊早治初步研究

目的研究深圳城市人群子宫颈癌早诊早治的适宜方式。方法2006～2007年采取整群随机抽样方法获得福田区教育局和龙岗区龙城街道紫薇社区样本人群及2005～2008年深圳市妇幼保健院妇科门诊机会性筛查人群。以上人群分别由学校工会和社区居委会、计划生育服务站宣教和组织;机会性筛查人群由妇科门诊护士和医师宣教和推荐。采用细胞学检查、HPV—DNA检测的筛查方法,异常者转诊阴道镜及病理诊断,病理诊断为金标准。采用筛查率、早诊率、早治率和行政费用率进行评价。结果2006年福田区教育局系统中小学教职工筛查率77．32％,紫薇社区人群筛查率18．56％,差异有统计学意义（X^2=3005．435,P=Q000）;两组人群早诊率100％,治疗率均在90％以上。2005～2008年深圳市妇幼保健院子宫颈癌机会性筛查干预后有连续增长趋势（X^2=1588．5503,P=nooo）。2004—2008年子宫颈癌早诊率年平均89．85％,5年早诊率差异无统计学意义（X^2=6．513,P=0．164）。2006～2008年治疗率明显增高（X^2=123．090,P=0.000）。机会性筛查行政费用率明显低于组织性筛查（X^2=30．626,P=0．000）。结论城市人群子宫颈筛查以工作单位或社区居委会计划生育服务站组织为佳;机会性筛查可做为城市人群子宫颈癌组织性筛查的重要补充,门诊医师的宣教可提高机会性筛查率;城市人群子宫颈癌筛查宜提倡组织性筛查与机会性筛查相结合。     

Influence of age on cervical cancer survival in Japan

BACKGROUND: Relative 5-year survival for cervical cancer has been reported to be lower in older women in Japan. A population-based study was carried out to clarify why increased age is associated with decreased survival in spite of a nationwide cervical cancer screening program having been carried out since 1982 in Japan. METHODS: The Osaka Cancer Registry's data were used to investigate associations between age groups and survival for cervical cancer patients. Survival analysis was restricted to the reported 8966 cases diagnosed in 1975-1996 who lived in Osaka Prefecture (except for Osaka City), or resided in Osaka City in 1993-1996, since active follow-up data on vital status 5 years after the diagnosis were available. RESULTS: Relative 5-year survival for cervical cancer cases was lower in older age groups (88.6% in <30 years, 78.1% in 30-54 years, 67.7% in 55-64 years and 54.4% in 65+ years), as was the proportion of the detection by screening (6.3, 9.8, 9.2 and 6.0%), the proportion of the localized stage (83.0, 67.3, 51.0 and 42.7%) and the proportion of women who underwent surgery (79.2, 83.2, 65.6 and 35.2%). Among localized cases detected with screening, the survival in those > or =55 years old was >92% and almost comparable with that in 30 to 54 year olds, but significantly lower among those detected without screening. CONCLUSION: Lower survival among older women was caused mainly by the presence of more advanced disease at diagnosis. Further extension of the nationwide cervical cancer screening program should result in improved diagnosis of earlier stage disease, which might improve differences of cervical cancer survival among these age groups.     

细胞DNA定量分析技术在宫颈癌筛查中的应用

目的:比较和评估两种宫颈癌筛查方法的应用价值。方法:选取2010年1月至 2013年2月到漳浦县医院进行宫颈癌检查的病例14119例。均为宫颈刷取材,液基方法同时制两张片,一张进行巴氏染色,用于常规细胞学TBS诊断。另一张经Feulgen染色,用于细胞DNA定量分析检测。临床活检取材均在阴道镜指导下进行。结果:共建议活检671例。用于回顾性研究的388例有活检结果。其中有宫颈癌5例,CINⅢ/原位癌38例,44例CINⅡ及137例CINⅠ,其余164例为慢性宫颈炎。以活检结果≥CINⅡ作为宫颈癌前病变的阳性标准,采用细胞DNA定量分析检测的敏感性分别为70.11%与97.7%,而常规细胞学检测的敏感性分别为45.98%与58.62%。同一个标本同时采用两种方法联合检测,敏感性可提高到99.89%。结论:细胞DNA定量分析技术可作为宫颈癌及癌前病变检测的辅助手段。     

Risk of cervical abnormality after age 50 in women with previously negative smears

There is discussion over the benefit of continuing cervical screening in women over the age of 50 with a history of negative cytology. We aimed to determine the risk of abnormal cytology in such women. Screening history data from 1985 to 2003 were obtained for a cohort of 2 million women from the NHS cervical screening programme from four Health Authorities in England. The 57 651 women in the cohort who reached age 40 between 1 January 1985 and 31 December 1990 and had at least one routine or opportunistic smear between ages 50 and 54 were included in the analysis. Exposure groups (negative cytology history, negative but including inadequate smears, and positive history) were defined on the basis of screening histories from ages 40 to 49. Sixty-four percent (134/206) (95% CI: 57–71%) of the moderate dyskaryosis or worse lesions at ages over 50 were detected from women in the negative smear history group. After allowance for time since last negative smear, the relative risk for the first primary smear over the age of 50 having moderate dyskaryosis or worse decreased from 0.60 (95% CI: 0.41–0.84) for two negative smear episodes to 0.25 (95% CI: 0.10–0.56) for four negative smear episodes, compared with the positive history group. If screening were discontinued for all women over 50 with a negative history, the majority of cytological abnormalities now being detected at these ages that lead directly to referral to colposcopy would be missed.     

Disease detection at the 48-month exit round of the HPV FOCAL cervical cancer screening trial in women per-protocol eligible for routine screening

HPV FOCAL is a randomized control trial of cervical cancer screening. The intervention arm received baseline screening for high-risk human papillomavirus (HPV) and the control arm received liquid-based cytology (LBC) at baseline and 24 months. Both arms received 48-month exit HPV and LBC cotesting. Exit results are presented for per-protocol eligible (PPE) screened women. Participants were PPE at exit if they had completed all screening and recommended follow-up and had not been diagnosed with cervical intraepithelial neoplasia Grade 2 or worse (CIN2+) earlier in the trial. Subgroups were identified based upon results at earlier trial screening. There were 9,457 and 9,552 and women aged 25–65 randomized to control and intervention and 7,448 (77.8%) and 8,281 (86.7%), respectively, were PPE and screened. Exit cotest results were similar (p = 0.11) by arm for PPE and the relative rate (RR) of CIN2+ for intervention vs. control was RR = 0.83 (95% CI: 0.56–1.23). The RR for CIN2+ comparing intervention women baseline HPV negative to control women with negative cytology at baseline and at 24 months, was 0.68 (95% CI: 0.43–1.06). PPE women who had a negative or CIN1 colposcopy in earlier rounds had elevated rates (per 1,000) of CIN2+ at exit, control 31 (95% CI: 14–65) and intervention 43 (95% CI: 25–73). Among PPE women HPV negative at exit LBC cotesting identified little CIN2+, Rate = 0.3 (95% CI: 0.1–0.7). This per-protocol analysis found that screening with HPV using a 4-year interval is as safe as LBC with a 2-year screening interval. LBC screening in HPV negative women at exit identified few additional lesions.     

Cervical Cancer Screening: Patients Understanding in Major Hospitals in Malaysia

We studied women with cervical cancer to determine whether they had had a Pap smear within the 3 yearspreceding cancer development and their understanding of screening for this cancer. The study had 2 parts;Pathology Data and Survey Data. For pathology data, all cases of cervical cancer diagnosed in 2000-2006 wereretrieved from eight hospitals and Pap smear history was obtained from clinical records. For the Survey data;patients who were still undergoing treatment in some of these hospitals and three others were administeredstructured questionnaires to determine their awareness about screening. The results showed 1431 cases ofcervical cancer in women aged 25-85 were diagnosed in these hopsitals. Most had not had a Pap smear within 3years before cancer development. The percentage of patients who had had Pap smear ranged from 0-12%.Questionnaires were returned by 221 patients; 56.3% had none or only primary education and 61.1% had ahousehold income of RM1000 or less. Level of education and the household income were strongly associated(p<0.05) with knowledge and having had a Pap test. The main reasons cited for not having had a Pap smearwere “Never heard about it” (36.2%), “Shy” (10.4%), “Afraid to do it” (13.1%), “Think the test is not important”(8.1%) and “No encouragement from family” (4.5%). A large majority (95.9%) of the patients did not know theoptimal interval. In conclusion, a large number of cervical cancer patients had not had a Pap smear within 3years preceding cancer development and most had inadequate knowledge about this screening test.     

山西省襄垣县2009~2015年农村女性宫颈癌筛查项目结果分析

[目的]通过分析襄垣县2009～2015年农村妇女宫颈癌筛查结果,为国家宫颈癌筛查项目的评价和优化提供理论依据.[方法]对襄垣县35～64岁妇女开展宫颈癌筛查.2009～2013年采用醋酸/碘染色后肉眼观察(VIA/VILI),2014年开始部分引入人乳头状瘤病毒(HPV)检测,2015年又引入新柏氏液基细胞学(TCT)检测,根据卫生资源情况在不同人群中分别使用三种方法.任意筛查结果阳性者转诊阴道镜,镜下有病变时取活检,以病理诊断为金标准.通过评价不同方法对宫颈上皮内瘤变(CIN)2级及以上病变的检出率评价不同方法对宫颈癌的筛查效果.[结果] 2009～2015年共筛查62 618名女性,其中CIN2级及以上(CIN2+)病变的患病率为0.76％,早诊率为90.53％,下生殖道感染率为25.68％,其中滴虫性阴道炎、细菌性阴道炎和宫颈炎与HPV感染相关.根据2014及2015年数据,VIA/VILI的CIN2+病变检出率为0.74％,TCT的病变检出率为0.70％,两者相似,但均低于HPV检测,其病变检出率为1.37％.[结论]HPV检测是首选的宫颈癌初筛方法,在资源匮乏地区,培训合格的基层医生使用VIA/VILI或TCT方法对适龄妇女开展宫颈癌筛查是有效的备选方案.     

Negative human papillomavirus testing in normal smears selects a population at low risk for developing high-grade cervical lesions

High-risk human papillomaviruses (HR-HPV) are the necessary cause of cervical carcinomas and there is an increasing interest in using HR-HPV DNA detection in adjunction to cytological examination for primary cervical screening. To determine whether women with a normal smear negative for HR-HPV DNA detection with the Hybrid Capture II assay might represent a low-risk population for developing a high-grade squamous intraepithelial lesion (HSIL), 4401 women have been followed in a period of 12-72 months (median=34 months). During this follow-up, four HSIL and one microinvasive carcinoma have been detected in this cohort (three in the cohort of 3526 women >29 years). The global negative predictive value (NPV) of double-negative tests is thus of 99.9% (ninety-five percent confidence interval (95% CI): 99.8-100%), whereas cytology alone gives an NPV of 99.2% (95% CI: 98.9-99.5%). If we obtain a second negative HR-HPV test 1-2 years after the initial test, the NPV is 100%. The NPV is also of 100% in the cohort of women >49 years. We conclude that all these women could be safely screened at longer intervals between 3 and 5 years. This policy will offset the increased costs induced by an additional HR-HPV testing in primary screening.