Zhao Yuqian, Zhao Fanghui, Hu Shangying, Zhang Xun, Zhang Wenhua, Pan Qinjing, Gage Julia C, Sankaranarayanan Rengaswamy, Qiao Youlin
Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Research Center of Cancer Prevention, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China.
Chin J Cancer Res. 2020 Jun;32(3):383-394. doi: 10.21147/j.issn.1000-9604.2020.03.09.
The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs. However, there is no widely adopted biopsy guideline up to date. Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions.
Eleven population-based cervical cancer screening studies were conducted in China. Cytology, high-risk human papillomavirus (hrHPV) testing and visual inspection were performed for primary screening. Females positive on one or more tests were referred for colposcopy and biopsy. The proportion of detected cervical intraepithelial neoplasia (CIN)2+ and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared.
Among 4,923 females included, 1,606 had quadrant lesion-targeted biopsy, and 3,317 had 4-quadrant random biopsy. The cumulative CIN2+ yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21, 0.34, and 0.58 for at most two, three and four quadrants targeted biopsies. Among hrHPV positive females with high-grade squamous intraepithelial lesion (HSIL)+ cytology, the cumulative CIN2+ yield of a second targeted biopsy in another quadrant was significantly increased (P<0.05). Among hrHPV-negative females, the yield of 4-quadrant random biopsies was 0.005, and the yield by lesion-targeted biopsies was 0.017. For hrHPV positive females who had 4-quadrant random biopsy, the additional CIN2+ yield for HSIL+, low-grade squamous intraepithelial lesion (LSIL) cytology, or abnormal visual inspection via acetic acid and Lugol's iodine (VIA/VILI) were 0.46, 0.11, 0.14.
A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology, and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI. Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low- and middle-income countries.
阴道镜引导下活检的准确性是宫颈癌筛查项目中阴道镜分诊成功的关键。然而，目前尚无广泛采用的活检指南。我们的研究旨在确定多象限活检是否能提高宫颈病变的检出率。
在中国进行了11项基于人群的宫颈癌筛查研究。采用细胞学检查、高危型人乳头瘤病毒（hrHPV）检测和肉眼检查进行初筛。一项或多项检查呈阳性的女性被转诊进行阴道镜检查和活检。比较了按象限病变靶向活检或四象限随机活检检测到的宫颈上皮内瘤变（CIN）2+的比例及检出率。
纳入的4923名女性中，1606名进行了按象限病变靶向活检，3317名进行了四象限随机活检。累积CIN2+检出率从仅一个象限靶向活检的0.10，增加到最多两个、三个和四个象限靶向活检时的0.21、0.34和0.58。在hrHPV阳性且细胞学检查为高级别鳞状上皮内病变（HSIL）+的女性中，在另一个象限进行第二次靶向活检的累积CIN2+检出率显著增加（P<0.05）。在hrHPV阴性的女性中，四象限随机活检的检出率为0.005，按病变靶向活检的检出率为0.017。对于进行了四象限随机活检的hrHPV阳性女性，HSIL+、低级别鳞状上皮内病变（LSIL）细胞学检查或醋酸和卢戈氏碘（VIA/VILI）肉眼检查异常时额外的CIN2+检出率分别为0.46、0.11、0.14。
仅推荐对细胞学检查为HSIL的hrHPV阳性女性进行四象限随机活检，对于细胞学检查为LSIL或VIA/VILI异常的hrHPV阳性女性也可接受。我们的研究结果为制定客观实用的活检标准提供了证据，以指导低收入和中等收入国家宫颈癌筛查项目中的阴道镜检查。
