Gynaecological screening--the benefits and pitfalls

Gynaecological screening, as with all screening, must have clear indications, objectives and modus operandi. The types of screening addressed are osteoporotic screening, gynaecological oncological screening involving the various hormonal target organs and breast cancer screening. Apropos osteoporotic screening, a suggestion is made that assessment of bone mineral content be used as a research tool in following the progress of therapy in osteoporosis rather than a screening modality. Cervical cytological screening remains the mainstay of screening for pre-invasive cancer of the cervix, and has contributed significantly to reduction of the incidence and mortality in cervical cancer over the past decade in many countries worldwide. Data should be standardised. Causes of false negative smears are outlined. Colposcopy, with colposcopically directed biopsies where necessary, is advocated in selected cases, namely all CIN, atypical and persistently inflammatory cytological smears. In the near future, DNA hybridisation tests could become desirable for the detection of HPV in targetted cases. Oncology screening for vagina and vulva follow a similar pattern for the cervix. Ultrasound screening of the uterine body and endometrium as well as the ovaries has had favourable reports. Mammographic screening is recommended in patients at higher risk for breast cancer. The benefits and pitfalls of screening are outlined both for individual screening modalities and generally.     

宫颈细胞刷取材：传统涂片与液基涂片的比较分析

目的改进传统宫颈细胞学的取材方式,用宫颈细胞刷取材,比较传统涂片与液基涂片在宫颈癌筛查中阳性细胞检出率的差异。方法用上述两种方法进行宫颈癌筛查,TBS系统诊断报告。细胞阳性的病人行阴道镜下病理活检。SPSS软件包分析结果。结果两种不同的制片方法细胞学阳性率未明确诊断意义的非典型鳞状上皮细胞(ASC-US及以上)为:传统涂片6.26%(63/1007),液基涂片6.98%(75/1075),两种制片方法对宫颈癌筛查中阳性细胞的检出率差异无显著性。细胞学阳性者与病理活检诊断结果符合率均较高(P<0.05)。结论液基细胞学的问世,只是制片技术的重大革新,但不能完全替代人工的经验判读且成本低的传统涂片方法。     

Cervical cancer screening programs: summary of the 1982. Canadian task force report.

The Canadian Task Force on Cervical Cancer Screening Programs, which produced its first report in 1976, was reconvened by the Department of National Health and Welfare in 1980 in response to concerns expressed about the significance of new data, changing sociosexual patterns and wide variations in the implementation of the 1976 recommendations. This article is a summary of the 1982 task force report. In addition to updates of the 1976 material new sections appear on groups at risk, mathematical models of screening, quality control in screening programs, cytologic screening coverage of the Canadian population and management of patients with abnormal smears. The 1982 recommendations deal with frequency of screening, laboratory quality control and follow-up mechanisms. The task force concludes that measures to improve the quality and sensitivity of screening programs and to include women who have never been screened will be more effective in reducing mortality from carcinoma of the cervix than will attempts to increase the frequency of screening. The task force views as unnecessary the annual screening of women over 35 years of age whose previous smears have been normal. Since younger women are sexually more active and tend to have more than one sexual partner they are at high risk. Therefore, the task force recommends annual screening for sexually active women aged 18 to 35 years. Physicians, health care professionals and government health agencies have a role to play in informing women about the recommended intervals for cervical smears and ensuring that screening programs of adequate quality are available. Although women are primarily responsible for entering and continuing in such a program, government-sponsored registries are essential if the full potential of cervical smear programs is to be realized.     

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。     

Gynecological care of elderly women. Another look at Papanicolaou smear testing

Mortality from cervical cancer is decreasing in countries where aggressive Papanicolaou smear screening programs are in place. However, elderly women are likely to be lifelong nonusers or underusers of Papanicolaou screening, and mortality has not declined for older women. Many studies have noted that nonparticipants in Papanicolaou screening have a 2.7 to four times greater incidence of cervical cancer when they are screened compared with women who have been screened at least once. Gynecological screening was offered to 1542 elderly women in a primary care setting; 75% of the women had not had regular prior screening and 25% had never been screened. Half of these women chose to participate in our screening program. An overall prevalence rate of 13.5 per 1000 abnormal Papanicolaou smears (95% confidence interval, 5.6 to 21.4) was noted in the group. Age, race, prior screening history, and abnormal gynecological symptoms failed to predict the women who would have abnormal Papanicolaou smears. Our results suggest that cervical cancer screening should continue beyond 65 years of age if women have not received regular prior screening.     

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.     

阴道镜检查结合宫颈细胞学在宫颈病变中的应用价值

目的：探讨阴道镜检查结合宫颈细胞学在宫颈病变诊治中的临床应用价值。方法随机选在该院接收的656例行阴道镜检查结合宫颈细胞学的妇女作为研究对象,对所有对象的资料进行回顾性分析,总结患者的治疗效果。结果单纯行阴道镜检查筛查3例,无漏诊,癌前期可疑1例。单纯行新柏氏液基细胞学检测检查筛选宫颈癌4例,漏诊1例。行阴道镜检查结合新柏氏液基细胞学检测符合宫颈癌病例5例,无漏诊。结论单纯性阴道镜检查或者新柏氏液基细胞学检测宫颈癌存在漏诊情况,而结合两种方法进行检查后无漏诊现象,即结合两种方法诊断早期宫颈癌有助于提高疾病检出率,值得在临床上推广和使用。     

初善仪在子宫颈病变筛查系统中的应用

目的 探讨宫颈癌筛查系统初善仪(TniScreen)在子宫颈病变诊断中的临床意义.方法 对38例在我院妇科门诊行LCT检查(采用TBS分类标准)阳性(ASCUS及以上)者依次进行TruScreen及阴道镜下活检,以阴道镜下病理学检查为金标准,比较宫颈癌筛查系统TniScreen(初善仪)与病理结果的符合程度,验证初善仪...     

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.     

三种方法在鲁西南地区宫颈癌筛查中的可用性分析

目的 了解鲁西南地区的宫颈癌流行状况,比较3种流行筛查方法的优劣,为宫颈癌的防治提供依据.方法 鲁西南地区选取890名适龄妇女进行宫颈癌筛查,以阴道镜检查的病理组织学结果为金标准,比较巴氏涂片、液基细胞学、肉眼观察辅以醋酸白染色3种方法的可用性.结果 三种方法对宫颈上皮内高度病变的敏感度、特异度、阳性预测值、阴性预测值分别为:巴氏涂片:27.8％,87.5％,29.9％,98.1％；液基细胞学:79.6％,91.2％,38.4％,99.3％；肉眼观察辅以醋酸白染色:67.2％,78.5％,9.2％,99.6％.结论 液基细胞学的诊断价值最高,可作为首选的宫颈癌筛查方法；肉眼观察辅以醋酸白染色简单易行,适用于贫困地区的宫颈癌筛查工作.     

5368例宫颈癌筛查结果分析

目的分析东莞市塘厦镇免费宫颈癌筛查结果,探讨宫颈癌普查的临床价值。方法对塘厦镇2012年10月至2013年9月共5 368例35~59岁妇女采用妇科常规、液基细胞学检查(TCT)和HPV-DNA检测,对TCT和(或)高危型HPV阳性患者行阴道镜检查及必要的宫颈组织活检,比较各检查方法的阳性率。结果人群筛查中HPV阳性率(7.94%)高于TCT阳性率(1.27%);但组织活检阳性率TCT(67.65%)高于HPV(35.21%),差异均有统计学意义(P0.05);TCT及HPV均阳性患者组织活检阳性率83.72%。结论 TCT联合HPV-DNA检测能够明显提高CIN的敏感性及准确性,对CIN早期发现及治疗具有重要的临床意义。     

宫颈HPV-DNA联合阴道镜检查在宫颈癌早期筛查中的临床应用

目的 探讨宫颈人乳头瘤病毒（HPV）-DNA联合阴道镜检查在宫颈癌早期筛查中的应用价值.方法 选择2011年3月至2013年2月广州市妇女儿童医疗中心妇产科收治的206例液基细胞学检查（LCT）呈阴性的接触性阴道出血患者为研究对象,采取宫颈HPV-DNA联合阴道镜检查,并与宫颈组织病理学活检结果进行比较.结果 阴道镜检查与宫颈活检、宫颈HPV-DNA检查与宫颈活检、宫颈HPV-DNA联合阴道镜检查与宫颈活检结果具有高度的一致性（P＜0.05）;宫颈HPV-DNA联合阴道镜检查用于早期诊断宫颈癌的灵敏度（90.3%）、特异度（92.7%）、阳性预测值（84.7%）及阴性预测值（95.6%）均显著优于单用宫颈HPV-DNA检查或阴道镜检查（P＜0.05）.结论 宫颈HPV-DNA联合阴道镜检查用于早期筛查宫颈癌准确率高,对于LCT呈阴性的接触性出血患者,最好采取宫颈HPV-DNA联合阴道镜检查,以提高宫颈癌早期检出率.     

阴道镜下宫颈活检在宫颈病变中的诊断价值

目的探讨阴道镜下宫颈活检诊断宫颈病变的准确性。方法回顾性分析我院近3年门诊行阴道镜下宫颈活检提示为宫颈炎及宫颈上皮内瘤变的病例共1473例,进行宫颈LEEP/锥切术,将病理结果进行比较,分析两者的符合程度,判断阴道镜下宫颈活检在宫颈病变中的诊断价值。结果以宫颈LEEP/锥切术之病理结果作为诊断标准,两者病理结果相符率93.48%(67/102)。102例宫颈上皮内瘤变病例中,LEEP术较活检病理级别降低者占22.55%(23/102);LEEP术较活检病理级别升高者占11.76%(12/102),两种方法结果相比,P>0.05,差异无显著性。结论阴道镜可发现宫颈微小病灶,结合宫颈活检是诊断宫颈病变的有效手段,适用于宫颈癌前病变的早期诊断。     

LBP在宫颈癌早期筛查中应用价值的研究

目的 探讨LBP液基细胞沉降式制片染色检测技术在宫颈癌筛查中的应用价值.方法 应用液基细胞沉降式制片染色检测技术对本院妇产科1170例育龄期妇女进行宫颈脱落细胞检测,诊断标准采用TBS分类系统,并通过阴道镜检查及多点宫颈活检术对宫颈脱落细胞检测结果进行验证.结果 1170例细胞学检查结果阳性94例,其中ASC-US 42例,LSIL45例,HSIL6例,SCC1例;经阴道镜检查及多点宫颈活检术后提示:ASC-US中8例CINI,LSIL中18例CINI～CINⅢ,HSIL中5例CINI～CINⅢ,SCC中1例原位癌以上.结论 LBP液基薄层细胞学能早期发现宫颈癌变,可作为宫颈癌筛查的方法之一.     

南宁市城市人群宫颈癌筛查方法的探讨

目的从经济学的角度探讨在南宁市进行人群宫颈癌筛查的最佳方法。方法选择2006～2009年以单位工会或社区统一组织的适龄妇女进行宫颈癌筛查的人群为对象，按自愿选择新柏氏薄层液基细胞学（TCT）＋人乳头瘤病毒（HPV）、TCT、宫颈刮片＋HPV、宫颈刮片、醋酸染色肉眼观察法（VIA）＋碘染色肉眼观察法（VIM）五种宫颈癌筛查方法进行筛查，细胞学诊断≥ASCUS，VIA或VILI阳性的妇女进行阴道镜检查＋活检。以病理诊断为金标准。对选择宫颈癌筛查五种方式的团体个数进行比较分析。结果506个团体进行宫颈癌筛查的25—59岁妇女共12507人，五种宫颈癌筛查方法的团体个数分别为43、59、60、182和162个，五种宫颈癌筛查方法的阳性率分别为10．32％、9．52％、5．48％、2．69％和4．48％。结论从经济学角度出发，VIA＋VILI宫颈癌筛查方法是最适宜在南宁市开展人群宫颈癌筛查的方法。     

液基细胞学结合阴道镜检查在北京市社区妇女宫颈病变筛查中的意义

目的探讨宫颈液基细胞学及阴道镜检查在北京市社区妇女宫颈病变筛查中的临床意义。方法2006年6月至2007年6月对北京市展览路社区的795位20～54岁有性生活的妇女进行筛查。筛查对象接受妇科检查时,留取宫颈超柏氏薄层液基细胞学检测标本,并对宫颈细胞学异常者行阴道镜检查及活组织检查。结果宫颈细胞学阳性[≥ASC-US（不能明确意义的不典型鳞状细胞）]45例,占5．7％（45／795）。其中ASC-US33例,占73．3％（33／45）;低度鳞状上皮内病变8例;高度鳞状上皮内病变3例;不典型腺细胞1例。细胞学阴性750例,占94．3％（750／795）。宫颈细胞学阳性的45例中,5例拒绝行阴道镜检查,占11．1％（5／45）。在行阴道镜活组织病理检查的40例中,慢性宫颈炎11例（27．5％）;宫颈湿疣14例（35．0％）;宫颈上皮内瘤样病变（CIN）1为7例（17．5％）;CIN2为3例（7．5％）;CIN3为4例（10．0％）;早期浸润癌1例（2．5％）。细胞学阴性的750例中,宫颈湿疣2例（0．3％）;CIN1为5例（0．7％）;宫颈低级别腺上皮内病变1例（0．1％）。宫颈液基细胞学筛查CIN1及以上宫颈病变和宫颈癌的敏感度71．4％,特异度94．2％,阳性预测值37．5％,阴性预测值99．2％;筛查CIN2及以上宫颈病变和宫颈癌的敏感度100．0％,特异度96．0％,阳性预测值20．5％,阴性预测值100．0％。结论应重视并及时进行北京市社区人群宫颈病变的早期筛查,薄层液基细胞学结合阴道镜活组织检查及病理学检查,对提高早期宫颈癌筛查的准确性效果明显。     

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.     

基于宫颈上皮与血管特征的阴道镜图像深度学习模型探索

目的 通过识别阴道镜图像中的上皮与血管特征,探讨深度学习的目标检测技术在宫颈癌前病变定位及分类中的可行性.方法 收集2018年3月至2019年7月复旦大学附属妇产科医院病理诊断为宫颈低级别(5708例)、高级别(2206例)癌前病变和宫颈癌(514例)患者的28975张阴道镜图像.依照国际宫颈病理与阴道镜联盟及美国阴道...     

薄层液基细胞学检查与宫颈涂片检查在宫颈病变诊断中的对比分析

目的对比分析薄层液基细胞学检查与宫颈涂片检查在宫颈病变诊断中的应用情况。方法回顾性分析我院2010年10月-2011年9月妇产科行薄层液基细胞学检查与宫颈涂片检查患者的临床资料,随机选取薄层细胞学检查480例和宫颈涂片检查480例．以病理结果为对照判定以上两种检查宫颈病变诊断中应用效果。结果薄层液基细胞学检查取材满意率为99．8％,宫颈涂片检查的涂片满意率为96．O％,前者明显高于后者,差异有统计学意义（P〈0．05）;薄层液基细胞学检查宫颈细胞学与病理学结果符合率为98.3％,宫颈涂片检查的符合率为92．9％,前者明显高于后者,差异有统计学意义（P〈O．05）。结论薄层液基细胞学检查与宫颈涂片检查在宫颈病变诊断中均具有重要的临床价值,薄层液基细胞学检查对对病变的检查率更高,有利于及早发现宫颈早期病变。     

阴道镜联合病理活检对宫颈病变筛查的价值

目的 探讨阴道镜联合病理活检对宫颈病变筛查的应用价值.方法 以我院2007年1月至2009年12月妇产科行宫颈病理学检查患者614例为研究对象.随机分为阴道镜联合病理活检组(简称联合组)372例和病理活检组(简称活检组)242例,比较2组宫颈病变检出率及联合组不同病理分型宫颈癌的阴道镜影像表现.结果 2组对宫颈糜烂.内...