Passamonti Basilio, Gustinucci Daniela, Giorgi Rossi Paolo, Cesarini Elena, Bulletti Simonetta, Carlani Angela, Martinelli Nadia, Broccolini Massimo, D'Angelo Valentina, D'Amico Maria Rosaria, Di Dato Eugenio, Galeazzi Paola, Malaspina Morena, Spita Nicoletta, Tintori Beatrice, Giaimo Maria Donata
1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy.
2 Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Italy.
J Med Screen. 2017 Sep;24(3):153-162. doi: 10.1177/0969141316663580. Epub 2016 Sep 10.
Objective To present the results of the first and second round human papilloma virus (HPV)-based screening programme in the Umbria region after three years. Methods From August 2010 to November 2011, the entire female population aged 35-64 in a local health district was invited for HPV testing (HPV-DNA cobas4800 on a liquid-based cytology sample). HPV-negative women were re-invited after three years. For HPV-positive women, a slide was prepared and interpreted. Positive cytologies were referred to colposcopy; negatives were referred to repeat HPV after one year. If HPV was persistently positive, women were referred to colposcopy; if negative, to normal screening. Indicators of the first and second round are compared with those of cytology screening in the same area in the preceding three years. Results Participation was 56.5%, the same as cytology (56.6%). HPV-positivity was 6.4% (396/6272), cytology triage positivity was 35.6%; 251 cytology negative women were referred to one-year HPV retesting, 84.1% complied, and 55.5% were positive. Total colposcopy referral was 4.1%, and for cytology 1%. The detection rate for cervical intraepithelial neoplasia grade 2 or more severe was 10‰, compared with 3.7‰ using cytology. After three years, HPV-positivity was 3.4% (129/3831), overall colposcopy referral was 2.3% (most at one-year follow-up), and detection rate was 0.5/1000. Conclusions The first round detection rate was more than twice that of cytology screening, while colposcopy referral increased fourfold. At the second round, the detection rate decreased dramatically, showing that longer interval and more conservative protocols are needed.
目的 呈现 Umbria 地区基于人乳头瘤病毒（HPV）的首轮和第二轮筛查计划三年后的结果。方法 2010 年 8 月至 2011 年 11 月，邀请当地一个卫生区 35 - 64 岁的全体女性进行 HPV 检测（在液基细胞学样本上采用 cobas4800 进行 HPV - DNA 检测）。HPV 阴性的女性在三年后再次被邀请检测。对于 HPV 阳性的女性，制备并解读涂片。细胞学检查阳性者转诊至阴道镜检查；阴性者在一年后再次进行 HPV 检测。如果 HPV 持续阳性，女性转诊至阴道镜检查；如果为阴性，则进行常规筛查。将首轮和第二轮的指标与该地区前三年细胞学筛查的指标进行比较。结果 参与率为 56.5%，与细胞学筛查（56.6%）相同。HPV 阳性率为 6.4%（396/6272），细胞学分流阳性率为 35.6%；251 名细胞学检查阴性的女性被转诊进行一年后的 HPV 复测，84.1%的人依从，其中 55.5%为阳性。阴道镜检查的总转诊率为 4.1%，而细胞学检查为 1%。宫颈上皮内瘤变 2 级或更严重病变的检出率为 10‰，而细胞学检查为 3.7‰。三年后，HPV 阳性率为 3.4%（129/3831），总体阴道镜检查转诊率为 2.3%（大多数在一年随访时），检出率为 0.5/1000。结论 首轮检测率是细胞学筛查的两倍多，而阴道镜检查转诊率增加了四倍。在第二轮时，检测率大幅下降，表明需要更长的间隔时间和更保守的方案。
