Terrazas Solana, Ibáñez Carolina, Lagos Marcela, Poggi Helena, Brañes Jorge, Barriga María Isabel, Cartagena Jaime, Núñez Felipe, González Francisca, Cook Paz, Van De Wyngard Vanessa, Ferreccio Catterina
Rev Med Chil. 2015 Jan;143(1):56-62. doi: 10.4067/S0034-98872015000100007.
Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile.
To describe the experience of implementing this new molecular test and present the main results of the study.
Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions.
Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively.
This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program.
人乳头瘤病毒（HPV）检测的分子技术作为筛查测试具有良好的性能，可纳入宫颈癌早期检测项目。我们在智利圣地亚哥的一项公共卫生服务中开展了一项基于人群的试验，比较HPV检测和巴氏涂片作为主要筛查测试的效果。
描述实施这项新分子检测的经验并展示该研究的主要结果。
邀请了在三个公共卫生中心登记的25至64岁女性参与。对所有女性采集样本进行巴氏涂片和HPV DNA检测，并对宫颈进行醋酸肉眼视诊。任何筛查测试呈阳性的女性被转诊至当地医院，通过阴道镜检查和对可疑病变进行活检来确诊。
8265名女性获得了筛查结果，其中931名（11.3%）任何一项测试呈阳性。宫颈上皮内瘤变2级或更严重（CIN2+）的患病率为1.1%；9名女性患有浸润性宫颈癌。巴氏涂片检测CIN2+的敏感度为22.1%（95%置信区间（CI）16.4 - 29.2），HPV检测的敏感度为92.7%（95%CI 84.4 - 96.8）；特异度分别为98.9%（95%CI 98.7 - 99.0）和92.0%（95%CI 91.4 - 92.6）。
这一经验表明，在智利实施宫颈癌筛查的分子检测并非重大挑战：它得到了卫生团队和参与者的良好接受，并且可能提高筛查项目的有效性。
