资源匮乏地区宫颈癌筛查中的补充程序。

Complementary procedures in cervical cancer screening in low resource settings.

作者信息

Katyal Surabhi, Mehrotra Ragini

机构信息

Department of Obstetrics & Gynecology, Moti Lal Nehru Medical College, 390 New Mumfordganj, Allahabad, 2110021 Uttar Pradesh India.

出版信息

J Obstet Gynaecol India. 2011 Aug;61(4):436-8. doi: 10.1007/s13224-011-0067-y. Epub 2011 Sep 22.

DOI:10.1007/s13224-011-0067-y

PMID:22851828

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3295876/

Abstract

OBJECTIVE

To evaluate the efficacy of pap smear, HPV DNA testing and colposcopy and to determine the approach for cervical cancer screening in low resource settings.

METHODS

Eight hundred non pregnant married women above 30 years of age were studied and subjected to pap smear examination. Hysterectomised women were excluded from the study. Selected patients were followed by HPV DNA testing by Hybrid Capture II method, colposcopy and biopsy. Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV), diagnostic accuracy and kappa value (k) were calculated for each screening test.

RESULT

Out of eight hundred women with mean age 36.5 ± 5.94 years undergoing pap smear, ASCUS was found in 66(8.25%), ASC-H in 2(0.25%), LSIL in 48(6%), HSIL in 8(1%), inflammatory in 540(67.5%). Out of 260 women who underwent HPV DNA testing, 120 (46.15%) had abnormal cytology and/or positive HPV DNA test (Group I, n = 120) and 140(53.8%) had dual negative results (Group II, n = 140) HPV DNA test was found positive in 64 women (53.3%) in Group I. Sensitivity and specificity of pap smear was 69.2 and 63.72% while for HPV DNA testing was 92.3 and 84% respectively. PPV and NPV of pap smear, HPV DNA testing and colposcopy was 18, 40, 76.4% and 94.7, 98.9, 100% respectively. Diagnostic accuracy of pap smear (k = 0.14), HPV DNA test (k = 0.70) and colposcopy (k = 0.81) was 64.29, 84.9, and 96.8% respectively. Combining pap smear & HPV DNA testing (k = 0.25) increased the sensitivity and NPV to 100%.

CONCLUSION

Sensitivity and diagnostic accuracy of HPV DNA test is more than that of pap smear and the test is not influenced by inflammatory conditions of vagina. In low resource settings, women with ASCUS and LSIL on cervical cytology should be subjected to HPV DNA test and only if found positive should be referred for colposcopy thereby reducing colposcopy referrals. Women with HSIL should be directly subjected to colposcopy guided biopsy. Using this approach, most of the preinvasive cervical lesion will be detected but few cases will still be missed among inflammatory smears, if HPV DNA testing is not supplemented.

摘要

目的

评估巴氏涂片、人乳头瘤病毒（HPV）DNA检测及阴道镜检查的效果，并确定资源匮乏地区宫颈癌筛查的方法。

方法

对800名30岁以上的非妊娠已婚妇女进行研究并进行巴氏涂片检查。子宫切除的妇女被排除在研究之外。对选定的患者采用杂交捕获II法进行HPV DNA检测、阴道镜检查及活检。计算每项筛查试验的灵敏度、特异度、阳性预测值（PPV）、阴性预测值（NPV）、诊断准确性及kappa值（k）。

结果

800名平均年龄为36.5±5.94岁的妇女进行了巴氏涂片检查，其中不典型鳞状细胞不能明确意义（ASCUS）66例（8.25%），不典型鳞状细胞不排除高度病变（ASC-H）2例（0.25%），低度鳞状上皮内病变（LSIL）48例（6%），高度鳞状上皮内病变（HSIL）8例（1%），炎症540例（67.5%）。在260名进行HPV DNA检测的妇女中，120例（46.15%）细胞学异常和/或HPV DNA检测阳性（I组，n = 120），140例（53.8%）两者均为阴性（II组，n = 140）。I组64名妇女（53.3%）HPV DNA检测呈阳性。巴氏涂片的灵敏度和特异度分别为69.2%和63.72%，而HPV DNA检测的灵敏度和特异度分别为92.3%和84%。巴氏涂片、HPV DNA检测及阴道镜检查的PPV分别为18%、40%、76.4%，NPV分别为94.7%、98.9%、100%。巴氏涂片（k = 0.14）、HPV DNA检测（k = 0.70）及阴道镜检查（k = 0.81）的诊断准确性分别为64.29%、84.9%、96.8%。联合巴氏涂片和HPV DNA检测（k = 0.25）可将灵敏度和NPV提高到100%。

结论

HPV DNA检测的灵敏度和诊断准确性高于巴氏涂片，且该检测不受阴道炎症状态的影响。在资源匮乏地区，宫颈细胞学检查为ASCUS和LSIL的妇女应进行HPV DNA检测，只有检测结果为阳性时才应转诊进行阴道镜检查，从而减少阴道镜检查转诊人数。HSIL的妇女应直接进行阴道镜引导下活检。采用这种方法，大多数宫颈浸润前病变将被检测到，但如果不补充HPV DNA检测，在炎症涂片病例中仍会有少数病例漏诊。