Trzeszcz Martyna, Mazurec Maciej, Jach Robert, Mazurec Karolina, Jach Zofia, Kotkowska-Szeps Izabela, Kania Magdalena, Wantuchowicz Mariola, Prokopyk Anna, Barcikowski Piotr, Przybylski Marcin, Wach Joanna, Halon Agnieszka
Corfamed Woman's Health Center, Kluczborska 37, 50-322 Wroclaw, Poland.
Division of Pathology and Clinical Cytology, University Hospital in Wroclaw, Borowska 213, 50-556 Wroclaw, Poland.
Diagnostics (Basel). 2021 Oct 29;11(11):2012. doi: 10.3390/diagnostics11112012.
Recently, cervical cancer rates elevation has been noted in women aged 20-39 years in regions with a very high human development index (HDI). The onset of cancer elevation rates is observed in the age range of 25-29 years, which should necessitate effective precancer screening in younger age groups, including those <25 years. From 30.066 liquid-based screening tests results ( = 30.066), 3849 liquid-based cytology, 1321 high-risk human papillomavirus (HRHPV) and 316 p16/Ki67 performed in women <30 years were selected. Performance characteristics were calculated for three screening models: primary HRHPV with p16/Ki67 triage, primary cytology with reflex HPV and primary cytology alone. Primary HRHPV with p16/Ki67 triage was significantly more sensitive in high-grade squamous intraepithelial lesion quantified with cervical intraepithelial neoplasia grade 2 or worse [HSIL(CIN2+)] detection than cytology with reflex HRHPV and cytology alone (83.3% vs. 70.8%/45.8%) and had significantly higher diagnostic predictive values (PPV:29.4%/21.3%/22.9%; NPV:91.7%/82.9%/82.2%, respectively at CIN2+ threshold). The number of colposcopies per HSIL(CIN2+) detection indices was 3.4, 4.7 and 4.4, respectively. Primary HPV testing in women <30 years with p16/Ki67 triage of HPV-positive cases might be an effective cervical cancer screening strategy for HSIL(CIN2+) detection with superior diagnostic performance when compared with primary cytology-based models. Women <25 years might also benefit from an introduction to a more sensitive screening approach.
最近，在人类发展指数（HDI）非常高的地区，20至39岁女性的宫颈癌发病率有所上升。癌症发病率上升始于25至29岁年龄段，这就需要在包括25岁以下人群在内的更年轻年龄组中进行有效的癌前筛查。从30066例液基筛查检测结果（n = 30066）中，选取了30岁以下女性进行的3849例液基细胞学检查、1321例高危型人乳头瘤病毒（HRHPV）检测和316例p16/Ki67检测。计算了三种筛查模型的性能特征：HRHPV初筛联合p16/Ki67分流、细胞学初筛联合HPV检测和单纯细胞学初筛。与细胞学联合HRHPV检测和单纯细胞学相比，HRHPV初筛联合p16/Ki67分流在检测高级别鳞状上皮内病变（定义为宫颈上皮内瘤变2级或更高级别[HSIL（CIN2+）]）方面显著更敏感（83.3%对70.8%/45.8%），并且具有显著更高的诊断预测值（在CIN2+阈值下，PPV分别为29.4%/21.3%/22.9%；NPV分别为91.7%/82.9%/82.2%）。每检测到一个HSIL（CIN2+）指标进行阴道镜检查的次数分别为3.4、4.7和4.4。30岁以下女性采用HRHPV初筛并对HPV阳性病例进行p16/Ki67分流，与基于细胞学的初筛模型相比，可能是一种检测HSIL（CIN2+）的有效宫颈癌筛查策略，具有更好的诊断性能。25岁以下女性也可能受益于采用更敏感的筛查方法。
