[1]颜丽,杨君,周德平,等.24 530例妇女宫颈癌机会性筛查方法探讨[J].第三军医大学学报,2019,41(13):1267-1274.
 YAN Li,YANG Jun,ZHOU Deping,et al.Opportunistic screening protocols for cervical carcinoma among different female populations in Chongqing[J].J Third Mil Med Univ,2019,41(13):1267-1274.
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24 530例妇女宫颈癌机会性筛查方法探讨(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第13期
页码:
1267-1274
栏目:
临床医学
出版日期:
2019-07-15

文章信息/Info

Title:
Opportunistic screening protocols for cervical carcinoma among different female populations in Chongqing
作者:
颜丽1 杨君1 周德平1 周晓军2
重庆市妇幼保健院:宫颈病特色专科1,保健部2
Author(s):
YAN Li1 YANG Jun1 ZHOU Deping1 ZHOU Xiaojun2

1Department of Cervical Disease, 2Department of Healthcare, Maternal and Child Health Center of Chongqing, Chongqing, 401147, China

关键词:
宫颈肿瘤癌前状态机会性筛查
Keywords:
uterine cervical neoplasms precancerous conditions opportunistic screening
分类号:
R174.6; R730.4; R737.33
文献标志码:
A
摘要:

目的评估5种宫颈癌筛查方案,探索适合不同临床特征人群的宫颈癌筛查模式。方法收集2013年1月至2015年12月重庆市13家妇幼保健院就诊并完成全部随访的妇女24 530人。根据其临床特征分为5组:A组(年轻女性组)、B组(哺乳期人群组)、C组(不孕症人群组)、D组(围绝经期及老年期女性人群组)、E组(育龄期普通人群组),联合使用4种方法[醋酸肉眼观察法(visual inspection after acetic acid,VIA),液基细胞学检查(thinprep cytologic test,TCT),人乳头瘤病毒(human papillomavirus,HPV)-DNA检测,阴道镜检查]进行筛查,任一检查结果阳性即行宫颈活检送病理学检测,必要时行宫颈锥切术,其后每年随访1次,共随访2年。本研究以组织学诊断宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ级及以上病变作为随访终点,分别计算不同筛查方案(单独采用VIA、TCT、HPV、阴道镜及联合采用TCT+HPV)诊断CINⅡ+的灵敏度、特异度、阳性预测值、阴性预测值、约登指数及曲线下面积(area under curve, AUC),以AUC评价不同检测方法诊断的准确性。结果①A组中,5种筛查方案的AUC之间差异无统计学意义(P>0.005)。②B组中,HPV及联合方案的AUC大于其他3种筛查方案,差异有统计学意义(P<0.005);③C组中,联合方案的AUC大于其他4种筛查方案,差异有统计学意义(P<0.005);④D组中,TCT、HPV及联合方案的AUC大于其他2种筛查方案,差异有统计学意义(P<0.005);⑤E组中,HPV的AUC大于其他4种筛查方案,差异有统计学意义(P<0.005)。结论不同临床特征人群采取的宫颈癌筛查方案不尽相同,采取适宜的筛查方案可提高检出率。

Abstract:

ObjectiveTo evaluate the 5 protocols of opportunistic screening for cervical carcinoma among different female populations, in order to explore optional protocol for the women with different clinical characteristics. MethodsA total of 24 530 women who admitted in 13 maternal and child health hospitals from January 2013 to December 2015 and completed our follow-up were recruited in this study. According to their clinical characteristics, they were divided into 5 groups: group A (young females, 21~24 years old), group B (lactating women), group C (with identified infertility, 25~39 years old), group D (perimenopausal and elderly women), group E (women of childbearing age, 25~39 years old). Five protocols were used for opportunistic screening, that is, visual inspection after acetic acid (VIA), thinprep cytologic test (TCT), human papillomavirus (HPV)-DNA test, colposcopy, and combination of TCT and HPV-DNA test. All the suspected cases (at least 1 positive result) underwent biopsy, and/or cervical conization when necessary. All the cases were followed up once a year, for 2 years. Histological diagnosis of cervical intraepithelial neoplasia (CIN) grade Ⅱ and above lesions was regarded as the follow-up endpoints. The sensitivity, specificity, positive predictive value, negative predictive value, Youden’s index and area under curve (AUC) of CIN Ⅱ+ were calculated for different screening schemes (VIA, TCT, HPV, colposcopy and TCT+HPV) in order to evaluate the diagnostic accuracy of these protocols. Results①In group A, there was no significant difference in AUC among the 5 protocols (P>0.005). ② In group B, the AUCs of HPV and TCT+HPV were significantly greater than those of the other protocols (P<0.005). ③In group C, the AUC of the combined screening was greater than those of the other ones, with statistical differences (P<0.005). ④In group D, the AUCs of TCT, HPV, and the combined screening were significantly greater than those of the other ones (P<0.005). ⑤ In group E, the AUC of HPV was significantly greater than those of the other ones (P<0.005). ConclusionDifferent opportunistic screening protocols for cervical carcinoma are suitable for the women with different clinical characteristics. Optional screening protocols can improve the detection rate.

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更新日期/Last Update: 2019-07-08