Li Long-yu, Qiao Zhi-qiang, Zhang Min-fang, Yang Jian-ping, Bao Yan-ping, An Yun-ting, Lei Jun, Xiong Nan-hua, Yu Xiao-hong, Zhang Xun, Pan Qin-jing, Qiao You-lin
Department of Oncology, Healthcare Hospital for Women and Children of Jiangxi Province, Nanchang, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2007 Oct;28(10):964-7.
To evaluate the application value and feasibility of various cervical screening methods and to explore a rapid and efficient cervical cancer screening program for the women in the rural areas of China.
We sequentially conducted human papillomavirus (HPV) DNA test by hybrid capture-2 (hc2) with cervical cells, liquid-based thinprep cytology test (TCT), visual inspection with acetic acid (VIA), visual inspection with iodine (VILI), colposcopy respectively for the 2499 married women between 30 and 49 years from Xiushui county of Jiangxi province. All the detection methods were performed independently under double-blind design. Women who were diagnosed positive for having any VIA,VILI and colposcopy inspection or for those women who were diagnosed negative for VIA, VILI and colposcopy but with positive result of HPV or TCT test underwent cervical biopsy directly and endocervical curettage (ECC)when necessary. We performed cervical biopsy endocervical curettage within two weeks to observe the sensitive (SE), specificity (SP), negative predict value (NPV) and positive predict value (PPV) of these detection methods when used alone or combined each other, including HPV test, TCT inspection, VIA, VILI, and colposcopy, the pathological diagnosises of cervical tissue were confirmed by IARC (International Agency for Research on Cancer) while the cytological findings were underegone through the updated program of TBS (The Bethesda System) in 2001.
A total of 2499 women underwent the screening and found 443 women who were diagnosed as HPV positive, 337 women with abnormal cervical cytology and 27 women with ASC-H, 157 cases with ASCUS; 103 cases with HSIL, 49 cases with LSIL and 1 cervical cancer. According to the pathological findings. There were 181 women diagnosed as cervical intraepithelial neoplasia (CIN) or cervical cancer, including 81 cases with CIN1 37 cases with CIN2,60 case cervical cancer. The sensitivity rates of HPV, TCT, HPV+ TCT, VIA, VILI, VIA+VILI and colposcopy were 96.67%, 89.47%, 97.98%, 56.57%, 36.36%, 63.64% and 39.39%, and the specificity rates were 85.00%, 96.91%, 86.97%, 94.60%, 96.23%, 92.97% and 98.14% respectively.
HPV + TCT seemed to be more sensitive than other screening methods in the cervical cancer screening program.
评估各种宫颈癌筛查方法的应用价值及可行性，探索适合中国农村地区妇女的快速、高效宫颈癌筛查方案。
对江西省修水县2499名30至49岁已婚妇女依次进行人乳头瘤病毒（HPV）DNA杂交捕获-2（hc2）检测、液基薄层细胞学检测（TCT）、醋酸染色肉眼观察（VIA）、碘染色肉眼观察（VILI）、阴道镜检查。所有检测方法均在双盲设计下独立进行。对VIA、VILI及阴道镜检查诊断为阳性的妇女，或VIA、VILI及阴道镜检查诊断为阴性但HPV或TCT检测结果为阳性的妇女，直接进行宫颈活检，必要时行宫颈管搔刮术（ECC）。在两周内进行宫颈活检及宫颈管搔刮术，观察这些检测方法单独使用或联合使用时的敏感度（SE）、特异度（SP）、阴性预测值（NPV）和阳性预测值（PPV），包括HPV检测、TCT检查、VIA、VILI及阴道镜检查，宫颈组织病理诊断参照国际癌症研究机构（IARC）标准，细胞学结果按照2001年更新的TBS（贝塞斯达系统）方案进行判读。
共2499名妇女接受筛查，发现HPV阳性443例，宫颈细胞学异常337例，其中不典型鳞状细胞不能排除高度病变（ASC-H）27例、不典型鳞状细胞（ASCUS）157例；高级别鳞状上皮内病变（HSIL）103例、低级别鳞状上皮内病变（LSIL）49例，宫颈癌1例。根据病理结果，诊断为宫颈上皮内瘤变（CIN）或宫颈癌的妇女共181例，其中CIN1 81例，CIN2 37例，宫颈癌60例。HPV、TCT、HPV+TCT、VIA、VILI、VIA+VILI及阴道镜检查的敏感度分别为96.67%、89.47%、97.98%、56.57%、36.36%、63.64%和39.39%，特异度分别为85.00%、96.91%、86.97%、94.60%、96.23%、92.97%和98.14%。
在宫颈癌筛查方案中，HPV+TCT似乎比其他筛查方法更敏感。
