细胞DNA定量分析技术在宫颈癌筛查中的应用价值

目的比较细胞DNA定量分析技术与宫颈脱落细胞学TBS检查在宫颈癌筛查中的效果,探讨细胞DNA定量分析技术在宫颈癌筛查中的应用价值。方法选择2014年9月-2016年8月在该院就诊的2 821例适龄妇女进行宫颈脱落细胞学TBS检查和细胞DNA定量分析检查,对其中177例(检查阳性数≥1)进行活检。以活检诊断为金标准,评估两种技术在宫颈癌筛查中的敏感性、特异性、阳性预测值与阴性预测值,进而判断细胞DNA定量分析技术在宫颈癌初筛中的使用价值。结果宫颈脱落细胞学TBS检查与细胞DNA定量分析技术的敏感性、特异性、阳性预测值与阴性预期值分别为62.64%、65.11%、65.52%、46.67%和79.12%、81.40%、81.82%、78.65%;细胞DNA定量分析技术对宫颈癌筛查的检出率高于宫颈脱落细胞学TBS检查,差异有统计学意义(P0.05)。结论细胞DNA定量分析技术在宫颈癌筛查中,敏感性与特异性均高于宫颈脱落细胞学TBS检查,可以提高病变检出率,有效防止漏诊,在宫颈癌的筛查中具有优越性。     

DNA定量检测技术在农村妇女宫颈癌筛查中的应用

目的提高农村已婚妇女宫颈癌检出率,做到早发现、早诊断、早治疗,从而降低妇女宫颈癌的死亡率。方法应用宫颈脱落细胞DNA定量检测技术对江苏省东海县全县农村已婚妇女进行免费宫颈癌筛查。结果 2010-2013年筛查人数41 289人,DNA定量检测结果可疑人数为1685例,阳性为728例,阳性率为1.76%。经宫颈活体组织检查确诊宫颈癌及宫颈上皮内瘤变（CIN）209例,其中CIN 191例（患病率达462.59/10万）、浸润癌18例（患病率达43.60/10万）。结论宫颈脱落细胞DNA定量检测技术可以应用在开展妇女宫颈癌筛查项目。     

宫颈脱落细胞学检测在宫颈癌筛查中的应用

宫颈癌是妇女常见的恶性肿瘤之一,发病率居女性恶性肿瘤第二位,仅次于乳腺癌,80%的病例发生在发展中国家.近几年来,我国宫颈癌发病率有年轻化的趋势,病例数不断上升[1].绝大多数宫颈癌由癌前病变发展为宫颈癌大约需要10年,癌前病变具有可逆性,在此期间可以没有或少有临床症状.因此,推广宫颈癌的筛查,不断完善筛查技术,对宫颈癌的防治非常重要.现对2009年盱眙县农村妇女宫颈癌筛查情况分析如下.     

上海市居民大肠癌早期发现知识和行为调查

[目的]了解上海市15岁及以上居民大肠癌早期发现的知识和行为现状,为开展大肠癌筛查和早期发现工作提供科学依据. [方法]利用2010年上海市慢性病及其危险因素监测调查数据,采用多阶段分层概率随机抽样方法,对15 732名常住居民进行问卷调查. [结果]获取有效问卷15663份.15岁及以上居民对大肠癌的早期异常体征和3项筛检方法,即每年1次主动肛指检查、每年1次主动大便隐血检查(FOBT)和50岁及以上每5年1次主动肠镜检查的知晓率分别为44.04％、22.62％、20.97％和16.83％.不同性别、区域、年龄和文化程度者对此的知晓率差异均有统计学意义(P＜0.05).50～74岁居民曾做过舡指检查、大便隐血检查和肠镜检查者的比例分别为12.07％、6.65％和4.82％.不同年龄(不包括15～17岁)和文化程度居民受检比例差异有统计学意义(P＜0.05);中心城区和非中心城区居民受检比例差异无统计学意义;除肛指检查外,男、女受检比例差异亦无统计学意义.在曾经做过相关检查的调查对象中,不同性别、年龄、地区和文化程度者最近一次接受肛指和肠镜检查的时间距调查时间间隔差异无统计学意义. [结论]上海市居民对大肠癌早期发现的认知较差,参加相关早期发现检查的比例较低.     

华山论剑：宫颈癌筛查方法

今年卫生部公布的第三次全国死因调查显示，宫颈癌的致死率已经有所下降。在诸多癌症异军突起的时候，这样的消息确实可以给人希望。而这一切，很大程度上得益于宫颈癌筛查的推广。随着科普知识的传播，宫颈涂片、宫颈脱落细胞检查、HPV（人乳头瘤病毒）检测、阴道镜检查等名词，对许多关注健康的人来说，已经不陌生。但是，这些筛查手段究竟谁独占鳌头，或者如何选择、怎样组合才最有成效？我们不妨组织一场华山论剑，是骡子是马，拉出来遛遛。     

北京市宫颈癌筛查宫颈细胞学结果分析

目的:了解北京市适龄妇女生殖健康状况。方法:2008年~2009年对北京市25~65岁户籍妇女进行妇科及宫颈细胞学检查,记录个人基本信息及个人病史。结果:宫颈癌筛查728 704人,进行传统巴氏细胞学检查的妇女共有424 620人,阳性(ASC-US及以上)检出率2.17%。国产液基细胞学技术检查304 078例,阳性检出率为2.42%。在细胞学结果为鳞状上皮内高度病变的1 031人中,有26人被最终确诊为宫颈癌,并且有219人最终诊断为宫颈上皮内瘤变。细胞学结果为鳞状细胞癌的27人中,有7人被最终确诊为宫颈癌,并且有6人最终诊断为癌前病变。传统巴氏的灵敏度为75.00%,特异度为97.80%。国产液基的灵敏度为59.10%,特异度为97.60%。结论:筛查中宫颈细胞学阅片困难凸显,由于阅片人员有限,且仅有的阅片人员能力水平较低,使得细胞学阅片结果敏感度不高。     

宫颈癌前病变和宫颈癌筛查新进展

目的:探讨宫颈癌前病变和宫颈癌筛查国内外研究最新进展,为临床诊治提供帮助。方法:查阅近年来国内外有关宫颈癌前病变和宫颈癌筛查国内外相关研究,总结筛查方式进展,寻找存在问题。结果:HPV DNA检测在宫颈癌前病变及宫颈癌筛查中作用关键,但与细胞学、阴道镜及病理组织学检查联合诊断方式仍然有待优化。结论:HPV DNA检测可有效提示宫颈病变预后,但其早期预测特异性较低,具有早期预测宫颈癌发生风险的实验室指标还需寻找。     

妊娠女性宫颈癌筛查及管理

宫颈癌是妊娠期女性最常见的恶性肿瘤,每10 万例妊娠中就有1. 5～12例孕妇罹患宫颈癌,占宫颈癌年发病率的5％ ～13％.过去,由于筛查不足等原因,我国妊娠期宫颈癌的发病率为55/10万[1].人乳头瘤病毒( human papilloma virus,HPV)疫苗在我国获批使用不足5年,且人群接种率低,无法有效实现...     

铜陵县顺安镇3775例农村妇女宫颈癌筛查结果分析

目的：通过筛查了解农村妇女生殖健康及宫颈癌发病情况,探索开展农村群体宫颈癌筛查的可行方法及防治措施。方法：对参加筛查的3775例农村妇女进行常规妇科检查,阴道分泌物检查,宫颈细胞学检查及阴道镜检查,将结果进行回顾性分析。结果：经组织病理学检查,宫颈癌前病变者为11例。结论：宫颈细胞学筛查是早期发现宫颈上皮内瘤变及宫颈癌的主要措施,做好农村妇女宫颈癌防治的健康教育宣传,促进农村妇女自觉进行宫颈癌筛查,可有效降低宫颈癌的发病率及病死率。     

宫颈癌普查关注低入者

几天前，看到隔壁诊室的桌子上有几瓶宫颈脱落细胞的采样瓶，到现在一直没有送去检验，我问护士是怎么回事。护士告诉我，患者拿了检查申请单去交费，却一去不复返，可能是嫌检查费太贵，没有交费就走了。现在是，没有检查申请单，标本瓶送不出去，但又不敢丢，万一她交了费将检查单送来了，而标本瓶丢了。又要引起纠纷。所以只得先放着再说。为什么会发生这种怪事呢？很快，我悟出了问题的所在：高昂的价格使她望而生畏。     

Breast Cancer Knowledge and Screening Behaviors of the Female Teachers

Breast cancer is the most frequently occurring cancer in women. The objective of this study was to determine the level of knowledge about risk factors for breast cancer and screening behaviors among 468 female teachers who work in Sivas, Turkey. In this cross-sectional survey, a self-administered, structured questionnaire was used for data collection. Up to one-half (52.4%) of the teachers thought that they had enough knowledge about breast cancer. The sources of that information were television (59.0%), newspapers (48.9%), and health professionals (24.1%); 58.5% of the teachers had a sufficient knowledge level about breast cancer risk factors. The most frequently reported risk factor was family history of breast cancer (94.9%), followed by getting older, high fat diet and having a first child at a late age (68.6%, 51.7%, and 45.1%, respectively). No significant differences were found in knowledge by age groups, having breast-related complaints, teaching experience, or marital status. Among the teachers, 43.9% had performed breast self-examination; yet only 10.5% of them performed it monthly. Only 22.3% of the teachers reported having at least one clinical breast-examination. Among the 136 women over the age of forty years, only 37.5% had had at least one mammogram. A significant association was noted between level of knowledge about breast cancer risk factors and use of breast self-examination. Also, being married and having breast-related complaints were significantly related to practicing clinical breast-examination and mammography. This study revealed a relatively low awareness about the knowledge and practice of screening methods among teachers. The relatively low rates of breast self-examination, clinical breast-examination, and mammography practiced by this group of teachers are of concern and suggest that increased awareness of these methods, their value, and how they should be conducted is needed.     

Knowledge and Attitudes of Cervical Cancer Screening Among Caribbean Women: A Qualitative Interview Study From Barbados

The purpose of this study was to explore Barbadian women’s attitudes toward and knowledge of routine cervical cancer screening (Pap tests). We conducted semi-structured individual interviews with fourteen female patients between the ages of 20 and 60 years who attended a selected public clinic in Barbados in May and June 2013. Interviews were audio-recorded with participants’ consent. The interviews were then transcribed verbatim and, using thematic content analysis, indexed and coded inductively for emerging similar themes. We identified four themes: (1) women had poor knowledge of the purpose of Pap tests. The most frequently occurring misconception was that the test was for the detection of sexually transmitted infections. (2) The women displayed limited cervical cancer awareness. (3) Health professionals were identified by the women as the main driving force behind women taking up screening. (4) The screening procedure was perceived as painful, but women’s overriding attitude was that screening was necessary. These findings suggest that Barbadian women would benefit from focused health education efforts surrounding cervical cancer screening to eradicate the misconception that the purpose of the Pap test is the detection of sexually transmitted diseases.     

上海地区女性宫颈脱落细胞筛查工作的实施及其影响因素

[目的]了解上海地区女性宫颈癌宫颈脱落细胞检查的覆盖情况,并分析其影响因素。[方法]采用随机入户调查的方法收集女性居民宫颈癌宫颈脱落细胞检查覆盖情况及其影响因素,采用单因素和多因素分析其影响的因素。[结果]上海地区女性人群一生中曾做过宫颈脱落细胞检查的占37．61％（中心城区女性为32．04％,非中心城区为42.01％）。其中,86．14％的人最近一次宫颈脱落细胞检查年限〈3年;在最近3年中做过检查的人群中,73．50％是由于参加单位组织女工体检获得受检机会。〈35岁年轻女性的检查覆盖率为21．97％;55,64岁组妇女最近一次检查距本调查（2007年）的平均时间为4．00年,明显长于〈35岁组及35～54岁组。居住在非中心城区、在婚、年龄在35～54岁、农民、由单位组织女S-体检者、对宫颈癌的癌前症状和女性需要定期检查的知识知晓者检查覆盖率高。3年内做过筛检的主要影响因素仅为年龄和女工体检的组织者。[结论]上海市女性宫颈涂片检查的覆盖率相对发于达国家较低;单位组织女工体检是女性接受宫颈涂片检查的主要途径;35岁以下女性宫颈涂片检查的覆盖率低;55—64岁者宫颈涂片筛查间隔时间长。     

Annals Journal Club: Impact of Cervical Cancer Screening Guidelines on Screening for Chlamydia

The highest prevalence of chlamydia infection in the United States is among people aged 15 to 24 years. We assessed the impact of not doing routine cervical cancer screening on the rates of chlamydia screening in women aged 15 to 21 years. We classified visits to family medicine ambulatory clinics according to their timing relative to the 2009 guideline change that led to more restrictive cervical cancer screening. Women had higher odds of being screened for chlamydia before vs after the guideline change (odds ratio = 13.97; 95% CI, 9.17–21.29; P <.001). Chlamydia and cervical cancer screening need to be uncoupled and new screening opportunities should be identified.     

龙川县1620例宫颈癌机会性筛查结果分析

目的研究龙川县妇女宫颈癌及癌前病变的现状,探讨液基细胞学检查（TCT）及阴道镜等在宫颈癌诊断的临床意义及应用价值。方法收集分析2008年1月-2013年6月妇科门诊进行宫颈癌机会性筛查的1620例,根据就诊类型分为观察组（各机关事业单位及部分企业计划定期普查发现宫颈癌前病变及宫颈癌患者,480例）和对照组（随机抽查同期来我院就诊发现宫颈癌前病变及宫颈癌患者,1140例）。对TCT阳性者进行阴道镜下宫颈活检及病理检查,确诊宫颈病变及宫颈癌。结果1620例受检者中,TCT阳性258例（占15.9%）,活检证实为宫颈上皮内瘤变（CIN）者64例（占3.95%）、宫颈浸润癌2例（占0.12%）。在TCT阳性（258例）病例中,阴道镜检出异常者130例（占50.4%）,其中活检结果为湿疣17例、CIN或浸润癌72例,阴道镜与活检诊断符合率为68.4%（89/130）。此外,不同年龄组对比发现,宫颈癌发病率差异有统计学意义（P＜0.05）;观察组和对照组阳性检出率差异有统计学意义（P＜0.05）。结论宫颈癌前病变及早期宫颈癌高发年龄为30～49岁,TCT结合阴道镜检查是较好的宫颈癌筛查手段之一。加大宣传力度,提高山区医师培训质量和增加经济投入,广泛开展宫颈癌前病变筛查工作,能显著降低宫颈癌的发生和发展几率。     

61610例宫颈液基薄层细胞学检查的统计与分析

目的 探讨准确评价薄层液基细胞学检查(LCT)在宫颈癌筛查中的应用价值.方法 回顾性分析2004年3月至2011年3月本院收集的61 610例标本的LCT结果,与阴道镜下多点组织活检结果进行对照研究,并与同期收集的128 554例传统巴氏涂片(Pap smears)检查结果进行对照分析.结果 ①61 610例LCT的复检结果为,未明确意义不典型鳞状细胞(ASCUS)及以上患者为1772例(2.88%,1772/61 610),对其中1017例进行多点组织活检发现,38例(0.06%,38/61 610)为鳞状上皮细胞癌(SCC)及腺癌(GLCA);251例(0.41%,251/61 610)为高级别鳞状上皮内病变(HSIL)[子宫上皮内瘤变(CIN)Ⅱ～Ⅲ级分别为169例和82例];409例(0.66%,409/61 610)为低级别鳞状上皮内病变(LSIL)(湿疣为216例,CIN I级为193例),腺上皮不典型增生(AGC)为5例,宫颈原位癌(AIS)为2例;慢性炎症为312例.同期进行巴氏涂片检查的128 554例标本中,共检出巴氏III级及以上为272例(0.211%),其中253例进行组织活检发现,65例为SCC和GLCA,97例为HSIL(CIN II～Ⅲ级分别为40例和57例),82例为LSIL(CIN I级为45例、湿疣为37),慢性炎症为9例.两种方法在筛查宫颈癌方面比较,差异无统计学意义(P>0.05),但在筛查宫颈鳞状上皮病变(SIL)方面,LCT明显优于巴氏涂片,两者比较,差异有统计学意义(P<0.05).②LCT诊断与组织学诊断的符合率分别为HSIL(82.77%,173/209)>SCC(73.53%,25/34)>LSIL(63.46 264/416),LCT的假阳性主要来源于对LSIL的判定.结论 LCT筛查CIN和宫颈癌较灵敏、可靠,明显优于传统巴氏涂片,特别是筛查高级别CIN,具有重大意义,但在筛查宫颈癌时,若存在因有效细胞数目过少、细胞重叠、炎症背景杂乱等因素,则可能造成漏诊或严重低诊,临床应引起重视.     

广东省潮州地区农村妇女宫颈癌不同筛查方法的效果评价

目的探讨对广东省潮州地区农村妇女采用高危型人乳头状瘤病毒(HPV)感染、液基细胞学(LBC)和传统巴氏涂片(CPS)筛查法进行宫颈癌筛查的效果,为建立适宜农村地区妇女的宫颈癌筛查策略提供依据。 方法选择2011年3月至6月,采用分阶段整群抽样法在潮州地区5个乡镇招募的3723例35～59岁符合筛查条件的农村常住妇女为研究对象(子宫颈完整存在)。对其同时采用高危型HPV,LBC和CPS筛查法进行宫颈癌筛查,并对其中HPV呈阳性者进行HPV分型。对宫颈细胞学改变为低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、HPV呈阳性的未明确诊断意义的不典型鳞状上皮细胞(ASC-US)、非典型鳞状细胞、不能排除高级别鳞状上皮内病变(ASC-H)的受试者,进行阴道镜下宫颈组织活检及随访,评价不同筛查法的筛查效果(本研究遵循的程序符合广东省妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与受试者签署临床研究知情同意书)。 结果3723例接受宫颈癌筛查的受试者中,高危型HPV感染率为8.2%,常见HPV亚型为HPV-52,-16,-58,-33及-68;宫颈上皮内瘤变(CIN)Ⅰ～Ⅲ检出率分别为1.05%(39/3723),0.40%(15/3723)和0.54%(20/3723)。若以宫颈组织病理学活检结果≥CINⅡ为标准,则高危型HPV,LBC和CPS筛查法的灵敏度与特异度分别为94.4%(34/36)与46.6%(27/58),97.2%(35/36)与25.9%(15/58)及52.9%(9/17)与38.0%(19/50)。3种宫颈癌筛查方法的灵敏度与特异度比较,差异均有统计学意义(P<0.05)。LBC与CPS对宫颈癌筛查的阳性预测值(PPV)分别为44.9%(35/78)与22.5%(9/40),且差异具有统计学意义(χ²＝5.7,P＝0.02)。 结论在广东省潮州地区农村妇女中开展宫颈癌筛查发现,高危型HPV检测法相对于LBC,具有更高灵敏度和特异度,在成本许可条件下具有一定推广价值;而LBC相对于CPS,具有更高灵敏度、PPV和更好的制片效果。     

Women's Knowledge About Cervical Cancer,Pap Smear and Human Papillomavirus and Its Relation to Screening in Argentina

The purpose of this study was to evaluate women's knowledge about cervical cancer, Pap smears, and human papilloma virus in relation to their cervical cancer screening behavior. This hospital-based study was conducted with a sample of 200 women: 100 women screened in the last three years and 100 non-screened women who attended a hospital located in the metropolitan area of Buenos Aires, between September 2008 and February 2009. Women at the hospital were surveyed using a structured questionnaire. Multiple logistic regression models were used to evaluate the relation of women's knowledge about Pap smears to screening behavior, controlling for socio-demographic characteristics. Of the women who had been screened, 49% compared to 73% of those not screened had inadequate knowledge about Pap smears (P = 0.001), and 47% of screened and 30% of non-screened women reported that they had ever heard about human papilloma virus (P = 0.013). In multivariate analysis, having adequate knowledge about Pap smears (odds ratio: 2.6 or 95%, confidence interval: 1.4–4.8) having health insurance (odds ratio: 2.6 or 95%, confidence interval: 1.1–6.4) and being married (odds ratio: 1.8 or 95%, confidence interval: 1.1–3.4) were the factors related to being screened in the previous three years. Knowledge was related to screening. Comprehensive educational approaches may enhance screening for cervical cancer prevention.