Khan Michelle J, Massad L Stewart, Kinney Walter, Gold Michael A, Mayeaux E J, Darragh Teresa M, Castle Philip E, Chelmow David, Lawson Herschel W, Huh Warner K
Division of Women's Reproductive Healthcare, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
Gynecol Oncol. 2016 May;141(2):364-370. doi: 10.1016/j.ygyno.2015.11.023. Epub 2016 Feb 22.
Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (hrHPV) tests, and clinicians are faced with managing their abnormal results. Our objective is to review the literature on vaginal cytology and hrHPV testing and to develop guidance for the management of abnormal vaginal screening tests.
An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted.
The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that 1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and 2) in women for whom surveillance is recommended, e.g. women post-treatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors.
Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.
阴道癌是下生殖道一种不常见的癌症，不建议进行标准化筛查。阴道癌的风险因素包括其他下生殖道瘤变或癌症病史、吸烟、免疫抑制以及子宫内接触己烯雌酚。尽管不建议对因良性疾病行全子宫切除术后的女性进行宫颈癌筛查，但许多女性仍不恰当地接受了阴道细胞学检查和/或人乳头瘤病毒（hrHPV）检测，临床医生面临着对其异常结果的处理。我们的目的是回顾关于阴道细胞学检查和hrHPV检测的文献，并制定异常阴道筛查检测管理的指南。
对截至2015年的PubMed数据库进行电子检索。对描述阴道细胞学检查或阴道hrHPV检测的文章进行了综述，并记录了这些检测在可获得时的诊断准确性。
现有文献过于有限，无法为异常阴道细胞学检查和hrHPV筛查检测的管理制定基于证据的建议。然而，数据确实表明：1）子宫切除术后女性患阴道癌的风险极低，证明了反对常规筛查的建议是合理的；2）对于建议进行监测的女性，例如宫颈癌前病变或癌症治疗后的女性，则hrHPV检测可能有助于识别阴道癌前病变。
阴道癌罕见，无症状低风险女性不应进行筛查。提出了一种基于专家意见的算法，用于处理阴道检测结果异常的女性。
