基于人群的中国宫颈癌筛查研究中液基细胞学性能的汇总分析。
Pooled analysis of the performance of liquid-based cytology in population-based cervical cancer screening studies in China.
机构信息
Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
出版信息
Cancer Cytopathol. 2013 Sep;121(9):473-82. doi: 10.1002/cncy.21297. Epub 2013 Apr 23.
BACKGROUND
Liquid-based cytology (LBC) has been widely used for cervical cancer screening. Despite numerous studies and systematic reviews, to the authors' knowledge few large studies to date have focused on biopsy-confirmed cervical lesions and controversy remains concerning its diagnostic accuracy. The objective of the current study was to assess LBC for detecting biopsy-confirmed cervical intraepithelial neoplasia (CIN) and cancer.
METHODS
A pooled analysis of LBC using data from 13 population-based, cross-sectional, cervical cancer screening studies performed in China from 1999 to 2008 was performed. Participants (n = 26,782) received LBC and human papillomavirus testing. Women found to be positive on screening were referred for colposcopy and biopsy. The accuracy of LBC for detecting biopsy-confirmed CIN of type 2 or worse (CIN2+) as well as CIN type 3 or worse (CIN3+) lesions was analyzed.
RESULTS
Of 25,830 women included in the analysis, CIN2+ was found in 107 of 2612 with atypical squamous cells (4.1%), 142 of 923 with low-grade squamous intraepithelial neoplasia (15.4%), 512 of 784 with high-grade squamous intraepithelial neoplasia (65.3%), 29 of 30 with squamous cell carcinoma (96.7%), 4 of 27 with atypical glandular cells (14.8%), and 85 of 21,454 with normal cytology results (0.4%). No invasive cancers were found to have atypical squamous cells, atypical glandular cells, or cytologically normal slides. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of LBC for detecting CIN2+ were 81.0%, 95.4%, 38.3%, 99.3 %, and 94.9%, respectively. Although Hybrid Capture 2 was more sensitive than LBC, the specificity, positive predictive value, and overall accuracy of LBC were higher than those of Hybrid Capture2 at 85.2%, 18.6%, and 85.5%, respectively.
CONCLUSIONS
The results of the current study indicate that the performance of LBC can effectively predict the risk of existing CIN2+ and may be a good screening tool for cervical cancer prevention in a developing country.
背景
液基细胞学（LBC）已广泛应用于宫颈癌筛查。尽管有许多研究和系统评价，但据作者所知，迄今为止，很少有大型研究关注活检证实的宫颈病变，其诊断准确性仍存在争议。本研究的目的是评估 LBC 检测活检证实的宫颈上皮内瘤变（CIN）和癌症的能力。
方法
使用 1999 年至 2008 年在中国进行的 13 项基于人群的横断面宫颈癌筛查研究的数据进行 LBC 的汇总分析。参与者（n=26782）接受 LBC 和人乳头瘤病毒检测。筛查阳性的妇女被转诊行阴道镜检查和活检。分析 LBC 检测活检证实的 CIN2+（CIN2+）和 CIN3+病变的准确性。
结果
在纳入分析的 25830 名妇女中，在 2612 例非典型鳞状细胞（4.1%）、923 例低级别鳞状上皮内瘤变（15.4%）、784 例高级别鳞状上皮内瘤变（65.3%）、30 例鳞状细胞癌（96.7%）、27 例非典型腺细胞（14.8%）和 21454 例细胞学正常结果（0.4%）中发现 CIN2+。没有发现有非典型鳞状细胞、非典型腺细胞或细胞学正常的浸润性癌。LBC 检测 CIN2+的总体敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 81.0%、95.4%、38.3%、99.3%和 94.9%。虽然 Hybrid Capture 2 比 LBC 更敏感，但 LBC 的特异性、阳性预测值和总准确性分别为 85.2%、18.6%和 85.5%，高于 Hybrid Capture 2。
结论
本研究结果表明，LBC 的性能可有效预测现有 CIN2+的风险，可能是发展中国家宫颈癌预防的良好筛查工具。
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