HPV联合TCT检测在宫颈癌筛查中的价值分析

目的 评估人乳头瘤病毒（HPV）联合液基薄层细胞学检查（TCT）在宫颈癌筛查中的价值。方法 选取本院1251例实施的宫颈活检术病例,均接受HPV、TCT、病理学检查。根据HPV及TCT的结果分为HPV阳性+TCT阳性组（589例）、HPV阳性+TCT阴性组（367例）、HPV阴性+TCT阳性组（295例）。比较三组与宫颈活检病理检查的检出率以及宫颈低级别病变与宫颈高级别病变的占比情况。结果 HPV阳性+TCT阳性组的宫颈病变检出率（98.47%）高于HPV阳性+TCT阴性组（68.39%）、HPV阴性+TCT阳性组（34.92%）,HPV阳性+TCT阴性组的宫颈病变检出率高于HPV阴性+TCT阳性组,差异有统计学意义（P<0.05）。HPV阳性+TCT阳性组的宫颈高级别病变检出率最高（82.59%）,其次为HPV阴性+TCT阳性组（78.64%）、HPV阳性+TCT阴性组（24.70%）,两两比较差异有统计学意义（P<0.05）。结论 HPV联合TCT检测对宫颈病变的筛查检出率最高;对于宫颈低级别病变,可能HPV筛查效率更高,TCT筛查效率较低;但对于宫颈高级别病变,HPV...     

两种HPV检测方法在宫颈癌筛查中准确性比较的Meta分析

目的:评价HPV E6/E7 mRNA(Aptima)和HPV DNA二代杂交捕获(HC2)检测对宫颈上皮内瘤变2级(CIN2)及以上病变(≥CIN2)的诊断价值。方法:检索Cochrane图书馆、Pubmed、Embase、中国知网和万方数据库,收集Aptima和HC2用于宫颈癌筛查的研究数据。通过meta分析合并诊断效应量,比较Aptima和HC2对≥CIN2的诊断效能。结果:共纳入13篇文献,初筛人群累计31523例(其中Aptima 15767例,HC2 15756例)。转诊人群累计13982例(其中Aptima 7004例,HC2 6978例)。初筛人群中,Aptima和HC2诊断≥CIN2的汇总敏感度分别为0.95(95%CI为0.91~0.98)和0.95(95%CI为0.90~0.97),汇总特异度分别为0.90(95%CI为0.90~0.98)和0.85(95%CI为0.84~0.86)。转诊人群中,Aptima和HC2诊断≥CIN2的汇总敏感度分别为0.93(95%CI为0.92~0.94)和0.95(95%CI为0.93~0.96),汇总特异度分别为0.47(95%CI为0.45~0.48)和0.38(95%CI为0.36~0.39)。初筛人群中,Aptima和HC2诊断≥CIN2的AUC分别是0.9672和0.8888,Q*统计量分别为0.9154和0.8194;转诊人群中,Aptima和HC2诊断≥CIN2的AUC分别是0.8389和0.8766,Q*统计量分别为0.7708和0.8070,差异均无统计学意义。结论:Aptima与HC2对≥CIN2病变的诊断敏感度和诊断效能相当,但Aptima的特异度相对更高。     

老年女性宫颈癌筛查现状与展望

宫颈癌的发生与高危型人乳头瘤病毒(HPV)持续感染密切相关,老年女性出现了HPV感染的第2次高峰,老年女性仍具有相当的罹患宫颈癌的风险。然而老年女性的宫颈癌筛查情况受多种因素的影响不容乐观,同时目前全球针对老年女性宫颈癌的筛查建议,缺乏大样本的研究证据的支持,如何平衡筛查-保护的效益,选择何时作为终止筛查的年龄,还需更多大样本足够长时间的RCT研究以更好地指导制定卫生保健政策。     

HPV检测独立应用于宫颈癌筛查长期预测价值的Meta分析

目的:采用Meta分析的方法比较高危型人乳头瘤病毒(HPV)检测与细胞学检测在宫颈癌筛查中的长期预测价值。方法:计算机检索Pub Med及Web of Science数据库,纳入HPV及细胞学检测方法进行宫颈癌筛查且随访时间超过3年的临床研究。应用合并累积发生率及合并比值比(OR)评估在长期随访过程中不同筛查结果人群间宫颈上皮内瘤变(CIN)Ⅱ级及以上(CINⅡ~+)、CINⅢ级及以上(CINⅢ~+)和宫颈癌发生风险的差异。结果:纳入26篇临床研究文献。HPV检测阴性的人群在随访3年内发生CINⅡ~+、CINⅢ~+及宫颈癌的风险均低于细胞学筛查阴性人群,差异有统计学意义(CINⅡ~+:OR=0.500,P0.001;CINⅢ~+:OR=0.377,P0.001;宫颈癌:OR=0.546,P0.001)。而HPV阴性组在随访第5年CINⅡ~+、CINⅢ~+及宫颈癌的累积发生率仍要低于细胞学阴性组随访第3年的累积发生率,虽然差异无统计学意义(CINⅡ~+:0.47%vs 0.60%;CINⅢ~+:0.15%vs 0.20%;宫颈癌:0.016%vs 0.020%),但各OR值均小于1。结论:单独采用HPV检测是一种可行的宫颈癌筛查方法,对于HPV检测结果为阴性的人群,其筛查间期相较细胞学筛查可适当延长至5年。     

作为宫颈癌低危人群细胞学筛查辅助方法的人乳头瘤病毒年龄相关性研究[英]

高危人乳头瘤病毒（HR-HPV）检测已推荐作为一种细胞学或辅助细胞学的替代方法用于宫颈癌筛查。本研究旨在评估欧洲人群中HR-HPV感染的年龄特点和与细胞学诊断之间的关系。     

高危型HPV检测及TCT检查在宫颈癌筛查中的护理分析

目的 探究高危型人乳头状瘤病毒（HPV）检测及液基薄层细胞学（TCT）检查在宫颈癌筛查中的护理方式及成效。方法 选取80例接受宫颈癌筛查的疑似患者,根据随机数字表法分为对照组与观察组,每组40例。对照组采取常规护理,观察组在对照组基础上采用针对性护理措施。对比两组患者检出率及在筛查过程中的配合度。结果 观察组宫颈癌检出率为77.5%,略高于对照组的72.5%,但差异无统计学意义（P>0.05）。观察组在筛查过程中的配合度为97.5%,明显高于对照组的77.5%,差异具有统计学意义（P<0.05）。结论 在开展高危型HPV检测及TCT检查中,对于疑似宫颈癌患者采取常规护理联合针对性护理措施,可增加宫颈癌相关知识掌握度,缓解负面情绪,其积极配合筛查工作的开展。     

2005年中国12家医院宫颈癌机会性筛查资料分析

目的:探讨中国不同地区进行宫颈癌机会性筛查的价值.方法:收集分析2005年全国12家医院门诊进行宫颈癌机会性筛查(oppommistic screening,OS)的资料,筛查方法包括液基细胞学、巴氏细胞学、高危型HPV检测,以及中国癌症基金会推荐的Ⅰ方案(液基细胞学检查加高危型HPV DNA检测)、Ⅱ方案(巴氏涂片加高危型HPV DNA检测)、Ⅲ方案(醋酸白肉眼检查法);并经阴道镜检查,病理确诊宫颈病变及宫颈癌.结果:共收治门诊患者1242952例次,其中接受OS202231例次,占门诊例次16.27%.筛查方法依次为液基细胞学84082例(41.58%),巴氏细胞学79426例(39.27%),Ⅰ方案23658例(11.70%),Ⅱ方案6504例(3.22%),检测HPV筛查者5976例(2.96%);Ⅲ方案2585例(1.28%).最普遍采用的筛查方法是细胞学检查(液基及巴氏方法)占95.76%.检出宫颈癌前病变(CIN Ⅰ+CIN Ⅱ+CIN Ⅲ)共5146例(2.54%),宫颈癌1134例(0.56%).结论:医院内就诊人群宫颈病变检出率高,应高度重视其机会性筛查,及时进行规范性治疗.     

内蒙古东部地区宫颈癌及宫颈癌前病变的人群筛查研究

目的探讨内蒙古东部地区妇女宫颈癌及宫颈癌前病变的疾病状况。方法本研究是以人群为基础的横断面筛查研究,2005—2010年间,选取内蒙古东部地区三个筛查点的18～69岁的妇女作为目标人群,采集其宫颈脱落细胞标本,细胞学诊断采用TBS2001分级系统,异常者进行阴道镜检,有病变者直接取活检明确诊断。细胞学阳性定义为意义不明确的非典型鳞状上皮细胞（ASCUS）以及更高度病变,以组织病理学为金标准,分析不同年龄组,地区和民族患者宫颈癌及宫颈上皮内瘤变（CIN）的发病趋势。结果①内蒙东部地区全人群、蒙族和汉族妇女异常细胞学（ASCUS＋）的检出率分别为6.56%、8.03%和6.06%;其中蒙族妇女细胞学异常病变的检出率高于汉族妇女;②病理结果显示：内蒙东部地区宫颈上皮内瘤变（CIN1）的患病率为2.4%,〉CIN2的患病率为1.47%,宫颈早浸癌的患病率为0.04%;蒙族妇女患病率较汉族高,通辽地区的患病率较呼盟和赤峰地区高。其中蒙族妇女各级病变的患病率分别为：CIN12.87%、〉CIN21.80%、早期浸润癌0.10%;汉族分别为：2.25%、1.36%、0.03%。疾病年龄分布：CIN1现患率最高为35岁之前年龄组,〉CIN2的高发年龄为40～49岁,宫颈癌的高发年龄为50～54岁。结论①内蒙东部地区蒙古族妇女宫颈癌及癌前病变的现患率高于汉族妇女;②在内蒙东部地区宫颈癌的筛查年龄段应涵盖30～55岁年龄组,其中40～55岁年龄组为重点人群,应在该年龄段加强宫颈癌的筛查。     

人类乳头瘤病毒检测在宫颈癌筛查中的应用进展

宫颈癌是最常见的妇科恶性肿瘤之一,其发病率仅次于乳腺癌而位居第二[1]。大量的流行病学和分子生物学研究已经证明人乳头瘤病毒（human papillomavirus,HPV）感染是宫颈癌发生的最主要的致病因素。迄今可确定HPV16型和HPV18型是导致人类宫颈癌的常见型别,     

HPV拓展分型与宫颈癌筛查

宫颈癌是目前唯一病因明确且可有效预防的妇科癌症。高危HPV分型16、18型因在宫颈癌及癌前病变的发生发展中具有重要作用而被广泛关注,此前诸多研究聚焦于此。但近来研究发现,非HPV16、18型(HPV拓展分型)在宫颈癌前病变过程中亦发挥重要作用,并受到越来越多的关注。本文着重就HPV拓展分型分别与宫颈癌前病变、宫颈浸润癌、免疫缺陷及HPV疫苗的相关问题加以综述,进一步阐明HPV拓展分型在宫颈癌筛查中的作用及意义。     

Role of human papilloma virus testing in cervical cancer prevention

A clear causal relationship has been established between human papilloma virus (HPV) infection and the development of cervical cancer. Genital HPV infection is currently the most common sexually transmitted disease worldwide. The recent 2001 American Society for Colposcopy and Cervical Pathology Consensus Guidelines have included HPV testing for management of women with cervical cytological abnormalities. Clinicians now face the challenge of deciding when to use HPV testing in follow-up of abnormal Pap tests. This article includes updates on HPV, cervical cancer screening, and HPV testing technology. Recommendations for integration of HPV testing into clinical practice are provided.     

Cervical cancer screening in low resource settings using visual inspection with acetic acid

Cervical cancer is one of the leading causes of death for middle-aged women in the developing world, yet it is almost completely preventable, if precancerous lesions are identified and treated in a timely manner. Cervical cancer screening based on cytologic examination is largely unavailable in developing countries or made available to a small, select group of women in private facilities, maternal child health sites, or family-planning clinics, missing the age groups at highest risk for precancerous lesions. Visual inspection with acetic acid (VIA) can be used to screen women. It can be done by nurses or midwives with appropriate training. Although still under investigation, research results show that VIA is simple, accurate, cost-effective, and acceptable to most women. This article reviews the natural history of cervical cancer and important aspects to consider related to cervical cancer screening in low resource settings. The VIA technique is described in detail.     

Effectiveness of cervical cancer screening using visual inspection with acetic acid in Peru

Objective

To evaluate the effectiveness of screening using visual inspection with acetic acid (VIA).

Methods

In a low-resource area of Peru in 2005-2008, a randomly selected sample of women who had previously screened negative by VIA and Pap (intervention group), and a group of eligible women previously unscreened by VIA (comparison group) were screened by VIA. The outcome measures were histologically confirmed cervical intraepithelial neoplasia (CIN) 2-3 and invasive cervical cancer.

Results

There were 4252 women in the intervention group and 4392 in the comparison group. Histologically confirmed CIN 2 or worse was diagnosed in 31 (0.7%) and 115 (2.6%) women, and invasive cancer was diagnosed in 4 women (0.09%) and 43 women (1.00%), in the intervention and comparison groups, respectively. The adjusted odds ratio was 4.2 (95% confidence interval [CI], 2.7-6.4) for CIN 2 or worse, and 13.9 (95% CI, 4.9-39.6) for invasive cervical cancer in the comparison group.

Conclusion

A lower prevalence of CIN 2-3 and invasive cervical cancer was seen in women previously screened by VIA, as compared with women not previously screened by VIA, implying that a single VIA screening can lower the population risk for cervical cancer.     

HPV L1壳蛋白联合HR-HPV分型、TCT检测对宫颈癌前病变及宫颈癌的诊断价值分析

目的探究人乳头瘤病毒L1(HPV L1)壳蛋白联合高危型HPV(HR-HPV)分型、液基薄层细胞学(TCT)检测对宫颈癌前病变及宫颈癌的诊断价值。方法选取2018年5月至2020年2月在西安交通大学第一附属医院接受宫颈癌筛查的妇女1094例为对象,以组织病理学检查结果进行分组,比较各组HPV L1壳蛋白表达水平、HR-HPV和TCT检测阳性率。结果TCT检测阳性率与HR-HPV阳性率存在明显差异(P<0.05)。组织病理学检查,共检出正常或炎症179例(对照组)、CIN 1组26例、CIN 2组44例、CIN 3组40例和宫颈癌组21例,宫颈癌组的TCT检测阳性率和HR-HPV阳性率最高,HPV L1壳蛋白表达水平最低(P<0.05)。HPV L1壳蛋白联合HPV分型、TCT检测诊断宫颈癌前病变及宫颈癌的AUC值分别为0.897和0.804(P<0.05)。结论HPV L1壳蛋白、HPV分型和TCT检测在宫颈癌前病变及宫颈癌的诊断中具有一定的临床价值。     

HPV L1壳蛋白联合HR-HPV分型、TCT检测对宫颈癌前病变及宫颈癌的诊断价值分析#br#

Objective? To explore the diagnostic value of human papilloma virus L1 (HPV L1) capsid protein combined with high-risk HPV (HR-HPV) typing and thinprep cytology test (TCT) for cervical precancerous lesions and cervical cancer. Methods?1 094 women who received cervical cancer screening were selected as the research subjects, and were grouped based on histopathological results. The expression level of HPV L1 capsid protein, and positive rates of HR-HPV and TCT were compared between the groups. Results?There was a significant difference between TCT positive rate and HR-HPV positive rate (P<0.05). Histopathological examination found 179 normal cases or cases only with inflammation (control group), 26 cases of CIN gradeⅠ (CIN1 group), 44 cases of CIN gradeⅡ (CIN2 group), 40 cases of CIN gradeⅢ (CIN3 group) and 21 cases of cervical cancer (cervical cancer group). The positive rates of TCT and HR-HPV in cervical cancer group were the highest, and the expression level of HPV L1 capsid protein was the lowest (P<0.05). The AUC values of HPV L1 capsid protein combined with HPV typing and TCT to diagnose cervical precancerous lesions and cervical cancer were 0.897 and 0.804, respectively (P<0.05). Conclusion?HPV L1 capsid protein, HPV typing and TCT are of clinical value in the diagnosis of cervical precancerous lesions and cervical cancer.     

Accuracy of visual inspection with acetic acid for cervical cancer screening

Objective

To provide an updated estimation of the accuracy of visual inspection with acetic acid (VIA) in detecting true disease.

Methods

A PubMed search provided original studies on VIA accuracy in which the gold standard for confirmatory testing was histology alone or colposcopy followed by biopsy. The numbers of true-positive, false-positive, false-negative, and true-negative results were extracted from each study. Meta-analyses were then performed with different categories of studies according to confirmatory diagnosis threshold, category of women who received confirmatory testing, and whether a medical condition that could affect VIA accuracy was present at screening. The reference category consisted of 26 studies in which VIA was performed on asymptomatic women who all underwent confirmatory testing and in which the disease threshold was cervical intraepithelial neoplasia grade 2.

Results

We report an 80% sensitivity (range, 79%-82%) and a 92% specificity (range, 91%-92%) for VIA. Study region, capacity of screener, or size of the study population did not modify VIA accuracy. The positive predictive value was 10% (range, 9%-10%).

Conclusion

Screening for precancerous and cancerous cervical lesions using VIA is a simple, low-cost, and efficient alternative to cytologic testing in low-resource areas.     

Reproducibility of cervical intraepithelial neoplasia diagnosis on histological review of cervical punch biopsies from a visual inspection with acetic acid and HPV detection-based screening program

Objective

To assess the reproducibility of cervical intraepithelial neoplasia (CIN) diagnosis in a visual inspection with acetic acid (VIA) and HPV detection-based screening program, and to correlate CIN diagnosis with oncogenic HPV status.

Methods

A total of 9630 women were screened by VIA and high-risk HPV detection at community outreach clinics in India between June 2011 and June 2012. Biopsies obtained from women who were positive on either test were reviewed by two pathologists blinded to the histological diagnoses originally made by pathologists working at the Chittaranjan National Cancer Institute.

Results

The interobserver agreement between the pathologists’ diagnoses and the diagnoses made by the expert reviewers on 424 slides was fair (kappa = 0.26). There was a distinct difference in agreement in detecting CIN 2 (kappa = 0.21) and detecting CIN 3 (kappa = 0.74). The overall agreement in diagnosis improved when the slides obtained from the HPV-positive women were considered (kappa = 0.5). Almost half of the discordant CIN 2 cases were high-risk HPV negative.

Conclusion

Diagnosis of CIN 2 is poorly reproducible. The natural history of CIN 2 lesions is more similar to CIN 1 than CIN 3; it is therefore necessary to re-evaluate whether to consider CIN 2 lesions as high-grade squamous intraepithelial lesions with CIN 3, as in the Bethesda system of classification.     

The histopathologic patterns of cervical lesions and visual inspection with acetic acid on excised uterine cervices

The histologic patterns of cervical lesions as detected by visual inspection of the cervix with acetic acid (VIA) method were studied in 162 excised uterine cervices. There were 103 cervices of previous histologically confirmed cervical neoplasia treated by loop electrosurgical excision procedure (LEEP) or hysterectomy (group 1) and 59 cervices of hysterectomy specimens without known cervical pathology (group 2). Each freshly received cervix was examined with naked eye, photographed, 4% acetic acid applied, and then reexamined with naked eye for any color changes. Then it was rephotographed, divided spatially into 12 segments like on a face of a clock, processed to produce hematoxylin and eosin-stained glass slides, and histologically examined. The raised dull white changes, positive VIA, were highly correlated with the higher grade of cervical intraepithelial neoplasia (CIN) (CIN 2 + CIN 3). In group 1, the sensitivity of the acetic acid in detecting high-grade CIN was 98.6%, the specificity was 82.4%, the positive predictive value was 91.9%, and the negative predictive value was 96.6%. The flat white changes, negative VIA, were mostly correlated with CIN 1-koilocytosis. This study found that the validity of the VIA technique in detecting high-grade CIN was acceptable.