多种检测方法在子宫颈癌及癌前病变筛查中的应用评估

目的评估多种检测方法在子宫颈癌及癌前病变筛查中的应用价值及可行性，为子宫颈癌筛查方案提供依据。方法对子宫颈癌高发区江西省修水县大桥乡妇女进行以人群为基础的研究，对已登记的2499名年龄为30～49岁农村已婚妇女分别做人乳头瘤病毒（HPV）检测、新柏氏薄层液基细胞学（TCT）、醋酸染色后肉眼观察（VIA）、碘染色后肉眼观察（VILI）以及电子阴道镜检查。全部检查方法均以独立、双盲方式进行。对VIA、VILI及电子阴道镜三项检查中任何一项存在子宫颈可疑病变的妇女行子宫颈活检；对以上三项检查均未发现可疑病变，但子宫颈脱落细胞HPV阳性或TCT结果阳性（ASCUS以上级别）的妇女，2周后给予子宫颈活检。观察HPV、TCT、VIA、VILI、电子阴道镜等筛查方法单独使用或联合使用进行子宫颈癌及其癌前病变筛查的敏感度、特异度、阳性预测值、阴性预测值。宫颈组织病理诊断均经国际癌症研究所病理确诊。筛查时将病理诊断为子宫颈上皮内瘤变（CIN）1级（CINl）纳入阴性结果，将CIN2以上（包括CIN2）病变纳入阳性结果。宫颈细胞学按TCT（thinprep cytology test）标准制片，细胞学诊断按照2001年TBS（The Bethesda System）细胞病理分类标准判读诊断。结果2499名受检妇女中，2432名纳入研究（67名妇女因HPV或TCT阳性未行活检故未列入统计），其中HPV阳性妇女387例；TCT阳性妇女153例。宫颈活检病理诊断共检出CIN及子宫颈癌99例，其中CIN237例，CIN359例，宫颈癌3例。HPV、TCT、HPV＋TCT、VIA、VILI、VIA＋VILI、阴道镜检等筛查方法的敏感度分别为96．67％、89．47％、97．98％、56．57％、36．36％、63．64％、39．39％。特异度分别为85．00％、96．91％、86．97％、94．60％、96．23％、92．97％、98．14％。结论HPV＋TCT用于宫颈癌及癌前病变筛查的敏感度高于其他筛查方法。     

醋酸肉眼观察法在基层宫颈癌筛查的应用研究

目的 探讨在基层开展醋酸肉眼观察、阴道镜检查和病理活检取材进行宫颈癌筛查和早诊早治的可行性.方法 采取整群抽样的方法,对4 036例山西省某县两个镇全部30～60岁的已婚妇女进行醋酸肉眼观察和碘染色肉眼观察,并对可疑者进行阴道镜检查及病理活检.结果 醋酸肉眼观察异常/可疑和/或碘染色肉眼观察异常的病例共计345例(8.5%).对上述病例进行阴道镜检查,结果显示低度病变的337例,高度病变7例,宫颈浸润癌1例.组织活检病理结果显示慢性宫颈炎272例(78.8%),宫颈上皮内瘤样病变共73例(20.8%).结论 醋酸肉眼观察和碘染色肉眼观察的筛查结果可互为补充,建议两者联合应用,以提高筛查的灵敏度和特异度;在我国广大农村经济欠发达地区应用醋酸肉眼观察/碘染色肉眼观察法初筛宫颈癌是可行的.     

Is magnification necessary to confirm visual inspection of cervical abnormalities? A randomized trial in Peru.

OBJECTIVES: Cervical cancer is the leading cause of cancer death among women in developing countries. This study was designed to evaluate whether visual inspection with acetic acid and magnification (VIAM) improved confirmation of cervical lesions as compared to confirmation with visual inspection with acetic acid (VIA) without magnification when used by physicians. METHODS: From April-December 2004, women in San Martin, Peru, who were referred as VIA-positive by an "obstetriz" (a professional midwife with 6 years of university training) were randomized into two groups for confirmatory screening by a physician using either VIA or VIAM with an AviScope, a hand-held 4x magnification scope with a green light source. The reference standard for the presence or absence of cervical neoplasia was colposcopy and directed biopsy, as required. RESULTS: A total of 358 women participated in the study; 161 had a confirmatory examination with VIAM and 159 with VIA. Sensitivity for low- or high-grade lesions was 68% with VIA and 77% with VIAM, and specificity was 62% with VIA and 63% with VIAM; however, these differences were not statistically significant. CONCLUSIONS: For settings where physician confirmation of cervical abnormalities identified through visual inspection is required and available, this study demonstrates that VIAM had no significant advantage over VIA.     

碘染色肉眼观察作为宫颈癌初筛方法的效果评价

目的评价碘液染色后直接肉眼观察在宫颈癌筛查中的作用,为在现阶段宫颈癌高发且经济落后地区制定宫颈癌及其癌前病变的筛查方案提供依据。方法在山西省阳城县筛查人群中,以病理组织学诊断结果为金标准,利用约登指数比较使用碘液染色后肉眼观察、阴道镜、薄层液基细胞学和人乳头瘤病毒(HPV)DNA的筛查效果。结果该人群(735名)平均年龄为40.80岁±10.7岁,宫颈高度鳞状上皮内瘤样变及癌(≥CINⅡ)的现患率为4.35%(32/735)。以病理组织学结果为金标准(≥CINⅡ),碘液染色后直接肉眼观察的灵敏度和特异度(≥阳性)分别为53.13和82.19,阴道镜的灵敏度和特异度(≥低度病变为阳性)分别为56.25和79.09。运用约登指数进行比较,碘液染色后直接肉眼观察和阴道镜检查之间差异无统计学意义(P>0.05),而碘液染色后直接肉眼观察不如液基细胞学和HPVDNA检测(P<0.05)。另外,经过现场短时间培训后,以前无经验的医生与有经验医生间使用碘液染色的水平的差异无统计学意义(P>0.05)。结论鉴于碘染色后肉眼观察的灵敏度较低,但经济易行,容易掌握,如果能够开展经常性的筛查,可以将碘液染色后直接肉眼观察作为经济落后地区宫颈癌初筛方法之一。     

A comparison of two visual inspection methods for cervical cancer screening among HIV-infected women in Kenya

Objective

To determine the optimal strategy for cervical cancer screening in women with human immunodeficiency virus (HIV) infection by comparing two strategies: visual inspection of the cervix with acetic acid (VIA) and VIA followed immediately by visual inspection with Lugol’s iodine (VIA/VILI) in women with a positive VIA result.

Methods

Data from a cervical cancer screening programme embedded in two HIV clinic sites in western Kenya were evaluated. Women at a central site underwent VIA, while women at a peripheral site underwent VIA/VILI. All women positive for cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) on VIA and/or VILI had a confirmatory colposcopy, with a biopsy if necessary. Overall test positivity, positive predictive value (PPV) and the CIN 2+ detection rate were calculated for the two screening methods, with biopsy being the gold standard.

Findings

Between October 2007 and October 2010, 2338 women were screened with VIA and 1124 with VIA/VILI. In the VIA group, 26.4% of the women tested positive for CIN 2+; in the VIA/VILI group, 21.7% tested positive (P < 0.01). Histologically confirmed CIN 2+ was detected in 8.9% and 7.8% (P = 0.27) of women in the VIA and VIA/VILI groups, respectively. The PPV of VIA for biopsy-confirmed CIN 2+ in a single round of screening was 35.2%, compared with 38.2% for VIA/VILI (P = 0.41).

Conclusion

The absence of any differences between VIA and VIA/VILI in detection rates or PPV for CIN 2+ suggests that VIA, an easy testing procedure, can be used alone as a cervical cancer screening strategy in low-income settings.     

肉眼观察法在宫颈病变筛查中的价值

目的以宫颈活检的诊断结果为标准,评价宫颈醋白肉眼观察试验（visual inspection with acetic acid,VIA）和碘染色肉眼观察试验（visual inspection with Lugol’s iodine,VILI）在宫颈病变筛查中的价值。方法以2009年10月—2010年3月在我院门诊就诊的患者为研究对象,对入选的591例患者行宫颈刮片检查及VIA和VILI试验,最后行宫颈多点活检,比较3种方法的灵敏度、特异度、特异性、阳性预测值、阴性预测值、约登指数及3种方法的相符性。结果宫颈刮片的灵敏度为9.3%,特异度为100.0%,约登指数为0.09;VIA的灵敏度为46.9%,特异度为87.1%,约登指数为0.34;VILI的灵敏度为62.5%,特异度为83.1%,约登指数为0.45。宫颈刮片、VIA及VILI3种方法相比均有显著性差异,P〈0.05。结论肉眼观察法价格低廉,灵敏度和特异度均较宫颈刮片高,且可以立即出结果,是本地区宫颈癌筛查经济、有效的方法,同时应用VIA与VILI进行筛查,可以提高检查效能。     

HR-HPV在农村宫颈癌前病变高危年龄妇女中的感染状况调查

目的:探讨高危型人乳头瘤病毒(High risk-human papilloma virus,HR-HPV)在中国农村宫颈癌前病变高危年龄妇女中的感染状况,为宫颈癌前病变的防治及宫颈癌筛查方案的制定提供客观依据。方法:对宫颈癌高发区江西修水县人桥乡2499例年龄为30~49岁农村已婚妇女进行以人群为基础的宫颈癌及癌前病变筛查的横断面研究。采用了目前被普遍认可的多种筛查技术的联合筛查:包括宫颈薄层液基细胞学检查(TCT)、宫颈脱落细胞HPV DNA检查、醋酸染色肉眼观察(VIA)、碘染色肉眼观察(VILI)以及阴道镜检查等方法。不同方法间遵循独立、双盲原则。对其中任何一项检查异常的妇女进行宫颈活组织病理检查,以宫颈活组织病理检查作为诊断金标准。HPV DNA检测采用第二代杂交捕获实验(Hybrid capture-2,HC-Ⅱ)对受检妇女宫颈脱落细胞行HPV DNA半定量检测。观察农村宫颈癌前病变高危年龄妇女病变程度与HR-HPV感染的关系以及HR-HPV在宫颈癌前病变高危年龄妇女人群中的感染状况。结果:2499例受检妇女中,352例妇女因HPV DNA缺失被排除,其余2147例妇女纳入本研究,共检出无宫颈病变1966例、宫颈鳞状细胞化生81例、慢性宫颈炎271例、CINⅠ82例,CINⅡ37例、CINⅢ59例、宫颈癌3例。HR-HPV在不同程度宫颈病变的感染率分别为5.1%、54.9%、66.9%、80.5%、94.1%、98.1%、100.0%。HR-HPV检出妇女中总阳性率为20.63%,在30~34岁、35~39岁、40~44岁、45~49岁各年龄组的阳性率分别为21.07%、19.66%、21.29%及20.54%。宫颈癌前病变妇女HR-HPV感染率与慢性宫颈炎妇女比较,差异有统计学意义(P<0.05)。宫颈癌前病变高危年龄妇女不同年龄组HPV感染率无统计学差异(P>0.05)。结论:HR-HPV感染与宫颈病变程度呈正相关,与年龄无明显相关性。     

Pap smear, hybrid capture II, and visual inspection in screening for uterine cervical lesions

The objective of this study was to evaluate alterations in Pap smear, hybrid capture II (HCII), and visual inspection with acetic acid (VIA) in 684 women treated at a primary health care unit. The performance and agreement of the exams were evaluated. The study also described social, demographic, and reproductive factors and their association with uterine cervical lesions. Women had specimens taken for Pap smear, HCII, and VIA. When at least one of the tests was positive, colposcopy was performed and targeted biopsies were taken from any suspicious lesions. Performance of tests was evaluated. Women's distribution in relation to social, demographic, and reproductive factors and histological diagnosis was evaluated using the odds ratio. Among 198 women with at least one positive screening test, only 21 showed histological disease. Sensitivities of the tests were similar. VIA and Pap smear presented higher specificity than HCII. Only absence of a previous Pap smear was associated with the presence of histological disease. Pap smear performed better than VIA and HC II. Absence of previous cytology was associated with histological disease.     

阴道镜下活检、TCT及HPV检测对宫颈病变的临床应用分析

目的:探讨阴道镜下活检、宫颈液基薄层细胞学检查(TCT)及人乳头瘤病毒(HPV)检测对宫颈病变的临床价值。方法:2017年3月~2019年3月收治的427例妇女均进行TCT检查,其中315例同时进行了HPV检查,对其中高度怀疑有宫颈病变的239例进行阴道镜活检,以活检病理学为金标准,判断TCT、HPV的敏感性、特异性、阳性预测值、阴性预测值。结果:活检病理学证实,正常或炎症改变93例(38.9%),CINⅠ39例(16.3%),CINⅡ48例(20.1%),CINⅢ28例(11.7%),宫颈癌31例(13.0%)。以活检病理学为金标准,TCT的敏感性为63.7%,特异性为61.9%,阳性预测值为77.4%,阴性预测值为48.1%。HPV的敏感性为94.8%,特异性39.4%,阳性预测值为60.5%,阴性预测值为44.8%。结论:HPV检测宫颈疾病的敏感性高,灵活运用多种检测方法对宫颈病变的早期发现、早期诊断有重要意义。     

沈阳市妇女人乳头瘤病毒感染型别分布的研究

目的探讨沈阳市妇女人乳头瘤病毒（HPV）感染的型别分布。方法在沈阳市某社区抽取年龄为15～59岁的1000名妇女进行子宫颈癌危险因素的流行病学问卷调查，对已婚未孕妇女采集子宫颈细胞标本，用PCR分析和酶联免疫实验进行HPV检测分型，用薄层液基细胞学、醋酸染色后肉眼观察试验、碘试验和电子阴道镜进行子宫颈癌和癌前病变筛查。结果在纳入研究的702例妇女中，总的HPV感染率为17．0％。HPV感染在细胞学异常者中占64．1％，细胞学正常者中占11．1％，差异有统计学意义（P〈0．05）。人群中高危型HPV感染率为11．9％，低危型为6．5％。高危型及低危型HPV在细胞学异常人群中的感染均明显高于细胞学正常的人群。共有32个型别的HPV被鉴定。感染最多的类型为HPVl6（3．4％），52（2．4％）和58型（1．9％）。总HPV感染率、高危型及低危型在各年龄组间的分布差异均无统计学意义（P〉0．05）。但是高危型HPV感染在45岁以下年龄组中占主导地位，即高危型及低危型感染的差异有统计学意义（P〈0．05）；在45岁以上年龄组，高危型及低危型感染的差异无统计学意义（P〉0．05）。结论沈阳市妇女HPV感染在细胞学异常人群中明显高于细胞学正常的人群。主要感染型别是16、52和58型。     

Détection et quantification des infections génitales à papillomavirus humains : conséquences virologiques, épidémiologiques et cliniques

Human papillomaviruses (HPV) are the main risk factor for cervical cancer. By introducing its DNA into the genome of infected human cells, the virus expresses two oncoproteins (E6 and E7) that induce inactivation of tumour suppressors and telomerase. HPV infection is extremely common. But most of women will clear the infection over an 8-10-month period without developing any cervical lesion. In fact, it is the persistence of infection that truly exposes to the risk of cervical cancer. HPV testing, used for primary screening, has better sensitivity but lower specificity than cervical cytology. A secondary use of cytology would compensate the loss of HPV testing specificity. Thus, cervical cytology would be performed only in HPV positive women and colposcopy finally performed only in women with abnormal cytology. The characteristics of such screening would allow to increase interscreening intervals and therefore to reduce additional costs. The quantification of HPV viral load could be a way to differentiate significant infections from others. Despite proven significant association between high HPV viral load and the risk of CIN 2-3 and cervical cancer, crude variations within disease grades currently limit the clinical utility of viral load measurement. More than a just measure of HPV viral load, its evolution over time is what would really be of clinical relevance.     

A meta-analysis of human papillomavirus type-distribution in women from South Asia: implications for vaccination

OBJECTIVE: To determine human papillomavirus (HPV) prevalence and type-distribution in women from South Asia, with and without cervical lesions, in order to estimate the impact of an HPV 16/18 prophylactic vaccine in this region and to assess additional types that should be incorporated in new vaccines. METHODS: A meta-analysis was conducted that included studies using polymerase chain reaction to detect HPV-16, -18, -6, -11 and at least one other HPV type, with a minimum of 20 cases in each grade of lesion. Total as well as type-specific prevalence of various HPV types were estimated, stratified by cervical lesion grade, using Stata 9.0 software package. RESULTS: Nine studies from India fulfilled the inclusion criteria. A total of 558, 52, 52 and 3061 women, respectively with invasive cervical cancer (ICC), high-grade squamous intraepithelial lesions (HSIL), low-grade squamous intraepithelial lesions (LSIL) and normal cytology/histology were included. Overall HPV prevalence was 94.6%, 86.5%, 65.4% and 12.0% in women with ICC, HSIL, LSIL and normal cytology/histology, respectively. In ICC, HPV-16 was the predominant type (64.8%), followed by HPV-18, -45, -33, -35, -58, -59 and -31. The estimated HPV-16/18 positive fraction was 78.9% in women with ICC (87.7% in North and 77.2% in South India), 61.5% with HSIL, 30.8% with LSIL and 3.9% in women with normal cytology/histology. There was no difference in overall HPV prevalence in cervical cancer between North and South India (P=0.063). However, HPV-16 and -45 appeared to be more prevalent in North India (P=0.018 and 0.013, respectively), while HPV-35 appeared to be more prevalent in South India (P=0.033). CONCLUSION: It is estimated that HPV-16/18 vaccines will provide over 75% protection against ICC in South Asia. HPV-45, -33, -35 and -58 account for an additional 20% of cervical cancer in this region. The addition of these additional HPV types in a second-generation vaccine could provide optimal cervical cancer prevention in this region.     

高危型人乳头状瘤病毒DNA检测联合液基细胞学检查在宫颈病变筛查中的价值

目的:评价高危型人乳头状瘤病毒(HPV)DNA检测联合宫颈液基细胞学检查在宫颈病变筛查中的价值。方法:采用宫颈超薄液基细胞学检测及第二代杂交捕获试验(HC-Ⅱ)对14 861例妇女进行宫颈病变筛查,以宫颈组织病理学检查结果作为确诊的金标准。结果:HR-HPV感染3 595例,感染率24.19%;细胞学检查发现非典型鳞状细胞202例,非典型腺细胞1例,LSIL303例;HSIL92例;病理学证实CINⅠ90例、CINⅡ65例、CINⅢ86例、宫颈鳞状细胞癌7例、腺癌2例。高危型HPV DNA在不同宫颈病变中的阳性率分别是:HSIL 92.05%(139/151)、LSIL 52.22%(47/90)和无宫颈上皮病变26.70%(25/939),各组间比较有显著性差异。高危型HPV DNA检测CIN的敏感度是91.05%,特异度是81.35%,阴性预测值为99.55%。宫颈液基细胞学筛查CIN的敏感度、特异度和阴性预测值分别是88.92%、95.56%和99.20%。高危型HPV DNA检测联合细胞学检查筛查CIN的敏感度、特异度和阴性预测值分别是96.12%、82.56%和100.00%。结论:高危型HPVDNA检测在宫颈癌的筛查中有很高的敏感度和阴性预测值,高危型HPV DNA检测联合细胞学检查可使敏感度和阴性预测值有所提高,其结果对宫颈病变有预警作用。     

张家口市门诊女性HPV感染与宫颈病变筛查的临床资料分析

目的:了解张家口地区妇产科门诊女性生殖道高危型HPV感染现状及子宫颈上皮瘤样病变(CIN)的发生情况。方法:回顾性收集2010年11月～2011年6月,在河北北方学院附属第一医院妇产科就诊的19～70岁女性筛查资料和临床病理资料。所有调查对象均行子宫颈醋酸肉眼观察、电子阴道镜检查、液基细胞薄层涂片技术子宫颈脱落细胞学检查(LCT)及第二代杂交捕获技术(HC-Ⅱ)检测高危型HPV。对于HPV阳性、未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、LSIL及以上病变者,行电子阴道镜检查,并取活检,进行病理诊断。结果:共调查了2 397例妇女,分为15～24岁、25～29岁、30～34岁、35～39岁、40～44岁、45～49岁和50～70岁年龄组,高危HPV检出率分别为19.5%、21.7%、12.6%、10.8%、11.2%、19.3%和21.0%,组间存在差异(P<0.05);25～29岁组与50～59岁组HPV感染率较高,但两组间HPV感染率无差异(P>0.05)。CINⅠ、CINⅡ和CINⅢ现患率分别为4.2%、1.8%和0.4%,CINⅠ现患率高于CINⅡ和CINⅢ(P<0.05)。HPV感染率随子宫颈病变级别升高呈趋势性增加,无CIN病变的子宫颈HPV感染率为8.7%。结论:张家口地区门诊妇女生殖道HPV高危型感染率较高,且子宫颈病变多处于CIN的早期阶段。     

Bolivian health providers' attitudes toward alternative technologies for cervical cancer prevention: a focus on visual inspection with acetic Acid and cryotherapy

Abstract Background: Little is known about health providers' attitudes toward visual inspection with acetic acid (VIA) and cryotherapy in the prevention of cervical cancer, as most research in Latin America and the Caribbean (LAC) has examined attitudes of the general population. This study describes attitudes of Bolivian health professionals toward new technologies for cervical cancer prevention, focusing on VIA and cryotherapy. Methods: Between February 2011 and March 2012, we surveyed 7 nurses and 35 physicians who participated in 5-day workshops on VIA and cryotherapy conducted in Bolivia. Multiple choice and open-ended questions were used to assess participants' acceptability of these procedures and the feasibility of their implementation in the context of perceived barriers for the early detection of cervical cancer in this country. Results: Most believed that cultural factors represent the main barrier for the early detection of cervical cancer (70%), although all stated that VIA and cryotherapy would be accepted by women, citing the advantages of VIA over cytology for this belief. Most also believed their colleagues would accept VIA and cryotherapy (71%) and that VIA should replace Pap testing (61%), reiterating the advantages of VIA for these beliefs. Those who believed the contrary expressed a general resistance to change associated with an already existing cytology program and national norms prioritizing Pap testing. Conclusions: Most participants had favorable attitudes toward VIA and cryotherapy; however, a sizable minority cited challenges to their adoption by colleagues and believed VIA should not replace cytology. This report can inform the development of strategies to expand the use of alternative cervical cancer screening methods in LAC and Bolivia.     

宫颈细胞学、HPV检测配合阴道镜对宫颈病变筛查的结果分析

目的:评价宫颈细胞学检查、HPVDNA检测配合阴道镜检查对子宫颈病变的诊断价值。方法:2004年3月～10月对来站体检妇女行宫颈细胞学检查、HPVDNA检测配合阴道镜检查,对子宫颈病变进行筛查,以组织学为金标准对结果进行分析。结果:宫颈涂片4092例,异常涂片222例(5.43%);宫颈HPVDNA检测4092例,阳性71例(1.74%);行阴道镜检查79例,62例在阴道镜指引下行宫颈活体组织检查。病理结果显示:宫颈上皮内瘤样变(CIN)52例,其中CINⅠ19例(0.47%),CINⅡ8例(0.20%),CINⅢ25例(0.61%),HPV感染2例(0.05%),宫颈慢性炎症8例(0.19%)。宫颈细胞学检查异常、HPVDNA检测阳性,活检确诊为CIN与宫颈细胞学检查异常,HPVDNA检测阴性活检确诊为CIN,两者比较差异有显著性(P<0.05)。阴道镜诊断CIN的敏感性为98.08%,特异性为80.00%。结论:采用宫颈细胞学检查、HPVDNA检测配合阴道镜下病理检查能及早发现宫颈癌前病变。     

宫颈刮片、阴道镜及HPV检测在宫颈癌筛查中的应用研究

目的:评价宫颈刮片、阴道镜及高危HPV检测在宫颈癌筛查中的作用,对宫颈癌筛查提出合理化建议。方法:同时进行宫颈刮片、阴道镜检查及高危HPV检测,对一项或多项异常者进行病理组织学检查,以组织学诊断作为金标准。对187例病理结果阳性(CINⅠ、CINⅡ、CINⅢ、宫颈浸润癌)的患者,比较3种方法的检出敏感度。结果:187例病理结果阳性者中,宫颈刮片阳性者114例,敏感度为60.96%;阴道镜阳性者149例,敏感度为79.68%;高危型HPV感染者155例,敏感度为82.89%,3种方法的敏感性具有统计学意义(P0.05)。结论:宫颈癌筛查及早期诊断应采用宫颈细胞学检查、阴道镜检查及HPV检测相结合,可以提高检出率,减少假阴性。     

细胞学和高危型HPV在宫颈电圈切除术治疗重度宫颈上皮内瘤变术后随访中的价值

目的:评价TCT和高危型HPV在LEEP术治疗宫颈上皮内瘤变C IN 2~3术后随访中的价值。方法:72例阴道镜下活检病理诊断为C IN 2~3患者采用LEEP治疗,术后每半年随访,包括:TCT,HPV,阴道镜。有阴道镜异常或HSIL者行活检,病理证实为C IN 2~3以上视为病变残留或复发,评价TCT和HPV在检测残留和复发中的价值。结果:72例随访中,9例(12.5%)复发或残留。第1次随访中,HC 2和TCT作为独立试验检测残留或复发C IN 2~3,灵敏度相近,达100%。第2、3次随访中,TCT在特异度和PPV高于HC 2,两者均有较高的灵敏度和NPV,两者联合,特异度和PPV显著提高。结论:细胞学和高危型HPV检测术后复发或残留有重要价值。     

Visual inspection with acetic acid for cervical cancer screening outside of low-resource settings.

OBJECTIVES: To assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center in Peru, to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low-resource ones. METHODS: This was a prospective study of 1 921 asymptomatic women living in Lima, Peru, carried out in 1999 and 2000. The study was performed at a cancer center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy. RESULTS: More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P = 0.0001). There were 35 women with histologic cervical intraepithelial neoplasia grade 1 (CIN 1); of these, 15 were detected by Pap and 20 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN 2-3) was confirmed in a total of 13 cases; Pap detected 5 of the cases and VIA 11 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.3% for VIA and 6.3% for Pap (P = 0.5). Most importantly, while only 2.3% of patients with a positive VIA were lost to follow-up before colposcopy, that was true for 26.3% of the women with a positive Pap smear (P < 0.0001). CONCLUSIONS: VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non-low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology-based screening.     

细胞学联合HPV检测在宫颈病变筛查中的应用

目的:评价细胞学联合HR-HPV检测对宫颈病变筛查的效力。方法:对173例细胞学异常(TBS系统≥ASC-US)的患者同时用HC-Ⅱ(Hybrid CaptureⅡ)方法检测高危型HPV(HR-HPV)阳性,并与仅行细胞学检查的149例患者进行比较,以病理学为金标准,比较两种方法在宫颈病变筛查中的意义。结果:在173例细胞学≥ASC且HPV阳性者中,病理学为NILM39例,占22.5%;病理学≥LSIL/HPV139例,占80.3%,而单纯细胞学≥ASC共149例,病理学为NILM48例,占32.2%;≥LSIL101例,占67.8%。经统计学处理,HPV+细胞学检查与单纯细胞学异常比较,对低度宫颈病变(病理学≥CINⅠ/HPV)前者的敏感性、特异性均高于后者;对高度宫颈病变(CIN≥Ⅱ/Ⅲ),HPV+细胞学检查与单纯细胞学异常比较,敏感性无显著性差异,而特异性低于后者。结论:细胞学、HPV检测是有效的宫颈低度病变筛查方法,二者联合应用更有利于科学地管理宫颈病变。