Department of Pathology and Cytology, Uppsala University Hospital, Sweden.
BJOG. 2012 Jan;119(2):245-8. doi: 10.1111/j.1471-0528.2011.03147.x. Epub 2011 Oct 21.
To study the value of self-sampling of vaginal fluid at home in combination with high-risk human papillomavirus (HPV) testing in a cohort of older women not attending Papanicolaou (Pap) smear screening.
Women (n = 3618), aged 50-65 years, who had not attended screening for at least 6 years were offered self-sampling of vaginal fluid at home (study cohort). The collected material was analysed for the presence of high-risk HPV (using Hybrid capture 2; Hc2). Women with a positive HPV test were referred for colposcopy. These results were compared with the results of Pap smear screening in a corresponding age group of women (controls). The end point of the study was identification of a histological cervical intraepithelial neoplasia stage 2 (CIN2) and above (CIN2+).
In all, 39.4% (n = 1426) women participated and 4.6% (n = 66) were high-risk HPV positive. Of the HPV-positive women 56 chose to attend a surgery (84.8%) after a mean time of 2.1 months and ten of these women (17.9%) showed CIN2+, corresponding to 0.70% of all participating women. In the controls, who participated in organised Pap smear screening, the prevalence of CIN2+ was 0.25% (15/6048). The odds ratio for identification of CIN2+ in women aged 50 years or older performing self-sampling and HPV test in comparison with Pap smear was: 2.84 (95% CI 1.14-6.77, P = 0.0174). In older women primary high-risk HPV testing (Hc2) and Pap smear screening showed equal specificity of around 96%.
Self-sampling of vaginal fluid in combination with high-risk HPV testing appears to be an attractive method to improve screening coverage and decrease the prevalence of cervical cancer in women aged 50 years or older.
研究在家中自行采集阴道液并结合高危型人乳头瘤病毒（HPV）检测在未接受巴氏涂片（Pap）筛查的老年女性队列中的价值。
未接受筛查至少 6 年的年龄在 50-65 岁之间的女性（n=3618）被提供在家中自行采集阴道液（研究队列）。采集的材料用于检测高危型 HPV（使用杂交捕获 2；Hc2）的存在。HPV 检测阳性的女性被转诊行阴道镜检查。这些结果与同期年龄组女性的巴氏涂片筛查结果（对照组）进行比较。该研究的终点是识别组织学宫颈上皮内瘤变 2 级及以上（CIN2+）。
共有 39.4%（n=1426）的女性参与，其中 4.6%（n=66）为高危型 HPV 阳性。HPV 阳性女性中，56 人选择在平均 2.1 个月后接受手术（84.8%），其中 10 人（17.9%）显示 CIN2+，相当于所有参与女性的 0.70%。在接受组织化巴氏涂片筛查的对照组中，CIN2+的患病率为 0.25%（15/6048）。在年龄在 50 岁及以上的女性中，进行自我采样和 HPV 检测与巴氏涂片相比，识别 CIN2+的优势比为 2.84（95%CI 1.14-6.77，P=0.0174）。在老年女性中，高危型 HPV 检测（Hc2）和巴氏涂片筛查的特异性均约为 96%。
在家中自行采集阴道液并结合高危型 HPV 检测似乎是一种有吸引力的方法，可以提高筛查覆盖率并降低 50 岁及以上女性的宫颈癌患病率。
