Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, Guangdong, PR China.
Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, Guangdong, PR China.
J Infect Public Health. 2020 Nov;13(11):1780-1786. doi: 10.1016/j.jiph.2020.08.008. Epub 2020 Sep 9.
This study aimed to evaluate three different patterns of cervical cancer screening strategies for detection of cervical diseases.
In total, 10,186 women aged 21-70 years attending cervical screening program were recruited and cotested by human papillomavirus (HPV) assays and cytology. Three-year histological follow-up data was recorded on women with abnormal screening results, and six clinically common screening algorithms were evaluated.
Significantly better protection against cervical intraepithelial neoplasia 2 or worse (CIN2+) at three-year follow-up was associated with a negative HPV result than by normal cytology at baseline. HPV screening was more sensitive and less specific than cytology screening. Moreover, HPV screening with HPV16/18 and reflex cytology (atypical squamous cells of undetermined significance [ASCUS] threshold) showed a similar sensitivity (94.6% vs. 98.2%, p = 0.125) and a superior specificity as compared to cotesting reflex HPV16/18 and cytology (ASCUS threshold) for CIN2+ (95.8% vs. 95.1%, p < 0.0001), achieving a colposcopy referral rate of 5.4%, and consuming 4.8 colposcopies and 4.4 cytology tests to find one CIN2+.
HPV screening with triage of HPV-positive women by HPV16/18 genotyping and cytology provided a good equilibrium between screening effectiveness, the number of cytology tests required, and referral rates; HPV testing was similar in sensitivity to cotesting and safer than cytology, thus especially suitable for large population-based screening programs.
本研究旨在评估三种不同的宫颈癌筛查策略模式，以检测宫颈疾病。
共招募了 10186 名年龄在 21-70 岁之间的女性参加宫颈筛查计划，并通过人乳头瘤病毒（HPV）检测和细胞学检测进行联合检测。对筛查结果异常的女性记录了为期 3 年的组织学随访数据，并对 6 种常见的临床筛查算法进行了评估。
与基线时细胞学正常相比，HPV 检测结果阴性与 3 年随访时的宫颈上皮内瘤变 2 级或更高级别（CIN2+）显著更好的保护作用相关。HPV 筛查比细胞学筛查更敏感，但特异性更低。此外，HPV16/18 检测联合 HPV16/18 阳性者行细胞学检查（非典型鳞状细胞意义不明确[ASCUS]阈值）的敏感性（94.6%比 98.2%，p = 0.125）与联合检测 HPV16/18 及细胞学（ASCUS 阈值）的敏感性相似，而特异性更高（95.8%比 95.1%，p<0.0001），从而可使阴道镜转诊率达到 5.4%，并减少 4.8 次阴道镜检查和 4.4 次细胞学检查以发现一个 CIN2+。
HPV16/18 基因分型联合细胞学检测对 HPV 阳性妇女进行分流的 HPV 筛查在筛查效果、所需细胞学检查数量和转诊率之间提供了良好的平衡；HPV 检测的敏感性与联合检测相似，且比细胞学检查更安全，因此尤其适用于大型基于人群的筛查计划。
