Zheng Baowen, Austin R Marshall, Liang Xiaoman, Wei Guijian, You Jia, Liang Yaoming, Zhao Chengquan
Kingmed Guangzhou Diagnostics, Guangzhou, Guangdong, China.
Department of Pathology, Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Am Soc Cytopathol. 2017 May-Jun;6(3):120-125. doi: 10.1016/j.jasc.2017.03.005. Epub 2017 Apr 20.
Recently the Chinese government has introduced support for cervical screening in rural areas. The College of American Pathologists (CAP)-certified Guangzhou Kingmed Diagnostics laboratory supported rural screening program in Hainan Providence utilizing low-cost conventional Papanicolaou smears (CPS).
This was a retrospective study of CPS screening results from 2011 to 2014 in 11 rural counties in Hainan Province. Women, most previously unscreened, volunteered to attend free CPS screening. The targeted population was women aged 35-65 years.
Among total 218,195 conventional Papanicolaou smears, the reported abnormal rate was 4.4% of all smears, with 0.5% for high-grade squamous intraepithelial lesion (HSIL), 0.9% for low-grade squamous intraepithelial lesion (LSIL), 2.6% for atypical squamous cells of undetermined significance, and 0.3% for atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. Reporting rates for different TBS categories were generally within CAP benchmark ranges, except for low reporting rates for unsatisfactory smears and for atypical glandular cells. Abnormal cytology rates varied among counties. Comparing different age groups, the LSIL rate was significantly higher in women <50 years than in women ≥50 years (1.04% versus 0.64%). The HSIL rate was significantly higher in women ≥40 years than in women <40 years (5.3% versus 0.38%). A total of 2286 women with abnormal Papanicolaou smears had documented colposcopic and histopathologic follow-up. Cervical cancer was diagnosed in 23 of 2286 (1.01%) of screened and biopsied patients. Histopathologic HSIL results were confirmed in 80% of biopsied women with HSIL Papanicolaou tests.
CPS offered a low cost method to introduce cervical screening in rural China. The international College of American Pathologists Laboratory Accreditation Program provided laboratory quality control standards not otherwise readily available. Educational training programs have been instituted to address areas identified for quality improvement.
最近中国政府已开始支持农村地区的宫颈癌筛查。美国病理学家学会（CAP）认证的广州金域诊断实验室利用低成本的传统巴氏涂片（CPS）支持了海南省的农村筛查项目。
这是一项对2011年至2014年海南省11个农村县的CPS筛查结果的回顾性研究。此前大多未接受过筛查的女性自愿参加免费的CPS筛查。目标人群为35至65岁的女性。
在总共218,195份传统巴氏涂片中，报告的异常率为所有涂片的4.4%，其中高级别鳞状上皮内病变（HSIL）为0.5%，低级别鳞状上皮内病变（LSIL）为0.9%，意义不明确的非典型鳞状细胞为2.6%，非典型鳞状细胞、不能排除高级别鳞状上皮内病变为0.3%。除了不满意涂片和非典型腺细胞的报告率较低外，不同TBS分类的报告率总体上在CAP基准范围内。各县的异常细胞学率有所不同。比较不同年龄组，<50岁女性的LSIL率显著高于≥50岁女性（1.04%对0.64%）。≥40岁女性的HSIL率显著高于<40岁女性（5.3%对0.38%）。共有2286名巴氏涂片异常的女性进行了阴道镜和组织病理学随访。在2286名接受筛查和活检的患者中，有23人（1.01%）被诊断为宫颈癌。在巴氏涂片为HSIL的活检女性中，80%的组织病理学HSIL结果得到证实。
CPS提供了一种在中国农村地区开展宫颈癌筛查的低成本方法。美国病理学家学会国际实验室认可计划提供了其他情况下难以获得的实验室质量控制标准。已制定教育培训计划以解决确定的质量改进领域。
