Castanon Alejandra, Landy Rebecca, Michalopoulos Dimitrios, Bhudia Roshni, Leaver Hannah, Qiao You Lin, Zhao Fanghui, Sasieni Peter
and Wolfson Institute of Preventive Medicine, London, United Kingdom; and and National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China.
J Glob Oncol. 2017 Mar 1;3(5):524-538. doi: 10.1200/JGO.2016.008011. eCollection 2017 Oct.
To assess the sensitivity of cervical cytology to cancer by pooling individual patient cytology results from cancers diagnosed in studies that assessed cervical screening in low- and middle-income countries.
Two authors reviewed studies identified through PubMed and Embase databases. We included studies that reported cervical cytology in which at least one woman was diagnosed with cervical cancer and in which abnormal cytology results were investigated at colposcopy and through a histologic sample (if appropriate). When cytology results were not reported in the manuscript, authors were contacted. Stratified analyses and meta-regression were performed to assess sources of heterogeneity between studies.
We included 717 cancers from 23 studies. The pooled sensitivity of cytology to cancer at a cutoff of a high-grade squamous intraepithelial lesion (HSIL) or worse was 79.4% (95% CI, 67.7% to 86.0%). Results from stratified analyses did not differ significantly, except among studies that recruited symptomatic women or women referred because of abnormal cytology, when the sensitivity of cytology was much higher (95.9%; 95% CI, 86.5% to 99.9%). The cutoff of an HSIL or worse detected 85% of the cancers that would have been detected at a cutoff of atypical squamous cells of undetermined significance or worse (relative sensitivity, 85.2%; 95% CI, 80.7% to 89.7%).
Cytology at a high cutoff could be an excellent tool for targeted screening of populations at high risk of cervical cancer with a view to diagnose cancer at an earlier stage.
通过汇总在评估低收入和中等收入国家宫颈癌筛查的研究中诊断出的癌症患者个体细胞学结果，评估宫颈细胞学检查对癌症的敏感性。
两位作者回顾了通过PubMed和Embase数据库检索到的研究。我们纳入了报告宫颈细胞学检查的研究，其中至少有一名女性被诊断为宫颈癌，并且对异常细胞学结果进行了阴道镜检查和组织学样本（如适用）的调查。如果手稿中未报告细胞学结果，则与作者联系。进行分层分析和meta回归以评估研究之间异质性的来源。
我们纳入了来自23项研究的717例癌症。在高级别鳞状上皮内病变（HSIL）或更严重病变的临界值时，细胞学检查对癌症的合并敏感性为79.4%（95%CI，67.7%至86.0%）。分层分析的结果没有显著差异，但在招募有症状女性或因细胞学异常而转诊的女性的研究中，细胞学检查的敏感性要高得多（95.9%；95%CI，86.5%至99.9%）。HSIL或更严重病变的临界值检测到了在意义不明确的非典型鳞状细胞或更严重病变的临界值时可检测到的85%的癌症（相对敏感性，85.2%；95%CI，80.7%至89.7%）。
高临界值的细胞学检查可能是针对宫颈癌高危人群进行靶向筛查的优秀工具，以便在早期诊断癌症。
