Jung Leonard, Klamminger Gilbert Georg, Nigdelis Meletios P, Eltze Elke
Institute of Pathology, Saarbrücken-Rastpfuhl, 66113 Saarbrücken, Germany.
Department of General and Special Pathology, Saarland University (USAAR), Saarland University Medical Center (UKS), 66421 Homburg, Germany.
Cancers (Basel). 2025 Jun 17;17(12):2024. doi: 10.3390/cancers17122024.
Since 2020, Germany has replaced its annual cytological screening for cervical cancer in women aged 35 and older with a combination screening program. This updated protocol, conducted every three years, includes both a cervical Pap smear and an HPV (human papillomavirus) test. In addition, the 2020 update of the German Cervical Cancer Screening Program mandates a more timely follow-up for certain abnormal findings compared to the previous approach. : Results of cytologic, colposcopic, and histologic examinations between 2018 and 2021 were retrospectively retrieved from the electronic patient records of the Institute of Pathology Saarbrücken Rastpfuhl in order to present relevant findings within the years 2018-2019 and 2020-2021. The present study included all women who received appropriate follow-up based on the corresponding underlying screening modality. : Our reporting considered data from 30,715 women in 2018/19 (prior screening modality group) and 25,924 women in 2020/21 (updated screening modality group). In 2018/19, a total of 93 histological examinations were performed, compared to 237 in 2020/21. In 2018/19, 52 cases of CIN III and 12 cases of CIN II were identified, while in 2020/21, 78 cases of CIN III and 31 cases of CIN II were detected. In contrast, while women with negative cytological findings in 2018/19 were typically not referred for further colposcopic or histological evaluation, the updated program enabled earlier detection and treatment of cases with diagnosed high-grade dysplasia based solely on a positive HPV test. Notably, 31 women who were diagnosed at an earlier stage based solely on a positive HPV test initially presented with a cytological Pap I result (negative for intraepithelial lesion or malignancy; NILM). : Additional HPV co-testing within the updated German cervical cancer screening program resulted not only in high rates of high-grade dysplasia detection but also a rise in the number of colposcopic procedures. While negative follow-up HPV findings regularly showed remission of the original finding, incidence of high-grade dysplasia was usually linked to a positive HPV test.
自2020年起，德国已将针对35岁及以上女性的年度宫颈癌细胞学筛查替换为联合筛查方案。这个每三年进行一次的更新方案包括宫颈巴氏涂片和HPV（人乳头瘤病毒）检测。此外，德国宫颈癌筛查方案在2020年的更新要求，与之前的方法相比，对某些异常检查结果进行更及时的随访。为了呈现2018 - 2019年和2020 - 2021年期间的相关检查结果，回顾性地从萨尔布吕肯拉斯特普富尔病理研究所的电子病历中检索了2018年至2021年期间的细胞学、阴道镜检查和组织学检查结果。本研究纳入了所有根据相应的基础筛查方式接受了适当随访的女性。我们的报告考虑了2018/19年30715名女性（先前筛查方式组）和2020/21年25924名女性（更新筛查方式组）的数据。2018/19年共进行了93次组织学检查，而2020/21年为237次。2018/19年确定了52例CIN III和12例CIN II病例，而2020/21年检测到78例CIN III和31例CIN II病例。相比之下，虽然2018/19年细胞学检查结果为阴性的女性通常不会被转诊进行进一步的阴道镜或组织学评估，但更新后的方案能够仅基于HPV检测呈阳性就更早地检测和治疗诊断为高级别发育异常的病例。值得注意的是，31名最初细胞学巴氏I级结果（上皮内病变或恶性肿瘤阴性；NILM）的女性仅基于HPV检测呈阳性而在早期被诊断。德国更新后的宫颈癌筛查方案中额外的HPV联合检测不仅导致高级别发育异常的高检出率，还使阴道镜检查程序的数量增加。虽然随访HPV结果为阴性通常显示原始检查结果缓解，但高级别发育异常的发生率通常与HPV检测呈阳性有关。
