内蒙古少数民族地区宫颈癌的筛查方法研究

目的探讨内蒙古少数民族聚居区宫颈癌及癌前病变适宜的筛查方法。方法2009年4月-8月对内蒙古自治区鄂尔多斯、兴安盟、通辽三个地区的2958名年龄30～59岁的已婚妇女进行了宫颈癌筛查。取宫颈脱落细胞,做人乳头瘤病毒（HPV-HC2）检测;同时用醋酸着色及碘着色（VIA/VILI）肉眼观察的方法进行筛查。对HPV-HC2阳性或VIA/VILI肉眼观察异常或两者均异常者,行阴道镜检查,在可疑处取宫颈组织活检,必要时行颈管诊刮术（ECC）;送组织病理学检查确诊。结果内蒙古鄂尔多斯、通辽、兴安盟三地区HPV总感染率为17.36%,中度及以上宫颈上皮内瘤样病变（≥CIN2）和宫颈癌的检出率为0.9%;应用HPV-HC2筛出阳性者最后确诊≥CIN2者27例,而用VIA/VILI仅确诊13例,漏诊14例。结论HPV检测结合醋酸、碘肉眼观察是宫颈癌筛查的有效方法。在内蒙等经济发展不均衡地区,可尝试采用HPV检测进行初筛,对HPV阳性患者用VIA＋VILI或者细胞学筛查的方法进行分流的筛查策略,降低漏诊率,也相对降低HPV阳性患者阴道镜的转诊率。

The value of HPV testing combining with acetic acid,iodine visual inspection in cervical cancer screening

Objective To evaluate the financial burden of cervical cancer and cervical intraepithelial neoplasia (CIN) in minorities of Inner Mongolia,and to investigate the appropriate screening measure for the areas.Methods In 2009,2 958 married women of 30～59 yrs from three areas of Inner Mongolia Autonomous Region were underwent cervical cancer screening.Each subject was requested to collect the cervical exfoliated cells for human papilloma virus(HPV) detection(HC2),and then was screened by visual inspection with acetic acid (VIA) and Lugol’s iodine(VILI) for the visual inspection of the cervix.Direct biopsies under colposcopy were taken if any abnormalities were found by VIA+VILI or HPV positive,endocervical curettage (ECC) was conducted if necessary.Women with positive HPV test results were called back in two weeks,and were performed colposcopy examination.Direct biopsy was taken if any abnormal lesions were found.Pathological diagnoses were given by the experts of the Chinese Academy of Medical Sciences Cancer Institute.Results The total HPV infection prevalence was 17.36%,and the prevalence for CIN2+ and cervical cancer was 0.9%.There were totally 27 cases finally dignosed as ≥CIN2 screened by HPVHC2 method while by VIA+VILI method only 13 cases were diagnosed and 14 were misseddiagnosed.Conclusions HPV testing combining with acetic acid,iodine visual inspection is an effective method for cervical cancer screening.And it is recommended as the primary screening method for cervical cancer in inner Mongolia or other economic undeveloped areas in China,with respect to its high sensitivity and specificity.Moreover,visual inspection or cytology could be performed as the triage measure for a positive HPV test result,to help reduce the unnecessary rate for colposcopy examination and biopsies.