Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Eur J Cancer Prev. 2013 Jul;22(4):367-73. doi: 10.1097/CEJ.0b013e328359cbe0.
Unlike for human papillomavirus screening, little is known about the possible age-dependent variation in the outcomes of cervical cytology screening. The aim of our study was to describe age-related outcomes of five cytological technologies in a population-based screening program targeting women aged 23-59 years. All cervical cytology from women residing in Copenhagen has been analyzed in the laboratory of the Department of Pathology, Hvidovre University Hospital. We studied five technology phases: (1) conventional cytology with manual reading, (2) conventional cytology with 50% automatically signed out as normal, (3) liquid-based cytology (LBC) with 50% automatically signed out as normal, (4) LBC with 25% automatically signed out as normal, and (5) LBC with 25% automatically signed out as normal and with 16 preselected areas for attention in manual reading. We calculated proportion of samples with atypical squamous cells of undetermined significance or worse (≥ASCUS) by age and technology phase. We included 391 140 samples. The proportion of ≥ASCUS increased steadily from 3.8% in phase 1 to 6.0% in phase 5. This pattern varied considerably across age groups. In women aged 23-34 years, the proportion almost doubled, relative proportion 1.96 (95% confidence interval: 1.84-2.08). An opposite development was seen in women aged 45-59 years, relative proportion 0.68 (95% confidence interval: 0.57-0.82). Technological upgrading of cytology strongly affected the outcome of cervical screening for young women. If corroborated with data from other laboratories, these findings call for caution in implementation of new cytology screening technologies.
与人类乳头瘤病毒筛查不同，对于宫颈细胞学筛查结果可能随年龄变化的情况知之甚少。我们的研究目的是描述 23-59 岁女性人群为基础的筛查项目中五种细胞学技术与年龄相关的结果。所有居住在哥本哈根的女性的宫颈细胞学检查均在 Hvidovre 大学医院病理学系的实验室进行分析。我们研究了五个技术阶段：（1）传统细胞学检查和手动阅读，（2）传统细胞学检查，其中 50%自动签为正常，（3）液基细胞学检查（LBC），其中 50%自动签为正常，（4）LBC 中 25%自动签为正常，（5）LBC 中 25%自动签为正常，并且在手动阅读中有 16 个预先选定的关注区域。我们按年龄和技术阶段计算非典型鳞状细胞不能明确意义或更差（≥ASCUS）的样本比例。我们共纳入 391140 例样本。≥ASCUS 的比例从第 1 阶段的 3.8%稳步上升到第 5 阶段的 6.0%。这种模式在不同年龄组之间变化很大。在 23-34 岁的女性中，比例几乎翻了一番，相对比例为 1.96（95%置信区间：1.84-2.08）。而在 45-59 岁的女性中则出现相反的发展趋势，相对比例为 0.68（95%置信区间：0.57-0.82）。细胞学技术的升级对年轻女性的宫颈筛查结果有很大影响。如果得到其他实验室数据的证实，这些发现呼吁在实施新的细胞学筛查技术时要谨慎。
