宁德市2009-2018年农村妇女宫颈癌筛查结果分析

目的分析福建省宁德市农村妇女宫颈癌检查项目数据,了解宁德市农村妇女宫颈癌检查项目落实及宫颈疾病发生情况。方法收集2009-2018年宁德市农村妇女宫颈癌检查项目季报表数据,比较初筛阳性进一步接受检查落实、宫颈病变检出率的变化趋势及不同宫颈癌初筛方法宫颈病变检出率的变化。初筛方案根据卫生经济资源采用巴氏涂片或者液基薄层细胞学检查(LBC)以及人乳头瘤病毒(HPV)分型检测方法。初筛阳性妇女转诊阴道镜检查、组织病理学检查,确诊采用组织病理学诊断。结果2009-2018年全市共有195299人次农村妇女接受了宫颈癌检查,宫颈癌前病变及宫颈癌检出率分别为710.71/10万和71.69/10万。研究期间,初筛阳性病例转诊阴道镜检查比例逐年增高,阴道镜检查率从51.03%升高到85.63%,组织病理学检查率从85.55%升高到99.95%(P<0.001);宫颈低级别鳞状上皮内病变检出率从295.32/10万(126/42666)上升到1270.23/10万(456/35899),高级别上皮内瘤变检出率从656.26/10万(280/42666)上升到1066.88/10万(383/35899)(均P<0.001);但原位腺癌、微小浸润癌、浸润癌的检出率无明显增加;早期诊断率2012年为88.4%,其他年份均>90%;宫颈癌筛查技术:采用巴氏涂片、液基薄层细胞学检查(LBC)和HPV分型检测进行初筛的比例分别为59.18%、25.2%和15.62%,3种筛查方法宫颈疾病检出率分别为巴氏涂片90.24/10万(1043/115583)、LBC检查174.3/10万(858/49216)、HPV检查296.07/10万(903/30500),宫颈病变检出率、宫颈癌早期诊断率差异有统计学意义(P<0.001和P<0.05)。结论宁德市农村妇女宫颈上皮内瘤变检出率、宫颈癌前病变及宫颈癌的检出率高,随着宫颈癌筛查方法的优化及随访的加强,筛查效果明显提升。

Analysis of cervical cancer screening result of rural women in Ningde,Fujian province,2009-2018

Objective To analyze cervical cancer screening program data for rural women in Ningde,Fujian province,and to learn cervical cancer prevalence and implementation of cervical cancer screening program.Method The data was extracted from quarterly reports of Cervical cancer screening program for rural women in Ningde between 2009 and 2018.Further examination for preliminary positive cases,trends of detection rate of cervical lesions,changes in the detection rate of cervical lesions by different screening methods were compared in groups.PAP smear,liquid-based thin-layer cytology(LBC),and high-risk HPV genetic test(in pilot counties)were chosen as the primary screening methods based on local health economic resources.Women who were positive in preliminary screening were referred for colposcopy,histopathology,and pathology for confirmation.Result A total of 195,299 rural women accepted cervical cancer screening between 2009 and 2018.The detection rates of cervical precancerous lesions and cervical cancer were 710.71 per 100,000 and 71.69 per 100,000,respectively.The proportion of positive cases(in the preliminary screening)referred to colposcopy increased steadily;rate of colposcopy increased from 51.03%to 85.63%,rate of histopathology increased from 85.55%to 99.95%(P<0.001,respectively).The detection rate of low grade cervical intraepithelial neoplasia increased from 295.32/100,000(126/42,666)to 1270.23/100,000(456/35,899),the detection rate of high grade intraepithelial neoplasia increased from 656.26/100,000(280/42,666)to 1066.88/100,000(383/35,899)(bothP<0.001);Detection rate of adenocarcinoma in situ,microinvasive carcinoma,and invasive carcinoma did not increase significantly;the early diagnosis rate in2012 was 88.4%,and was>90%in other years.The proportion of preliminary screening using PAP smear,LBC and HPV test were59.18%,25.2%and 15.62%,respectively.The detection rates of cervical diseases were 90.24/100,000(1043/115,583)by pap smear,174.3/100,000(858/49,216)by LBC and 296.07/100,000(903/30,500)by HPV test.The detection rates of cervical diseases and the early cervical cancer diagnosis rates through three preliminary screening methods were statistically different(P<0.001 andP<0.05).Conclusion The detection rates of cervical intraepithelial neoplasia,cervical precancerous lesions and cervical cancer were high among rural women in Ningde,Fujian Province.With the improvement of cervical cancer screening methods and follow-up,the effectiveness of cervical cancer screening has been significantly improved.