日本 50 岁以上女性中，细胞学筛查高级别鳞状上皮内瘤变的准确性降低。

Lower accuracy of cytological screening for high-grade squamous intraepithelial neoplasia in women over 50 years of age in Japan.

机构信息

Department of Obstetrics and Gynecology, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan.

Department of Pathology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.

出版信息

Int J Clin Oncol. 2022 Feb;27(2):427-433. doi: 10.1007/s10147-021-02065-w. Epub 2021 Dec 6.

DOI:10.1007/s10147-021-02065-w

PMID:34873649

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8816739/

Abstract

BACKGROUND

As the population ages in developed countries, the number of Pap smears for cervical cancer screening of older women is increasing. There is concern that cervical atrophy may cause misinterpretation of results for this segment of the population. The present study evaluated the accuracy of screening for high-grade intraepithelial lesions (HSILs) in women younger or older than 50 years, to determine whether aging affects cytological interpretation.

METHODS

Patients with HSIL cytology (N = 1565) were dichotomized into those aged 20-49 years or aged ≥ 50 years. Association between histology results and age was examined. Pearson's chi-squared test and Cochran-Armitage trend test were used for statistical analysis.

RESULTS

The positive predictive value (PPV) for cervical intraepithelial neoplasia (CIN)2 and worse was 65.2% (62/95) in older women but 87.3% (482/552) in younger women (p < 0.001). Older patients had a significantly lower PPV (p = 1.69 × 10). Separately analyzing chronic cervicitis, CIN1 and overt cancer grouped together, compared with another group composed of CIN2 and CIN3, we found that the PPV for CIN2 and CIN3 was lower in older than in younger women [44.2% (42/95)-vs-82.4% (455/552), p < 0.001], respectively.

CONCLUSIONS

HSILs are associated with a wide range of disease categories as age increases, and the accuracy of HSIL interpretation is lower in older women.

摘要

背景

随着发达国家人口老龄化，对老年女性进行宫颈癌筛查的巴氏涂片数量不断增加。人们担心宫颈萎缩可能会导致对这部分人群的结果产生误解。本研究评估了对 50 岁以下和 50 岁以上女性进行高级别上皮内病变（HSIL）筛查的准确性，以确定年龄是否会影响细胞学解释。

方法

将细胞学检查为 HSIL 的患者（N=1565）分为 20-49 岁和≥50 岁两组。检查组织学结果与年龄之间的关系。采用 Pearson 卡方检验和 Cochran-Armitage 趋势检验进行统计学分析。

结果

老年女性的宫颈上皮内瘤变（CIN）2 及更高级别病变的阳性预测值（PPV）为 65.2%（62/95），而年轻女性的 PPV 为 87.3%（482/552）（p<0.001）。老年患者的 PPV 显著较低（p=1.69×10）。分别分析慢性宫颈炎、CIN1 和显性癌与另一组 CIN2 和 CIN3 相比，我们发现 CIN2 和 CIN3 的 PPV 在老年女性中低于年轻女性[44.2%（42/95）-vs-82.4%（455/552），p<0.001]。