重庆市宫颈癌机会性筛查方法研究

Screening Methods Studies of Cervical Cancer Opportunistic Screening in Chongqing

[目的]分析重庆市宫颈癌机会性筛查的基本现状,探索适合重庆市宫颈癌机会性筛查方法。[方法]收集分析2009年重庆市8家医院机会性筛查资料,筛查方法包括液基细胞学、巴氏涂片、HPVDNA检测,以及专家推荐的三种筛查方案,Ⅰ方案:HPV检测和液基细胞学组合;Ⅱ方案:传统巴氏涂片和HPV检测;Ⅲ方案:仅用肉眼观察(醋酸或碘染色法,VIA/VILI)。病理确诊宫颈病变及宫颈癌,并对受检妇女进行流行病学调查。[结果]筛查过程中医生实际使用液基细胞学2390例(64.26%),Ⅲ方案2300例(61.84%),巴氏涂片194例(5.22%),Ⅰ方案103例(2.77%),Ⅱ方案52例(1.40%),HPVDNA检测17例(0.46%),最普遍采用的方法是液基细胞学、肉眼观察。检出CIN217例,检出率为9.68%;宫颈癌22例,检出率为0.98%。对受检妇女进行流行病学调查显示,愿意选择液基细胞学所占比例(69.69%)最高,其次分别为阴道镜(47.26%)、VIA/VILI(40.04%)、巴氏涂片(4.35%),所占比例最低为HPVDNA(3.54%),而经济欠发达、文化程度低、年长者、家人未患有肿瘤者更愿意选择传统筛查方法。[结论]不管是筛查过程中医生实际使用,还是受检妇女的选择,均是以细胞学为重庆市宫颈癌的主要检测手段,液基细胞学正逐步被广泛使用;而肉眼观察仍为重庆市经济欠发达地区宫颈癌筛查的另一主要检测手段。

[Purpose] To analysis the cervical cancer opportunistic screening status in different hospitals in Chongqing, and to explore the cervical cancer opportunistic screening methods in Chongqing. [Methods] Opportunistic screening data in 2009 from eight hospitals was collected and analyzed. Six proposals were used for opportunistic screening, including 3 screening methods （liquid-based cytology, conventional pap smear, HPV-DNA test）, and 3 proposals[Proposal Ⅰ recommended by Cancer Foundation of China（liquid-based cytology and HPV-DNA test）, Proposal Ⅱ（conventional pap smear and HPV-DNA test）, Proposal Ⅲ（vision inspection with acetic acid / Lugol＇s iodine, VIA/VILI）]. Colposcopy and biopsy were performed for the positive. Cervical lesion or cervical cancer was confirmed pathologically. All the women to be screened entered the epidemiological investigation. [Result] Liquid-based cytology was carried out in 2 390（64.26%） cases, Proposal Ⅲ in 2 300 （61.84%） cases, conventional pap smear in 194（5.22%） cases, Proposal Ⅰ in 103 （2.77%） cases, Proposal Ⅱ in 52（1.40%） cases, HPV DNA test in 17（0.46%） cases. Liquid-based cytology and vision inspection were the most commonly used methods in screening. CIN were diagnosed in 217 cases （9.68%）, and cervical cancer in 22 cases （0.98%）. Epidemiological investigation showed that liquid-based cytology （69.69%） was the highest choice, thereafter colposcopy （47.26%）, VIA/VILI （40.04%）, conventional pap smear （4.35%）, and HPV DNA test （3.54%）. The women in developing areas, or less educated, elderly and without history of cancer in the family were preferred to conventional methods. [Conclusion] Regardless of the actual screening or the subjects’ choice in Chongqing city, the cytology is the major screening method for cervical cancer screening. Liquid-based cytology is becoming popular. Vision inspection is another major screening method for cervical cancer screening in developing areas.