Sangrajrang Suleeporn, Laowahutanont Piyawat, Wongsena Metee, Muwonge Richard, Karalak Anant, Imsamran Weerawut, Senkomago Virginia, Sankaranarayanan Rengaswamy
National Cancer Institute, Bangkok, Thailand.
Ubon Ratchatahni Cancer Hospital, Ubon Ratchathani, Thailand.
Papillomavirus Res. 2017 Jun;3:30-35. doi: 10.1016/j.pvr.2016.12.004. Epub 2016 Dec 26.
We evaluate the potential for using high-risk human papillomavirus (hr-HPV) testing-based screening for cervical intraepithelial neoplasia (CIN) in routine health services in Thailand; its accuracy in comparison to that of conventional cytology (CC); and the utility of HPV16/18 positive results and liquid-based cytology (LBC) triage for HPV-positive women in the detection of high-grade CIN. Women aged 30-60 years in Ubon Ratchathani province, Thailand were screened with CC and hr-HPV testing and those abnormal on either tests were referred for colposcopy and/or directed biopsies. The final diagnosis using COBAS was based on histology or colposcopy when histology was not available. Estimation of test accuracy parameters was done using latent class analysis using Bayesian models. Of the 5004 women were enrolled, 20 (0.4%) had abnormal CC and 174 (3.5%) women were HPV-positive. Among 185 women abnormal on CC or HPV-positive, 176 (95.1%) underwent colposcopy, of whom 101 (57.4%) had abnormal colposcopy findings. Ninety-seven women with abnormal and 69 with normal colposcopy had biopsies performed. All 21 women with histological CIN2 or worse had hr-HPV and none were abnormal on CC. The estimated sensitivity, specificity and positive predictive value were respectively 71.8%, 97.0% and 13.0% of HPV testing; 53%, 98.7% and 20.3% for triage of HPV-positive women with LBC; and 70.4%, 98.2% and 16.9% when test positivity was taken as HPV16/18 irrespective of LBC result or positive for hr-HPV non 16/18 types and LBC triage. Our study findings indicate poor performance of cytology screening and demonstrate the potential and utility of using HPV testing in public health services in Thailand as well as the utility of primary HPV testing and LBC triage in screening for cervical neoplasia.
我们评估了在泰国常规卫生服务中使用基于高危型人乳头瘤病毒（hr-HPV）检测进行宫颈上皮内瘤变（CIN）筛查的潜力；与传统细胞学检查（CC）相比其准确性；以及HPV16/18阳性结果和液基细胞学检查（LBC）分流对HPV阳性女性检测高级别CIN的效用。泰国乌汶叻差他尼府30至60岁的女性接受了CC和hr-HPV检测，任何一项检测结果异常者均被转诊进行阴道镜检查和/或定向活检。使用COBAS的最终诊断基于组织学检查，若无法获得组织学检查结果，则基于阴道镜检查。使用贝叶斯模型的潜在类别分析来估计检测准确性参数。在纳入的5004名女性中，20名（0.4%）CC结果异常，174名（3.5%）女性HPV呈阳性。在185名CC异常或HPV阳性的女性中，176名（95.1%）接受了阴道镜检查，其中101名（57.4%）阴道镜检查结果异常。97名阴道镜检查异常和69名阴道镜检查正常的女性进行了活检。所有21名组织学诊断为CIN2或更严重病变的女性hr-HPV检测均呈阳性，CC检查均无异常。HPV检测的估计灵敏度、特异度和阳性预测值分别为71.8%、97.0%和13.0%；LBC对HPV阳性女性进行分流的相应值分别为53%、98.7%和20.3%；当检测阳性定义为HPV16/18时，无论LBC结果如何，或hr-HPV非16/18型阳性且进行LBC分流时，相应值分别为70.4%、98.2%和16.9%。我们的研究结果表明细胞学筛查效果不佳，并证明了在泰国公共卫生服务中使用HPV检测的潜力和效用，以及原发性HPV检测和LBC分流在宫颈肿瘤筛查中的效用。
