Tjalma Wiebren A A
Multidisciplinary Breast Clinic, Unit Gynecologic Oncology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2017 Mar;210:275-280. doi: 10.1016/j.ejogrb.2017.01.009. Epub 2017 Jan 8.
Cervical cancer screening saves lives. Secondary prevention in cervical cancer screening relies on the results of primary cytology and/or HPV testing. However, primary screening with cytology has a low sensitivity, and HPV screening has a low specificity. This means that either cancers are missed, or women are over-treated. To improve performance outcomes, the concept of dual-stain cytology (CINtec PLUS Cytology test) has been introduced. In this approach, additional staining with p16/Ki-67 is performed in cases where cytology results are abnormal (LSIL or ASCUS) and/or HPV-positive. Another way to describe this approach might be "diagnostic" cytology. In order to assess the value of this "diagnostic cytology", a systematic literature review was conducted of dual-stain cytology performance across multiple studies until May 2016. In a Belgian screening population (women age 25-65 years), dual-stain cytology was significantly more sensitive (66%) and slightly less specific (-1.0%) than cytology. In the population referred to colposcopy or with abnormal cytology (ASCUS, LSIL), dual-staining showed a significantly higher increase in specificity, and a slightly lower sensitivity than HPV testing. Specificity gains resulted in fewer false positives and an increase in the number of correct referrals to colposcopy. Dual-staining with p16/Ki-67 cytology is an attractive biomarker approach for triage in cervical cancer screening.
宫颈癌筛查可挽救生命。宫颈癌筛查中的二级预防依赖于初次细胞学检查和/或HPV检测的结果。然而，细胞学初次筛查的灵敏度较低，而HPV筛查的特异性较低。这意味着要么癌症被漏诊，要么女性接受了过度治疗。为了改善筛查效果，引入了双染细胞学的概念（CINtec PLUS细胞学检测）。在这种方法中，当细胞学检查结果异常（低度鳞状上皮内病变或意义不明确的不典型鳞状细胞）和/或HPV呈阳性时，需进行p16/Ki-67额外染色。描述这种方法的另一种方式可能是“诊断性”细胞学。为了评估这种“诊断性细胞学”的价值，截至2016年5月，对多项研究中的双染细胞学性能进行了系统的文献综述。在比利时的筛查人群（25至65岁的女性）中，双染细胞学的灵敏度显著更高（66%），特异性略低（-1.0%）。在接受阴道镜检查或细胞学异常（意义不明确的不典型鳞状细胞、低度鳞状上皮内病变）的人群中，双染显示特异性显著提高，灵敏度略低于HPV检测。特异性的提高减少了假阳性，并增加了正确转诊至阴道镜检查的人数。p16/Ki-67双染细胞学是宫颈癌筛查中一种有吸引力的分流生物标志物方法。
