Université Grenoble Alpes, Grenoble, France.
Translational Innovation in Medicine and Complexity/Recherche Translationnelle et Innovation en Médecine et Complexité-UMR 5525-Laboratoire1043049, Domaine de la Merci, La Tronche, France.
Cancer Med. 2024 Oct;13(19):e70259. doi: 10.1002/cam4.70259.
This study aims to analyse high-grade intraepithelial lesions (LIEHG) observed in a screening programme from 2010 to 2018 to more accurately describe them and formulate recommendations for best practices in the context of screening evolution following the introduction of an HPV test in primary cervical cancer screening in 2020.
This study included 305,940 asymptomatic women aged 25-65 years. The eligible population was invited to undergo a screening cervico-uterine-smear every 3 years. If this smear was normal, the woman received a new invitation. In the case of a positive screen, the patient underwent further diagnostic procedures, such as colposcopy and biopsy to confirm the diagnosis. Only those diagnosed with LIEHG and above proceeded to treatment. The diagnoses associated with LIEHG were those related to the WHO Classification of tumours of the uterine cervix.
Positive smears led to the diagnosis of 3230 LIEHG. The prevalence of LIEHG in the screened population was 0.4%. The LIEHG distribution varied significantly according to the age of the women. The probability of diagnosing LIEHG in young women was 12.2% at 25-29 years. This probability decreased by half after 50 years. We observed that the type of smear was significantly associated with LIEHG detection. The positive predictive value for diagnosing LIEHG was 70.3% for high-grade squamous intraepithelial lesion (HSIL) smears and 35.1% for atypical squamous cells cannot exclude HSIL (ASC-H) smears.
In the study population, the prevalence of LIEHG was high in women under 35 years. Low-grade smears were correlated with the risk of LIEHG and should prompt screening facilities to allocate resources to ensure active follow-up of LSIL and ASC-US smears. Adherence to cytological screening recommendations was associated with a reduced risk of LIEHG in multivariate analysis.
本研究旨在分析 2010 年至 2018 年筛查项目中观察到的高级别上皮内病变（LIEHG），以便更准确地描述这些病变，并在 2020 年 HPV 检测引入宫颈癌筛查初级阶段后，针对筛查演变提出最佳实践建议。
本研究纳入了 305940 名 25-65 岁无症状女性。合格人群被邀请每 3 年进行一次宫颈涂片筛查。如果涂片正常，女性会收到新的邀请。如果筛查阳性，则患者需要进一步进行诊断程序，如阴道镜检查和活检以确认诊断。只有诊断为 LIEHG 及以上的患者才会接受治疗。与 LIEHG 相关的诊断与世界卫生组织（WHO）子宫颈肿瘤分类相关。
阳性涂片导致 3230 例 LIEHG 诊断。筛查人群中 LIEHG 的患病率为 0.4%。LIEHG 的分布随女性年龄显著变化。25-29 岁女性诊断 LIEHG 的概率为 12.2%。50 岁后，这一概率减半。我们观察到涂片类型与 LIEHG 检测显著相关。诊断 LIEHG 的高准确率为高级别鳞状上皮内病变（HSIL）涂片的 70.3%，不典型鳞状细胞不能排除 HSIL（ASC-H）涂片的 35.1%。
在研究人群中，35 岁以下女性的 LIEHG 患病率较高。低级别涂片与 LIEHG 风险相关，应促使筛查机构分配资源，确保对 LSIL 和 ASC-US 涂片进行积极随访。在多变量分析中，遵循细胞学筛查建议与降低 LIEHG 风险相关。
