宝鸡地区宫颈癌筛查方案的可行性研究

目的探讨宝鸡地区宫颈癌筛查方案的可行性。方法收集分析2010年1月-2013年11月在宝鸡市妇幼保健院进行宫颈癌筛查的患者资料,筛查方法包括巴氏细胞学、液基细胞学、高危型HPV检测,多功能醋酸白肉眼检测法,并经阴道镜检查,病理确诊宫颈癌及癌前病变。结果共筛查89714例,其中组织性筛查59745例,机会性筛查29969例,筛查方法依次为巴氏细胞学69285例,液基细胞学16114例,HPV检测625例,多功能醋酸白肉眼检测3604例。最常用的筛查方案是细胞学检查占95.19％。组织性筛查检出宫宫颈癌前病变（CINⅠ＋CINⅡ＋CINⅢ）916例（1.53％）,宫颈癌96例（0.16％）,机会性筛查检出颈癌前病变（CINⅠ＋CINⅡ＋CINⅢ）892例（2.98％）,宫颈癌159例（0.53％）。结论巴氏细胞学仍为经济欠发达地区主要的宫颈癌筛查方法,机会性筛查宫颈病变检出率高,但仍不能忽视组织性筛查。     

醋酸肉眼检查在宫颈癌筛查中的作用

目的：分析醋酸肉眼检查对宫颈高度病变诊断的灵敏度,探讨其在宫颈癌筛查中的应用价值。方法：对全部受检对象3076人进行宫颈巴氏细胞涂片后行5％醋酸肉眼观察,并对醋酸阳性且诊断为高度病变者即行宫颈活检病理组织学检查。对巴氏涂片为不典型鳞细胞以上者电话通知回访行宫颈活检病理检查,醋酸肉眼检查与巴氏涂片相结合筛查宫颈癌。以病理组织学检查为金标准,在同一人群中比较醋酸肉眼检查和巴氏细胞涂片细胞学检查对宫颈癌及癌前病变的阳性检出率。结果：醋酸肉眼检查和巴氏涂片细胞学检查对宫颈癌前病变及宫颈癌的阳性检出率分别为70．2％、72．7％,差异无显著性（P〉0．05）。醋酸肉眼检查和巴氏涂片细胞学检查对宫颈高度病变性检出率分别为51．4％、36．4％。结论：醋酸肉眼检查用于宫颈癌筛查的价值与巴氏细胞学检查相当,且对高度病变的检出率高于巴氏细胞涂片,特别适合农村大面积人群的筛查。     

早期宫颈癌筛查有效方案的探讨和研究

目的:评价当前常用的几种筛查方法在宫颈上皮细胞内瘤样变(G IN)及早期宫颈癌筛查中的应用,探索一种经济、合理的筛查方案。方法:巴氏涂片、5%醋酸肉眼观察、液基薄层细胞(TCT)系统TBS分类报告、HPV-DNA检测、阴道镜检查结合评分系统、镜下定点活检病理组织学诊断,合理联合应用。结果:高危型HPV-DNA检测和TCT灵敏度、特异性和准确度均比较满意。阴道镜观察的灵敏度尚可,但特异性和准确度欠佳。而醋酸肉眼观察和巴氏涂片的灵敏度过低。结论:TCT结合HPV-DNA检测是筛查宫颈癌及癌前病变的最佳组合。但在欠发达地区,醋酸肉眼观察和巴氏涂片结合阴道镜观察的筛查方法仍然具有应用价值。     

宫颈癌早期筛查3种方法的比较研究

目的:通过比较3种常用方法,以期找到宫颈癌早期筛查的最佳方案。方法:2013年5月~7月,依托大兴安岭地区人民医院,通过定期的公益活动宣传和组织育龄妇女体检,选取妇科门诊接诊病例50例,以病理检查作为金标准,采用肉眼观测辅以醋酸及碘试验、阴道镜检查、液基细胞学检查3种常用方法,对比其敏感性、特异性、准确性、阳性预测值、阴性预测值。结果:3种检测方法依次为:肉眼观测辅以醋酸及碘试验(33.33%、74.47%、72.00%、7.69%、94.59%),阴道镜检查(33.33%、91.49%、88.00%、20.00%、95.56%),液基细胞学检查(66.67%、97.87%、96.00%、66.67%、97.87%)。结论:肉眼观测辅以醋酸和碘试验诊断价值比较低;液基细胞学检测为宫颈癌早期筛查的可选方法,阴道镜检测不适用于早期筛查。     

宫颈上皮内瘤变的筛查和诊疗进展

宫颈上皮内瘤变早期筛查是宫颈癌防治的关键,常用方法有细胞学检查（巴氏涂片检查、液基细胞学检查）、人乳头瘤病毒（HPV）检测、醋酸染色肉眼检查（VIA）、碘染色肉眼检查（VILI）、宫颈脱落细胞DNA定量分析、阴道镜检查等;组织病理学是诊断的金标准;治疗应遵循个体化原则,现就这几方面的研究进展作一综述.     

罗定市552例妇女宫颈癌筛查宫颈液基细胞学标本筛查结果分析

目的:分析罗定市552例妇女宫颈癌筛查(TBS)宫颈液基细胞学标本筛查结果.方法:回顾性分析与抽查在罗定市人民医院妇保科接受宫颈液基细胞学标本筛查的妇女的临床资料,选取2016年4月-2019年4月收治的552例受检者作为实验对象,所有受检者均接受巴氏涂片法、宫颈液基细胞学标本筛查,依据筛查措施的不同将筛查结果分为两组,对照组采用巴氏涂片法检查,观察组采用宫颈液基细胞学检查,使用SPSS15.0统计学软件比较两组检查结果,以组织病理学结果作为最终诊断依据.结果:观察组制片满意率为91.85％、阳性检出率为48.91％,显著高于对照组的69.93％、23.91％(P<0.05);病理学检查确诊300例为宫颈癌,观察组阳性符合率为90.00％、CINII-III级检出率为11.85％,显著高于对照组的44.00％、3.03％(P<0.05).结论:宫颈液基细胞学筛查有助于提高宫颈液基细胞学检出效率及准确性,以便临床展开有效的防治措施.     

宫颈癌早期诊断三种方法的比较

目的通过比较三种宫颈癌早期诊断的常用检测方法,以期找到宫颈癌早期筛查的最佳方案。方法选取2009年1月—6月我院门诊阴道镜室接诊病例50例,以病理检查作为金标准,采用肉眼观测（辅以醋酸和碘试验）、阴道镜检查、液基细胞学检查三种常用方法,对其敏感性、特异性、准确性进行对比。结果三种检测方法敏感性、特异性、准确性依次为肉眼观测辅以醋酸和碘试验（33.33%,74.47%,72.00%）、阴道镜检查（33.33%,91.49%,88.00%）、液基细胞学检查（66.67%,97.87%,96.00%）。结论肉眼观测辅以醋酸和碘试验诊断价值很低;液基细胞学检查为宫颈癌早期筛查的最佳方法;阴道镜检测不适用于早期筛查。     

两种细胞学检查＋HPV检测筛查宫颈癌及癌前病变的比较

目的探讨液基薄层细胞学检查＋HPV检测及巴氏涂片细胞学检查＋HPV检测对早期宫颈癌及癌前病变筛查的价值。方法将816例体检者随机分为2组：液基薄层细胞学检查组400例,行液基薄层细胞学检查＋HPV检测;巴氏涂片细胞学检查组416例,行巴氏涂片细胞学检查＋HPV检测。2种方法均以病理组织检查为金标准,比较2种方法对宫颈异常细胞的检出率。结果液基薄层细胞学检查组进行早期宫颈癌及癌前病变筛查的敏感性为92.86%,特异性为79.21%,假阴性率为0.26%;巴氏涂片细胞学检查组敏感性为56.25%,特异性为98.25%,假阴性率为1.75%,2组比较差异有统计学意义（均P〈0.05）。阳性检出率2组比较差异无统计学意义（P〉0.05）。结论液基薄层涂片细胞学检查＋HPV检测在宫颈癌早期诊断中优于巴氏涂片细胞学检查＋HPV检测,筛查的敏感性高,假阴性率低,是一种先进的宫颈癌筛查方法。对经济条件差的患者行巴氏涂片细胞学检查＋HPV检测也能明显提高早期宫颈癌的诊断率。     

改良巴氏涂片与液基细胞学涂片的对比研究

目的 对比改良巴氏涂片与液基细胞学涂片对宫颈癌及宫颈上皮内瘤病(CIN)细胞学检查的准确性.方法 以手术后未固定的全子宫标本和锥切宫颈标本为研究对象.同时作改良巴氏涂片和液基细胞学涂片,采用TBS诊断报告方式,以组织病理学结果 为金标准.评价二种方法 对宫颈癌和CIN的筛查价值.结果 改良巴氏涂片宫颈阳性病变检出97例(28.03%),液液基细胞学涂片宫颈阳性病变检出88例(25.43%).两种方法 对组织病理学阳性病变检出率,改良巴氏涂片:SCC 100%,CIN-3 100%,CIN-2 78.26%,CIN-1(含HPV感染)67.8%;液基细胞学涂片:SCC 100%,CIN-3 100%,CIN-2 91.31%,CIN-1(含HPV感染)82.14%.结论 改良巴氏涂片可以和液基细胞学涂片媲美,且有方便价廉、简单快速的特点.     

液基细胞学检查与宫颈巴氏涂片的比较

目的 :探讨 Thinprep液基细胞学检查用于宫颈癌筛查与宫颈巴氏涂片相比的优越性。方法 :将门诊以宫颈疾病就诊的病人随机分为观察组和对照组 ,观察组 2 5 72例 ,用Thinprep液基细胞学检查初筛 ,对照组 1 2 0 8例 ,用宫颈巴氏涂片初筛。结果 :Thinprep液基细胞学的 L SIL以上病变检出率比宫颈巴氏涂片增加了 81 .5 7% ,L SIL、 HSIL的检出率分别增加了 75 .1 3%、1 1 0 .86%。液基细胞学、宫颈巴氏涂片与病理学检查诊断符合率分别为 84.69%、61 .33%。结论 :液基细胞学检查是细胞学领域的重大进步 ,大大提高了细胞学诊断的准确性     

五种检测方法在宫颈癌及其前期病变筛查中的准确性评估

目的 比较5种现行的筛查方法在宫颈癌高发地区的应用,从而评价出最佳宫颈癌筛查方案,进而在浙江省范围内推广.方法 在浙江省丽水市某社区内计划选取1005名年龄在25～65岁、有性生活的女性进行宫颈癌筛查,筛查手段选择巴氏涂片、液基细胞学、HPV-DNA检测法、肉眼观察辅以醋酸白染色(VIA)和肉眼观察辅以Lugol's碘染色(VILI)5种.所有筛查者均接受阴道镜检查,以病理组织学结果为金标准,阴道镜检查无异常作为阴性结果.结果 巴氏涂片对宫颈上皮内高度病变的敏感度、特异度、阳性预测值、阴性预测值分别如下:25%,90%,26.7%,98.6%;液基细胞学的上述指标分别为81.3%,97.3%,35.1%,99.6%;VIA上述指标为:68.9%,82.8%,7.1%,99.3%;VILI上述指标分别为:81.3%,84.6%,9.1%,99.6%;HPV-DNA检测法上述指标为:87.5%,77.3%,6.8%,99.7%.结论 液基细胞学的诊断价值好于其余4种方法,可作为宫颈癌筛查的首选方法;肉眼观察由于其简单易行,价格低廉,可适用于经济欠发达地区的普通人群的筛查.

Abstract：

Objective To evaluate five screening methods of cervical cancer so as to popularize an effective screening strategy for cervical cancer in Zhejiang province. Methods A total of 1005 women aged 25 -65 years old were selected from Lishui where cervical cancer was highly prevalent. And 859 subjects were ultimately enrolled between June 2009 and December 2009. Each subject was subjected to five screening methods, including Pap smear, liquid-based cytology (LBC), human papillomavirus DNA with a second-generation hybridization assay( HC2 ), visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). CIN (cervical intraepithelial neoplasia) 2 + on biopsy was used as the reference standard for disease positivity. Negative colposcopy was accepted as a negative outcome. Results The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV)were 25%, 90%, 26.7% and 98.6% for Pap smear; 81.3%, 97.3%, 35. 1% and 99.6% for LBC;68.9%, 82. 8%, 7. 1% and 99. 3% for VIA; 81.3%, 84. 6%, 9. 1% and 99.3% for VILI; 87. 5%,77.3% and 6. 8% for HPV-DNA test respectively. Conclusions LBC is associated with a better profile of sensitivity, specificity and predictive value for five screening methods. It has the potential of optimizing the effectiveness of primary cervical cancer screening. Due to a low cost and an easy operation, VIA screening is an effective method of screening cervical cancer in the underdeveloped areas.     

阴道镜在农村宫颈癌筛查中的应用价值

目的比较分析阴道镜检查与宫颈液基薄层细胞学检测（thinprep cytology test,TCT）联合阴道镜检查在宫颈癌筛查中应用效果,探讨阴道镜在农村宫颈癌筛查中的应用价值。方法以自愿为原则,对广州市番禺区20~55岁有两年及以上性生活史的妇女进行醋酸染色后肉眼观察（visual inspection with acetic acid,VIA）检查,发现VIA可疑病变者,随机分为两组,对照组进行阴道镜检查,观察组行TCT联合阴道镜检查,以病理活检为金标准。结果阴道镜联合TCT检查筛查宫颈癌及癌前病变灵敏度为52.9%,特异度为63.9%,阳性预测值为62.7%,阴性预测值为54.2%,受试者工作特征曲线（ROC曲线）下面积为0.584;单纯阴道镜筛查宫颈癌及癌前病变灵敏度为62.7%,特异度为54.5%,阳性预测值为71.2%,阴性预测值为45.0%,ROC曲线下面积为0.586。结论阴道镜检查能有效筛查宫颈癌及宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）病变,适合作为农村宫颈癌筛查手段。     

Comparative study between Pap smear and visual inspection using acetic acid as a method of cervical cancer screening

This prospective study was done for the comparison of visual inspection using acetic acid (VIA) and Pap smear as a method of cervical cancer screening. This study was also done to determine the proportion of women screened positive with VIA and proportion of women screened positive with Pap smear. Another aim was to compare the sensitivity and specificity of VIA and Pap smear. A total of 300 women attended to the outpatient gynecologic clinic and cervical cancer screening programme at Bangabandhu Sheikh Mujib Medical University (BSMMU) were included. On VIA, 23 out of 300 women screened had aceto-white lesions. On Pap smear, 14 out of the 300 women had ASCUS or worse lesions. Of the 300 enrolled women, 11 were positive on both VIA and cytology; 12 were positive on VIA only; and 3 were positive on cytology only. Those women (n=26) who showed positive test result with either VIA or Pap smear or both tests were further subjected to colposcopy directed biopsy. Histology was taken as gold standard to compare the performance of VIA and cytology (Pap's smear). Histological diagnosis of CIN/cancer was made in 18 Positive cases out of the total 26 patients who underwent biopsy. Pap smear picked up 10 out of the 18 biopsy-proven cases whereas VIA could identify 17 out of the 18 CIN/carcinoma cervices. VIA was more sensitive (94.44%) than pap smear (55.55%), which was statistically significant. However, the specificity of VIA was slightly lower (97.87%) than that of cytology (98.58%). The PPV of VIA was 73.91% versus 71.42 % for Pap smear.     

Role of VIA in cervical cancer screening in low-resource countries

Cervical cancer is one of the few highly preventable cancers. The early detection and removal of precancerous cervical lesions effectively abolish the development of invasive cervical cancer. The Pap test has been the standard screening test in the Western world for the last five decades. Visual inspection of cervix with acetic acid (VIA) is currently more popular method of cervical cancer of screening test in low resource countries. Cervical cancer incidence and mortality have been reduced dramatically as a result of successful screening in many countries. Cancer cervix can be prevented through both primary prevention using human papilloma virus (HPV) vaccine and early detection using screening techniques. Several screening modalities are now available for early detection of cervical cancer and its precursor lesions. They all differ with regard to their test characteristics, feasibility and economic considerations. This review has different aspects of these screening modalities and provides different options considering mass application. In developed countries, Pap smear cytology is used for cervical cancer screening. But in low-resource country, like Bangladesh, it is too expensive and is not feasible. VIA, a non-cytological test is a simple and inexpensive test which can be provided by trained paramedical personnel with a short training. So VIA can be done in low-resource countries for screening of cervical cancer as an alternative to Pap smear cytology.     

液基细胞学在宫颈疾病诊断中应用

目的探讨液基细胞学（TCT）检查在诊断宫颈疾病中临床价值。方法收集我院2011年8月“2012年8月门诊和住院妇产科患者1150例,进行宫颈TCT检测,1200例进行宫颈阴道细胞学巴氏涂片染色,两种方法检查结果阳性行宫颈电子阴道镜检查及多点活检。结果TCT制片和传统巴氏涂片法对低度鳞状上皮内病变（LSIL）以上病变的检出率分别为4．28％、1．78％,P〈0．01。TCT检出LSIL、高度鳞状上皮内病变（HSIL）、鳞状细胞癌（SCC）与阴道镜活检阳性符合率分别为83．33％、88．23％、100％高于巴氏涂片法的60％、66．66％、100％,P〈0．05。结论对LSIL和HSIL的患者,宫颈TCT检查可作为宫颈疾病普查的首选方法之一。     

Human papillomavirus screening and cervical cancer prevention

Infection with one of several types of human papillomavirus (HPV) appears to be a necessary first step in the development of invasive cervical cancer. We cannot currently treat HPV infections; thus, the role of HPV testing is to identify women with precancerous lesions that can be removed and, in so doing, prevent progression to invasive carcinoma. Although HPV testing may help to identify women at risk of cervical cancer who might be missed by other screening tests, it is inherently nonspecific at identifying those who would otherwise develop cervical cancer. In order to avoid overtreatment of women with minor lesions with little potential for progression, HPV testing needs to be repeated or combined with Pap smears. Protocols for HPV screening have yet to be properly evaluated. Here we consider several possible applications of HPV testing in the prevention of cervical cancer. The most immediate role is as a secondary test in women with minor cytological abnormalities. Appropriate use of HPV testing as a primary screening tool depends on the setting. In a developed country without an organized screening program, HPV testing might be used in addition to Pap smears in women age 35 and over to increase sensitivity. Within an organized screening program, HPV testing might be used in combination with Pap testing, but with extended screening intervals so as to obtain the maximum advantage to women without unduly increasing costs. Where resources are strictly limited, an attractive option would be to perform visual inspection of the cervix after application of dilute acetic acid using a low threshold for referral, and to test for HPV only on those with abnormal looking lesions.     

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.     

液基薄层制片宫颈细胞学的临床应用价值

目的:对应用液基薄层制片法新技术进行宫颈病变的细胞学诊断进行评价.方法:对2001年5月～2003年10月,在我院妇产科门诊行宫颈细胞学检查者11340例,应用液基薄层法和传统法制片对比,细胞病理学专职人员光镜下读片,TBS法进行诊断分类.阳性者阴道镜下活检、组织病理学检查.结果:液基薄层法与传统法的阳性预测值分别为91.25%和76.22%(P＜0.01).结论:液基薄层法制片是宫颈细胞学诊断的重要革新,在宫颈病变的筛查中具有重要作用.