Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
The Center for Vulvovaginal Disorders, Washington, DC, USA.
BMJ Open. 2020 Mar 30;10(3):e035153. doi: 10.1136/bmjopen-2019-035153.
Implementation of a novel, rapid, high-volume, see-and-treat cervical cancer screening programme using self-swab human papillomavirus (HPV) testing and digital colposcopy in underserved regions of Yunnan China.
480-980 women per day self-swabbed for high-risk HPV (hrHPV+). Four careHPV machines (Qiagen) were run simultaneously to test the specimens. All hrHPV+ patients were contacted the same day and digital colposcopy was performed with the enhanced visual assessment system (MobileODT). Digital images were obtained, and all suspected lesions were biopsied and then treated.
Rural and underserved areas of the Yunnan province, Kunming municipality.
3600 women, mean age 50.2 years, who had never been screened for cervical cancer. The women were of the Yi, Hui, Dai and Han ethnicities.
Cryotherapy was performed on all lesions suspicious for cervical intraepithelial neoplasia (CIN) 1 and loop electrosurgical excision procedure was performed on all lesions suspicious for ≥CIN2. Endocervical curettage was performed if the transformation zone was not fully visualised.
216 women (6%) were hrHPV+. 168 underwent same-day colposcopy (23 CIN1, 17≥CIN2). Digital colposcopy was able to identify 15 of 16 (93.8%)≥CIN2 lesions.
This study illustrates a high-volume, rapid and practical strategy that can be used to screen and treat an ethnically diverse group of Chinese women. First, HPV self-sampling allows large numbers of women to be screened rapidly and relatively inexpensively. Only hrHPV+ women will then require further evaluation. Digital colposcopy is then performed on hrHPV+ women with a portable digital colposcope. The high-resolution images obtained can facilitate appropriate same-day treatment as they are able to accurately distinguish between CIN1 and ≥CIN2 lesions.
在中国云南省贫困地区实施一种新型、快速、大容量、即检即治的宫颈癌筛查方案，采用自我采样人乳头瘤病毒（HPV）检测和数字阴道镜检查。
每天有 480-980 名妇女进行高危型 HPV（hrHPV+）自我采样。同时运行四台 careHPV 机器（Qiagen）检测标本。所有 hrHPV+患者均在同一天进行联系，并使用增强视觉评估系统（MobileODT）进行数字阴道镜检查。获取数字图像，对所有可疑病变进行活检，并进行治疗。
云南省昆明市农村和贫困地区。
3600 名从未接受过宫颈癌筛查的妇女，平均年龄为 50.2 岁。这些妇女来自彝族、回族、傣族和汉族。
对所有疑似宫颈上皮内瘤变（CIN）1 的病变进行冷冻治疗，对所有疑似≥CIN2 的病变进行环形电切术。如果转化区未完全可视化，则进行宫颈内膜刮除术。
216 名妇女（6%）为 hrHPV+。168 名妇女当天接受阴道镜检查（23 例 CIN1，17 例≥CIN2）。数字阴道镜能够识别出 16 例（93.8%）≥CIN2 病变中的 15 例。
本研究说明了一种大容量、快速和实用的策略，可用于筛查和治疗不同种族的中国妇女。首先，HPV 自我采样允许快速且相对廉价地筛查大量妇女。只有 hrHPV+妇女才需要进一步评估。然后对 hrHPV+妇女进行便携式数字阴道镜检查。所获得的高分辨率图像可以促进当天的适当治疗，因为它们能够准确地区分 CIN1 和≥CIN2 病变。
