宫颈癌筛查项目中增加人乳头瘤病毒检测后阴道镜检查的评估。
Evaluation of colposcopy after the addition of human papillomavirus testing to the Turkish cervical cancer screening program.
机构信息
Mamak State Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
出版信息
Cancer Med. 2023 Dec;12(24):21751-21760. doi: 10.1002/cam4.6740. Epub 2023 Nov 23.
OBJECTIVE
To evaluate colposcopy performance following the human papillomavirus (HPV) DNA screening program in Turkey.
METHODS
Women aged 30-65 years are screened for cervical cancer every 5 years, with individuals positive for HPV 16 and/or 18 or other high-risk HPV types with abnormal cytology referred for colposcopy. Both HPV test and cytology are obtained at the same visit. If HPV is negative, cytology will not be assessed. However, if HPV is positive, both cytology and HPV genotyping will be performed. Colposcopy-require was defined as HPV 16/18 positivity or abnormal smear results with any hrHPV positivity, and the remaining patients (normal smear with hrHPV positivity other than HPV 16/18) were grouped as colposcopy non-required. National data on colposcopy outcomes and unnecessary performance rates in February 2018-2019 were evaluated via a questionnaire.
RESULTS
A total of 9808 patients were included, divided based on colposcopy requirement: 5751 (58.6%) patients required colposcopy and 4057 (41.4%) did not. Unnecessary colposcopy was performed on 90.1% of the non-required group (3657 of 4057 patients). In the colposcopy-required group, 4455 patients (79.9%) underwent punch biopsy; 3194 (57.1%), endocervical curettage (ECC); and 421 (7.5%), "see and treat" in the non-required group, the results were 2790 (76.3%), 1957 (53.2%), and 211 (5.7%), respectively. A total of 746 cervical intraepithelial neoplasia (CIN)-3 isolates were detected, including 702 using existing screening and triage with 94.1% sensitivity (702/746). Multiple biopsies were taken in 69.8% (n = 3110) of patients from the colposcopy-required group and 63.7% (n = 1777) from the non-required group. The ECC samples included 19 cervical cancers and 212 ≥CIN-3 lesions in the colposcopy-required group, and four cancers and 41 ≥CIN-3 lesions in the non-required group. The proportion of ≥CIN-3 lesions detected by ECC only was 4.7% (35 of 746 ≥CIN-3 lesions).
CONCLUSION
Our results showed high rates of unnecessary colposcopies, and a high percentage of multiple and random punch biopsies and ECC.
目的
评估土耳其人乳头瘤病毒（HPV）DNA 筛查计划后的阴道镜检查表现。
方法
30-65 岁的女性每 5 年进行一次宫颈癌筛查，HPV16 和/或 18 阳性或其他高危 HPV 型别阳性且细胞学异常的患者转诊行阴道镜检查。HPV 检测和细胞学检查均在同一次就诊时进行。如果 HPV 为阴性，则不评估细胞学。然而，如果 HPV 为阳性，则同时进行细胞学和 HPV 基因分型。阴道镜检查指征定义为 HPV16/18 阳性或任何高危 HPV 阳性伴异常涂片结果，其余患者（HPV16/18 以外的高危 HPV 阳性伴正常涂片）为阴道镜检查非指征。通过问卷评估 2018 年 2 月至 2019 年期间全国阴道镜检查结果和不必要检查率的数据。
结果
共纳入 9808 例患者，根据阴道镜检查指征进行分组：5751 例（58.6%）患者需要阴道镜检查，4057 例（41.4%）不需要。非指征组中有 90.1%（3657 例）行不必要的阴道镜检查。在阴道镜检查指征组中，4455 例（79.9%）患者行活检；3194 例（57.1%）行宫颈管搔刮术（ECC）；421 例（7.5%）行“观察和治疗”。在非指征组中，相应结果为 2790 例（76.3%）、1957 例（53.2%）和 211 例（5.7%）。共检出 746 例宫颈上皮内瘤变（CIN）-3 病变，其中 702 例采用现有筛查和分流方法，敏感度为 94.1%（702/746）。阴道镜检查指征组中 69.8%（n=3110）的患者行多次活检，而非指征组中 63.7%（n=1777）的患者行多次活检。ECC 样本中，阴道镜检查指征组包括 19 例宫颈癌和 212 例≥CIN-3 病变，而非指征组包括 4 例宫颈癌和 41 例≥CIN-3 病变。ECC 仅检出≥CIN-3 病变的比例为 4.7%（35/746 例≥CIN-3 病变）。
结论
我们的结果显示，阴道镜检查存在较高的不必要检查率，且行多次、随机活检和 ECC 的比例较高。
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