子宫颈造影术作为子宫颈癌筛查乙酸目检的一种辅助检查

目的：验证数字子宫颈造影术是病毒感染相关抗原（VIA）和细胞学检查的辅助子宫颈癌筛查试验。方法：妇女（1292例）接受细胞学和VIA检查，得到了301例（23．3％）VIA阳性的样本，这些样本也做了数字子宫颈造影（DC）并进行评价。这些被DC诊断为阳性（149／301，49．5％）和（或）巴氏涂片试验也为阳性的病例在需要时做阴道镜及必要的活组织检查。结果：子宫颈涂片阳性占5．4％，包括低度鳞状上皮内病变（LGSIL）（4％），高度鳞状上皮内病变（HGSIL）（1％），1例浸润癌（0．4％）和1．6％的意义不明的不典型鳞状细胞（ASCUS）或性质未定的不典型腺细胞（AGUS）。DC确诊81例阳性（74例LGSIL，5例HGSIL，2例癌症）。细胞学检查敏感度为14．8％，DC为100％。相应的特异度分别是95．4％和69．1％。DC的阴性预测值（NPV）和阳性预测值（PPV）分别为100％和54．4％。结论：DC增加了VIA的敏感度、特异度和阳性预测值，成为一种资源匮乏地区的有效子宫颈癌辅助筛查试验。     

Comparing the results of Pap smear and Direct Visual Inspection (DVI) with 5% acetic acid in cervical cancer screening

Background:

Cervical cancer is the most second common cancer among Iranian women. This study was carried out to compare the results of Pap smear method and Direct Visual Inspection (DVI) with 5% acetic acid in cervical cancer screening in Tabriz, Iran.

Material and Methods:

This cross-sectional study was carried out in Alzahra Therapeutic-Educational Centre, Tabriz, Iran in 2013 on 1000 women. First, Pap smear was done for all women, and then the cervix exposed with 5% acetic acid by cotton swab for 30 seconds and observed under adequate light. At the end, women with abnormal results in Pap smear or DVI method were referred to colposcopy and biopsy. Test''s sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), LR+, LR- and confidence interval (CI) were determined (P < 0.05).

Results:

Nine-hundred and seventy-four (94.7%) cases were normal and had no abnormal findings and 26 (2.6%) participants had positive results in Pap smear or DVI test. Twelve women had abnormal Pap smear (nine women with atypical squamous cells of undetermined significance, ASCUS, three women with dysplasia, atypical endocervical, and low-grade squamous intraepithelial lesion, LSIL results) and 14 women had positive DVI (four women with human papillomavirus, HPV or koilocyte,) and one women with abnormality in both method had carcinoma in biopsy that referred to oncologist. In this study the sensitivity, specificity, PPV and NPV for DVI were 71.4%, 50%, 35.7%, and 81.8% respectively in comparison with 14.3%, 50%, 10%, and 60% for Pap smear.

Conclusion:

As the DVI method has higher sensitivity and positive predictive value than Pap smear, it could be used as a useful method beside the Pap smear.     

传统巴氏涂片与液基细胞学筛查宫颈病变的对比研究

目的 分析比较传统巴氏涂片(conventional smears,CS)及新柏氏液基细胞学(thinPrep cytology test,TCT)在宫颈病变筛查中的应用价值及临床意义.方法 回顾性分析了2247例宫颈细胞学检查结果,其中行CS1 204例,行TCT1 043例,分别对两种方法的标本满意率及宫颈病变的阳性检出率及病检符合率进行了比较.结果 TCT组标本满意率明显高于CS组(TCT组99.81%,CS组76.83%,P<0.01);宫颈病变的检出率TCT组亦明显高于CS组(TCT组23.78%,CS组8.64%,P<0.05),但二组的病检符合率无统计学差异(TCT组86.84%,CS组83.33%,P>0.05).结论 液基细胞学技术明显提高了标本满意率及宫颈病变的阳性检出率,液基细胞学技术是宫颈病变筛查的有效手段.     

醋酸/碘染色后肉眼观察在边远地区宫颈病变筛查中的运用

目的评价醋酸试验肉眼观察(visual inspection with acetic acid, VIA)和碘试验肉眼观察(visual inspection with Logu’s iodine,VILI)在边远地区宫颈癌及其癌前病变筛查中的应用价值.方法2012年6月至10月对30-60岁已婚妇女进行宫颈病变的普查.用5%醋酸染色后肉眼观察和2%碘染色后肉眼观察,结果异常者进行阴道镜检查,并在阴道镜下活检取得最终病理诊断.结果1929例人群中病理诊断的CIN1的检出率为2.7%(52例),CIN2为0.93%(18例),CIN3为0.7%(14例).结论醋酸染色后肉眼观察和2%碘染色后肉眼观察是适宜在经济欠发达的边远地区推广的经济有效的筛查方法.     

醋酸染色和碘染色后肉眼观察在宫颈病变筛查中的应用价值

目的评价醋酸染色和碘染色在宫颈癌及其癌前病变的筛查中的应用价值。为降低经济欠发达地区的宫颈癌的发病率和死亡率提供依据。方法 2009年5月对来我院就诊的的30～59岁已婚妇女进行宫颈病变的普查。普查方法为用5%醋酸染色后肉眼观察（VIA）和2%碘染色后肉眼观察（VILI）,结果异常者进行阴道镜检查,并在阴道镜下活检取得最终病理诊断。结果 1897名附和条件的妇女参加普查,其中265例VIA或VILI阳性,176例行阴道镜下活检,经病理确诊CIN以上44例,其中CINⅠ25例,CINⅡ8例,CINⅢ及原位癌8例,早期浸润癌1例,宫颈癌2例。结论 VIA和VILI是一种经济有效的筛查方法,适用于在经济欠发达地区广泛推广。     

宫颈刮片脱落细胞学检查在宫颈癌普查中的作用

目的:探讨宫颈刮片脱落细胞学检查在宫颈癌筛查中的作用。方法:回顾性分析行宫颈刮片脱落细胞学检查的5 801例妇女临床资料,分析宫颈刮片脱落细胞学检查结果异常受检者的病理学诊断结果以及各年龄段受检者宫颈病变的情况。结果:5 801例中,2 799例未见核异质细胞,2 914例有轻度核异质细胞,88例有轻度不典型增生细胞。其中45~55岁年龄段受检者检查异常率最高,为1.79%（61/3 413）。80例为轻度不典型增生细胞,5例为重度不典型增生细胞,3例发现癌细胞。88例宫颈刮片脱落细胞学检查异常的受检者中,发生宫颈上皮内瘤变的有13例。结论:宫颈刮片脱落细胞学检查是宫颈癌普查的首选方法,可早期发现宫颈癌癌前病变,有利于早期实施干预,降低宫颈癌的患病率。     

巴氏涂片与液基细胞学宫颈检查结果分析

目的 分析巴氏涂片和液基细胞学（TCT）宫颈检查结果,为宫颈液基细胞学检查的临床应用提供理论依据.方法 选取在我院体检中心妇科接受宫颈细胞学筛查的患者3800例.将接受巴氏涂片检查的1900例患者分为A组,接受液基细胞学检查的1900例患者分为B组,对比巴氏涂片和液基细胞学检查的阳性率,同时以阴道镜活检结果为金标准,对比两组检查的符合率.结果 A组的阳性率为6.89％,ASCUS检出率为5.05％,LSIL检出率为1.42％,HSIL检出率为0.26％;B组的阳性率为14.16％,ASCUS检出率为8.26％,LSIL检出率为4.84％,HSIL检出率为0.79％.A组的阳性率、ASCUS检出率、LSIL检出率、HSIL检出率均显著低于B组（均P＜0.05）;和阴道镜活检结果对比,A组LSIL患者的诊断符合率为62.96％,B组LSIL患者的诊断符合率为85.87％.A组LSIL的诊断符合率均显著低于B组（P＜0.05）.结论 液基细胞学检查能够显著提高宫颈病变的阳性率,减少假阴性结果,且诊断结果和病理诊断的符合率高,更适合于宫颈病变的筛查.     

Age at time of first intercourse v. chronologic age as a basis for Pap smear screening.

The Walton Report on cervical cancer screening programs recently recommended a new program for screening for cervical cancer based on chronologic age, calling for 3- and 5-year intervals between examinations. It recommended that such examinations be discontinued after 60 years of age. In a group of 232 routinely examined women (aged 18 to 47 years) in whom cervical intraepithelial neoplasia developed the timing of onset of the disease and the implications for screening were studied. The average age at the time of diagnosis was 30 years; in 20% of the patients the diagnosis had been made after age 35. The screening program recommended in the Walton Report would have been effective in diagnosing most cases (80%) in this sample by age 35 and all by age 60. However, when the patients were grouped according to age at the time of first intercourse, the diagnosis had been made after age 35 in only 13% of those who started having intercourse at age 15 to 17 years, 20% of those who started at age 18 to 19 years and 33% of those who started at age 20 years of later. When the times of diagnosis were expressed by number of years of intercourse the distributions became uniform in the same three groups; in 72% of all the patients the diagnosis had been made within the first 15 years of intercourse, in 88% it had been made within 20 years and in 100% it had been made by 30 years. These data suggest that a program based on number of years of intercourse may be more uniform and more efficient than one based on chronologic age, and that cytologic examinations should be concentrated during the time when most cases develop -- 6 to 20 years after the time of first intercourse.     

Papanicolaou smear screening and cervical cancer. What can you expect?

More than 90% of the total female population of three Swedish counties between the ages of 30 and 59 years, 53% of women between 60 and 69 years, and 25% of women older than 70 years were screened for cervical cancer with the Papanicolaou smear over a ten-year period. The uniqueness of the study is that in Sweden it is possible to follow up the entire population during their lifetimes via a population register, which has its roots in the 17th century, natural to Swedes but almost incomprehensible in the United States or United Kingdom. Every Papanicolaou smear taken was computer recorded and linked on an individual level to the cancer registry. There were 207,455 women followed up for ten years. No women were lost to follow-up. There was a 75% decrease in invasive cervical cancer incidence among women who had smears taken at least once during the ten-year period. Among those women who had never had smears taken, the incidence of invasive cervical cancer was four times as great as among those women who had been examined at least once. We estimate that the system proposed by Swedish Medical Board (at least one smear every three years) for cervical cancer screening can reduce the incidence of invasive cervical cancer to a level between one and five cases per 100,000 women per year in a completely screened population.     

巴氏涂片检查与液基细胞学筛查宫颈癌的对比研究

目的：探讨巴氏涂片与液基细胞学筛查宫颈癌的效果.方法：选2011年11月至2012年12月本院体检已婚女性2 377例,随机将巴氏涂片检查1 188例为对照组,液基细胞学筛查1 189例为研究组,分析两组检查阳性率、符合率等.结果：研究组阳性率（6.73％）高于对照组（1.18％）,具有统计学意义（P＜0.05）;研究组阳性患者与病理组织学的检查符合率：癌症100％,CINⅢ100％,CINⅡ90.63％,CINⅠ84.21％.结论：液基细胞学筛选的宫颈癌前病变检出率比传统巴氏涂片高且准确性强.     

肉眼观察在子宫颈癌筛查中的效果评价

目的 评价肉眼观察法VIA、VILI和阴道镜检查在宫颈癌筛查中的效果,为寻找基层子宫颈癌筛查的适宜技术,制定切实可行的筛查方案提供依据.方法 由经培训的基层医务人员在重庆市涪陵区贫困人群中应用VIA、VILI肉眼观察,评价VIA、VILI和阴道镜检查的阳性率、特异度.结果 以病理组织学诊断为金标准,VIA、VILI和阴道镜检的阳性率为.15.1%、4.81%.VIA、VILI和阴道镜栓的特异性分别为86.2%、94.4%和95.8%,VILI的特异性与VIA相比较,差异有统计学意义(P<0.01).结论 在资源有限,经济不发达的农村地区,由经过培训的基层医务人员用肉眼观察的宫颈癌筛查是可行的.单纯肉眼观察是一种经济有效的宫颈癌筛查方法,适合于农村基层单位推广应用,对降低经济不发达地区宫颈浸润癌的发病率将起到良好的促进作用,VILI的特异性较VIA高.     

子宫颈癌筛查中传统子宫颈涂片、单层细胞学及人乳头状瘤病毒DNA检测的横断面研究

目的比较子宫颈癌筛查中传统子宫颈涂片、单层细胞学，以及人乳头状瘤病毒检测的敏感性、特异性和观察间的可信性。设计对同时进行了此3项检查并有参考标准(阴道镜和组织学)进行横断面研究。研究单位法国的公立大学和私人诊所，本研究完全独立于病例提供。研究对象因先前检出的细胞学异常而进行阴道镜检查的828名妇女和参加常规涂片检查的1757名妇女。主要结果判定指标临床读片和最优化解释(为取得一致所进行的双盲读片)。根据诊断异常的不同阈值计算出敏感性、特异性和加权κ值。结果根据Bethesda系统，传统子宫颈涂片检查得到的结果更为满意(91％比87％)，比单层细胞学更可靠(加权K值0．70比0．57)，其敏感性和特异性更高。这些结果适用于临床读片和最优化解释，区分高级别和低级别病变，以及有低和高异常发生率的人群。人乳头状瘤病毒检测与单层细胞学检查同时进行，不论是系统性的还是只对于意义不明的非典型细胞，并不比传统涂片检查优越。结论在子宫颈癌筛选中，单层细胞学检查不如传统子宫颈涂片检查可靠，且更容易出现假阳性和假阴性结果。     

液基细胞薄层涂片技术与巴氏涂片法在宫颈癌中诊断价值的比较分析

[目的]评价液基细胞薄层涂片技术（the thin-layer,liquid-based cytology pap smear test,TCT）及传统巴氏涂片法对早期子宫颈癌及癌前病变的诊断价值,为临床医生提供更准确的依据。[方法]采用早在50年代的巴氏涂片法和90年代的薄层液基细胞检测法对1685例成年妇女进行细胞学检测,报告方式采用2001年的TBS标准,以组织学活检作为阳性对照,进行统计学处理,评价液基细胞薄层涂片技术的诊断价值。[结果]薄层液基细胞学检测法和巴氏涂片法与组织活体检测的符合率分别为：鳞状上皮内低度病变（LSIL）83.12%和68.31%;鳞状上皮内高度病变（HSIL）91.01%和61.67%;鳞状细胞癌（SCC）为100%和75%。[结论]液基细胞薄层涂片技术的敏感性和特异性明显高于传统巴氏涂片检测法,对早期子宫颈癌及癌前病变筛查有重要的价值。     

Knowledge and practice of breast self examination and Pap smear screening among a group of electronics women workers

A total of 486 Malaysian women electronics workers participated in a study of reproductive health knowledge and cancer screening. The practice of Breast Self Examination (BSE) was found to be related to educational attainment; while ever having had a Pap smear was found to be related to being older than 30 years old, being ever married, living with family or relatives, and not staying in hostels. Knowledge on reproductive health was found to be higher for older women, married women, living with family or relatives, not staying in hostels, ever having done BSE and ever having had a Pap smear.     

宫颈刮片与阴道镜检查在诊断宫颈癌变中的临床研究

目的探讨宫颈刮片与阴道镜检查在诊断宫颈癌变的临床应用。方法通过对186例宫颈异常患者分别行宫颈刮片和阴道镜检查,然后以病理组织学诊断为金标准,用敏感性、特异性、阳性预测值、阴性预测值进行对比分析。结果阴道镜检查的敏感性60.87%、特异性70.00%、阳性预测值36.36%、阴性预测值81.67%;宫颈刮片细胞学检查的敏感性36.96%、特异性84.29%、阳性预测值50.00%、阴性预测值83.10%。两者敏感性比较有统计学意义(P<0.05)结论对于宫颈癌及其癌前病变的筛查及早期诊断,应以宫颈细胞学检查和阴道镜检查相互结合以提高检出率,降低假阴性。     

宫颈刮片、阴道镜及HPV检测在宫颈癌筛查中的体会

目的:总结宫颈刮片、阴道镜及HPV检测在宫颈病变诊断中的临床经验,对宫颈癌筛查提出合理化建议。方法:对3种方法任何一项检测异常者行阴道镜下病理活检及宫颈管搔刮,以组织学诊断作为金标准。对212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,及在细胞学及阴道镜检查中漏诊的临床体会。结果:212例病理结果阳性者中,宫颈刮片阳性者151例,敏感度为71.23%,阴道镜阳性者167例,敏感度为78.77%,两者阳性检出率相比无显著性差异(P>0.05)。高危型HPV感染者182例,敏感度83.02%,与阴道镜的敏感度相比,无显著性差异(P>0.05),与宫颈刮片相比,有显著性差异(P<0.05)。结论:宫颈癌的筛查及早期诊断,应以宫颈细胞学检查、阴道镜检查及HPV检测相互结合以提高检出率。