HPV检测技术初筛巴氏涂片分流应用于农村女性宫颈癌筛查效果

The effect of cervical cancer screening for rural women in China by using HPV test as primary screening method and pap smear as a triage test

目的分析人乳头瘤病毒(human papillomavirus,HPV)检测技术初筛巴氏涂片分流应用于农村女性宫颈癌筛查中的效果。方法 2015年对35~64岁农村女性使用HPV检测进行宫颈癌初筛,阳性者采用巴氏涂片法分流,巴氏涂片结果为不明确意义的非典型鳞状细胞(atypical squamous cells of undetermined signification,ASCUS)及以上病变的女性转用阴道镜检查。所有阴道镜下检查异常或不满意处均取活检或宫颈管搔刮术(endocervical canal curettage,ECC),病理结果为中度子宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 2,CIN2)及以上者转诊进行手术治疗。结果 HPV初筛、巴氏涂片分流策略HPV筛查阳性率为10.65%。CIN2及以上者共150人,全部进行阴道镜检查,实际阴道镜转诊率为3.55%,阴道镜顺应性为100%。经病理诊断,本次筛查分别发现轻度子宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 1,CIN1)、CIN2及以上、重度子宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 3,CIN3)及以上分别为16例(0.38%)、29例(0.69%)、15例(0.36%),未发现宫颈癌病例。结论 HPV初筛、巴氏涂片分流策略能够降低阴道镜转诊率,宫颈疾病检出率较高,可以在有条件的农村地区使用。但宫颈癌前病变及宫颈癌的检出率较HPV初筛不分流低,需要进一步加强对基层细胞学医生技术水平的规范化培训。

Objective To analyze the effect of HPV primary screening with HPV hybrid capture test and triage test with Pap smear of rural women for cervical cancer in China.Methods HPV test were performed for rural women aged 35 -64 as primary cervical cancer screening at 2015.Pap smear was conducted on HPV test-positive women.Colposcopy was conducted if Pap smear results were above ASC-US.Pathology-confirmed biopsies were implemented for final diagnosis.Surgery was performed on women with pathological results above CIN2.Results The HPV positive rate was 10.65% when using the strategy of DH2 test as primary screening method and Pap smear as a triage testing.The number of women with ASC-US and above was 150,and the referral rate of women who accepted colposcopy was 3.57%,the participation rate was 100%.The detection number（rate） of CIN1,CIN2 and above and CIN3 and above were16（0.38%）,29（0.69%） and 15（0.36%）,respectively.There were no cervical cancer cases in this study.Conclusions HPV test as primary screening method and Pap smear as a triage test can decrease the colposcopy referral,and the detection rate of cervical pre cancer and cancer was high.According to the diagnostic level of local hospitals,Pap smear as a triage test should be considered.The detection rate of cervical pre cancer and cancer was higher when using the strategy of HPV test without any triage test.We should improve the technological level of clinical cytologic diagnosis among doctors in rural areas to detect more cervical lesions.